Marmor Schelomo, Cohen Seth, Fujioka Naomi, Cho L Chinsoo, Bhargava Amit, Misono Stephanie
Department of Otolaryngology, University of Minnesota, 420 Delaware St SE, MMC 396, Minneapolis, MN 55455, USA; Department of Surgery, University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN 55455, USA; Masonic Cancer Center, University of Minnesota, 420 Delaware St SE, MMC 806, Minneapolis, MN 55455, USA.
Duke Voice Care Center, Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, 40 Duke Medicine Circle, Durham, NC 27710, USA.
J Geriatr Oncol. 2020 Sep;11(7):1115-1117. doi: 10.1016/j.jgo.2020.02.015. Epub 2020 Mar 11.
The impact of dysphagia in persons with lung cancer is unknown. The objective of this study is to measure the prevalence and survival differences associated with dysphagia in older adults with lung cancer.
Linked SEER cancer registries - Medicare data, 1991-2009 was utilized to identify 201,674 persons with lung cancer. Most were male (53%), had regional or distant disease (74%), and were aged <80 years (82%). The pre-existing prevalence of dysphagia was identified using claims codes before the lung cancer diagnosis. Survival was analyzed using Kaplan Meier curves and Cox proportional hazard models.
8517 (4%) had dysphagia prior to their lung cancer diagnoses. Younger age, worse disease stage, more comorbidities, and hospital rurality were associated with higher likelihood of dysphagia. Patients with dysphagia had worse survival (median survival 8 months [95%CI 7,9]) than those without dysphagia (median survival 12 months [95%CI 11,13]). After adjusting for sociodemographic, clinical, and disease characteristics, dysphagia was still associated with worse survival (Hazard ratio of death 1.34, [95%CI 1.28-1.35], p ≤ .0001).
This is the first Medicare claims-based study of older adults with lung cancer and dysphagia. Pre-existing dysphagia occurred in approximately 1 in 25 patients with lung cancer and was associated with worse survival. Determining the best methods to evaluate and treat dysphagia in patients with lung cancer is an important avenue for future studies.
吞咽困难对肺癌患者的影响尚不清楚。本研究的目的是测量老年肺癌患者吞咽困难的患病率及其与生存差异的相关性。
利用1991 - 2009年的SEER癌症登记与医疗保险数据相链接，识别出201,674例肺癌患者。大多数为男性（53%），患有局部或远处疾病（74%），年龄小于80岁（82%）。通过肺癌诊断前的理赔编码确定吞咽困难的既往患病率。使用Kaplan - Meier曲线和Cox比例风险模型分析生存率。
8517例（4%）在肺癌诊断前存在吞咽困难。年龄较小、疾病分期较差、合并症较多以及医院位于农村地区与吞咽困难的可能性较高相关。吞咽困难患者的生存期（中位生存期8个月[95%CI 7,9]）比无吞咽困难患者（中位生存期12个月[95%CI 11,13]）更差。在调整了社会人口统计学、临床和疾病特征后，吞咽困难仍与较差的生存率相关（死亡风险比1.34，[95%CI 1.28 - 1.35]，p≤0.0001）。
这是第一项基于医疗保险理赔数据对老年肺癌合并吞咽困难患者进行的研究。约每25例肺癌患者中就有1例存在既往吞咽困难，且与较差的生存率相关。确定评估和治疗肺癌患者吞咽困难的最佳方法是未来研究的一个重要方向。
