National treatment patterns in patients presenting with Stage IVC head and neck cancer: analysis of the National Cancer Database

Head and neck cancer patients presenting with distant metastases are generally considered incurable. Treatment patterns and survival by primary disease site and therapy have not been described. Retrospective cohort analysis of 2525 patients in the National Cancer Database (2003-2006). Kaplan-Meier and Cox proportional hazards analyses were performed. Combined locoregional and systemic therapy was the most common treatment regimen (39.2%), followed by no treatment (23.9%), locoregional (19.0%), and systemic treatment (17.8%). Multivariate analysis demonstrated decreased survival was associated with age 65-79 years hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.14-1.80), Medicaid/uninsured status (HR 1.27, 95% CI 1.13-1.42), Medicare/other government insurance (HR 1.21, 95% 1.07-1.38), treatment at a nonacademic/research program (HR 1.17, 95% CI 1.07-1.27), and Charlson comorbidity score of 1 (HR 1.33, 95% 1.19-1.48). Compared to systemic therapy alone, receiving locoregional and systemic therapy was associated with decreased risk of death (HR 0.73, 95% CI 0.65-0.83). Only 14.6% and 0.6% of patients were recorded as receiving palliative therapy or being enrolled in a clinical trial, respectively. Significant treatment diversity exists in distantly metastatic head and neck cancer. Those who received combination locoregional and systemic therapy were more likely to have improved overall survival, but important factors in treatment selection are unknown. A small proportion of patients was found to receive either palliative therapy or was enrolled in a clinical trial, although these data likely underestimate the true proportions.