Zhu and colleagues recently investigated whether having a medical
comorbidity influenced the choice of treatment of patients with advanced squamous
cell carcinoma of the larynx. Comorbidity
is the presence of an underlying pathologic condition that has an impact on a
patient's total burden of disease. More than 2/3 of patients with cancer have a
comorbid condition, and up to one-third of these patients have 2 or more, with
hypertension, cardiovascular disease, and pulmonary disease among the most
prevalent.
The study
evaluated 16
849 patients from more than 1400 medical centers diagnosed with primary
invasive advanced squamous cell carcinoma of the larynx between 2003 and 2008.
They were selected from the National Cancer Database.
The study demonstrated that receipt of treatment (chemoradiation
vs total laryngectomy) was significantly associated with comorbidity. Patients
with comorbidity were more likely to have subtotal or total laryngectomy.
Patients were also more likely to undergo laryngectomy if they had stage IV
disease and if they had been diagnosed at a teaching or research institution.
Patients were more likely to receive chemoradiation if they were diagnosed
after 2003 or if they lived in a zip code with a high percentage of high school
graduates.
The study is the first that demonstrates that patients with
advanced laryngeal cancer with one or more comorbidities are more likely to
receive surgery than chemoradiation compared with patients without any
comorbidity. Previous studies have demonstrated
better survival in patients with advanced laryngeal cancer who had been treated
with surgery compared with those without.
This study
supports the superiority of laryngectomy even in presence of comorbidity. Even though patients with a comorbidity were
less healthy initially their outcome was better after laryngectomy than those
who received chemoradiation.
