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dc.contributor.advisorStayner, Leslie T.en_US
dc.contributor.authorMonberg, Matthew J.en_US
dc.date.accessioned2016-07-01T22:31:47Z
dc.date.available2016-07-01T22:31:47Z
dc.date.created2016-05en_US
dc.date.issued2016-07-01
dc.date.submitted2016-05en_US
dc.identifier.urihttp://hdl.handle.net/10027/20886
dc.description.abstractBackground: Although head and neck cancer (HNC) is the sixth most common cancer type by incidence globally, few studies have focused on real world treatment patterns of this disease. A large, randomized study of erythropoietin stimulating agents (ESAs) produced worsened outcomes in patients with HNC. Real-world data on the treatment patterns HNC, and the use and outcomes of ESAs in this population is currently lacking. Methods: SEER Medicare was used to evaluate patients aged ≥65 years with a first diagnosis of HNC between 2002 and 2007. Logistic regression was used to evaluate predictors of treatment. An interrupted time series was used to estimate the changes in ESA use among patients receiving chemotherapy over time. Propensity weighted models predicted survival, thromboembolism (TEE), and disease recurrence outcomes associated with ESA exposure. Results: Characteristics associated with no treatment for HNC included being unmarried (adjusted OR=2.00, 95% CI: 1.75, 2.27) or African American (adjusted OR=1.65, 95% CI: 1.37, 1.98). ESA use was 50.0% among patients receiving chemotherapy and 3.1% among patients not receiving chemotherapy. ESA use was 50.0% among patients receiving chemotherapy and 3.1% among patients not receiving chemotherapy. Combination regimens such as cetuximab+taxane+platinum (63.8%) and taxane+platinum (56.0%) were associated with the highest rates of ESA use, while single-agent cetuximab was associated with the lowest rate of ESA use (22.3%). Use of ESAs significantly declined from 40.3% of patients receiving chemotherapy in January 2007 to 16.7% in August 2007. Patients receiving an ESA were more likely to have a TEE (adjusted HR=1.19 [95% CI: 1.31, 1.81), experience disease recurrence (adjusted HR=1.09 [95% CI: 1.00, 1.16]), or die (adjusted HR=1.17 [95% CI: 1.06, 1.30]). Discussion: Disparities in the diagnosis and treatment of patients with HNC were present, despite the uniform insurance status of patients in the database. Significant declines in ESA occurred following FDA action in January 2007. ESA use increased among HNC patients in the immediate aftermath of previous disclosure of negative trial data (June 2003). ESAs may be associated with modestly worsened outcomes in HNC.en_US
dc.language.isoenen_US
dc.rightsen_US
dc.rightsCopyright 2016 Matthew J. Monbergen_US
dc.subjectSEER Medicareen_US
dc.subjecthead and neck canceren_US
dc.subjectHNCen_US
dc.subjecterythropoietin stimulating agentsen_US
dc.subjectanemiaen_US
dc.subjectsupportive careen_US
dc.subjectESAsen_US
dc.subjectcetuximaben_US
dc.subjectdisparitiesen_US
dc.subjectchemotherapyen_US
dc.subjectradiationen_US
dc.titleEvaluation of the Patterrns and Risks of Erythropoietin Stimulating Agents in Head and Neck Cancersen_US
thesis.degree.departmentEpidemiology and Biostatisticsen_US
thesis.degree.disciplineEpidemiologyen_US
thesis.degree.grantorUniversity of Illinois at Chicagoen_US
thesis.degree.levelDoctoralen_US
thesis.degree.namePhD, Doctor of Philosophyen_US
dc.type.genrethesisen_US
dc.contributor.committeeMemberLee, Todd A.en_US
dc.contributor.committeeMemberRauscher, Garth H.en_US
dc.contributor.committeeMemberReda, Domenic J.en_US
dc.contributor.committeeMemberSchumock, Glen T.en_US
dc.contributor.committeeMemberZinner, Ralph G.en_US
dc.type.materialtexten_US


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