Clinical and economic burden of recurrence among older patients with locoregionally advanced head and neck squamous cell carcinoma in the United States

BACKGROUND: There is limited prior literature comparing survival and economic outcomes between those with and without recurrent disease among older individuals aged at least 66 years with locoregionally advanced head and neck squamous cell carcinoma (LA HNSCC). OBJECTIVE: To estimate the burden of recurrence among older patients with LA HNSCC in the United States. METHODS: Older patients diagnosed with LA HNSCC (2007-2019) from the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data were included. Overall survival (OS), health care resource utilization (HCRU), and health care costs were compared between patients with or without recurrence, separately for patients receiving surgical (resected) vs nonsurgical (unresected) primary treatment. RESULTS: In the resected group (n = 502), 333 patients experienced recurrence and had a 63% increased risk of death vs nonrecurrent patients (adjusted hazard ratio [aHR] = 1.63; 95% confidence interval [CI] = 1.24-2.15; P < 0.001). In those unresected (n = 1,217), 791 patients experienced recurrence and had a 77% increased risk of death (aHR = 1.77; 95% CI = 1.49-2.10; P < 0.001). Recurrence was associated with higher HCRU and monthly health care costs in both resected ($3,831; 95% CI = $2,319-$5,360) and unresected ($4,730; 95% CI = $3,611-$5,870) groups (P < 0.001). CONCLUSIONS: Recurrence in older patients with LA HNSCC is associated with shorter OS and higher HCRU/health care costs.