Impact of surveillance on survival after laryngeal cancer in the medicare population

Objectives/Hypothesis: Routine surveillance is advocated to detect recurrent disease after treatment for laryngeal cancer. This aim of this study was to determine the 1-and 5-year postrecurrence mortality for laryngeal cancers and evaluate whether more intensive surveillance improved survival. Study Design: Retrospective cohort study. Methods: Patients with recurrent cancers (1992-1999) were identified in a national cancer clinical database. Multivariate analysis was used to evaluate the effect of surveillance on postrecurrence survival. Results: Of 2,121 recurrent cancers identified, 913 were laryngeal. Patients with laryngeal cancer recurrence had 27% (P =.001) and 22% (P =.007) better odds of 1-and 5-year survival than other sites. The 1-and 5-year postrecurrence survival rates for laryngeal cancer patients were 72.4% and 41.3%, respectively. Glottic cancer cases had the best postrecurrence life expectancy. Multivariate regression revealed that clinical surveillance intensity had no independent impact on their survival (P <.05). However, patients with recurrent glottic cancer seen in surveillance had 23% improved odds of survival (P =.037). Conclusions: More frequent surveillance visits was not associated with a survival advantage in the overall population. Patients with glottic cancer had a postrecurrence survival advantage if seen during the surveillance period. Laryngeal cancer patients had better postrecurrence survival than other head and neck sites.