Analysis of the National Cancer Data Base to Describe Treatment Trends in Stage IV Oral Cavity and Pharyngeal Cancers in the United States, 1998-2012

Treatment recommendations for head and neck cancers have evolved over the last several decades, with a particularly clear shift in 2004 toward use of chemotherapy in late-stage patients. This study examines the national trends in treatment combinations for patients with stage IV oral cavity and pharyngeal cancer between 1998 and 2012 using the National Cancer Data Base (NCDB). Our analysis demonstrates that chemotherapy was widely integrated into the treatment plans for this population following 2004, confirming that recommendations were successfully translated into practice. Stage IV patients treated after this shift in treatment experienced higher 5-year survival rates compared to patients treated prior to the adoption of increased chemotherapy usage. We also examined the patient population for other changes over time and found that smaller primary tumors became more common and that 2 primary sites (base of tongue and tonsil) came to represent a larger percentage of the patient population; these changes may also contribute to a rising survival rate. Patients receiving the recommended trimodal therapy of surgery, radiation, and chemotherapy were found to be more geographically widespread over time, suggesting a penetrance of the recommendations into the medical system across the country.