Defining platinum-ineligible head and neck cancer patients from administrative data

Area of Science:

• Oncology
• Radiation Oncology
• Health Services Research

Background:

• Head and neck squamous cell carcinoma (HNSCC) survival remains poor.
• Cisplatin improves survival in HNSCC but has toxicities, limiting its use in comorbid patients.
• Accurate identification of cisplatin-eligible patients in large datasets is needed.

Purpose of the Study:

• To characterize populations eligible for cisplatin in administrative data.
• To define specific contraindications for cisplatin use in HNSCC.
• To evaluate factors influencing cisplatin use in HNSCC patients receiving definitive radiation.

Main Methods:

• Retrospective cohort study using SEER-Medicare data (2010-2019).
• Included adults with locoregionally advanced HNSCC treated with definitive radiation therapy.
• Defined cisplatin contraindications using validated algorithms and assessed comorbidity burden with the Elixhauser Comorbidity Index.

Main Results:

• 23.2% of 3548 HNSCC patients received cisplatin; 49.7% received no systemic therapy.
• Proportion receiving no systemic therapy increased over time.
• Elixhauser Index was associated with cisplatin use (OR 0.95; 95% CI [0.92-0.98]) on multivariable analysis.

Conclusions:

• Cisplatin use is limited in real-world HNSCC treatment with definitive radiation.
• An increasing number of patients receive no systemic therapy.
• Specific contraindications did not significantly predict cisplatin use, suggesting practice deviates from guidelines.