Treatments and costs for recurrent and/or metastatic squamous cell carcinoma of the head and neck in the Netherlands

• DOI: 10.1007/s00405-015-3495-y
• Publication Date: 2015-01-20T12:36:15Z
• Authors: Naomi van der Linden; Jan Buter; Chris P. Pescott; Roy I. Lalisang; Jan Paul de Boer; Alexander de Graeff; Carla M. L. van H...; Robert J. Baatenb...; Carin A. Uyl-de G...
• Keywords: Male; Disease-Free Survival; 03 medical and health sciences; 0302 clinical medicine; Cost of Illness; squamous cell of head and neck; Carcinoma, squamous cell of head and neck; Journal Article; EMC NIHES-05-63-02 Quality; Humans; Neoplasm Metastasis; Aged; Netherlands; Squamous Cell Carcinoma of Head and Neck; Research Support, Non-U.S. Gov't; Incidence; Carcinoma; Radboudumc 9: Rare cancers RIHS: Radboud Institute for Health Sciences; Middle Aged; Combined Modality Therapy; EMC OR-01-62-02; 3. Good health; Survival Rate; Otorhinolaryngology; Head and Neck Neoplasms; Carcinoma, Squamous Cell; Costs and Cost Analysis; Disease Progression; Costs and cost analysis; Female; Drug therapy; Neoplasm Recurrence, Local; Head and Neck

For patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN), chemotherapy can prolong life and alleviate symptoms. However, expected gains may be small, not necessarily outweighing considerable toxicity and high costs. Treatment choice is to a large extent dependent on preferences of doctors and patients and data on these choices are scarce. The purpose of this study is to obtain real-world information on palliative systemic treatment and costs of R/M SCCHN in the Netherlands. In six Dutch head and neck treatment centers, data were collected on patient and tumor characteristics, treatment patterns, disease progression, survival, adverse events, and resource use for R/M SCCHN, between 2006 and 2013. 125 (14 %) out of 893 R/M SCCHN patients received palliative, non-trial first-line systemic treatment, mainly platinum + 5FU + cetuximab (32 %), other platinum-based combination therapy (13 %), methotrexate monotherapy (27 %) and capecitabine monotherapy (14 %). Median progression-free survival and overall survival were 3.4 and 6.0 months, respectively. 34 (27 %) patients experienced severe adverse events. Mean total hospital costs ranged from € 10,075 (± € 9,891) (methotrexate monotherapy) to € 39,459 (± € 21,149) (platinum + 5FU + cetuximab). Primary cost drivers were hospital stays and anticancer drug treatments. Major health care utilization and costs are involved in systemically treating R/M SCCHN patients with a limited survival.