Dysphagia prevalence and associated survival differences in older patients with lung cancer: A SEER-Medicare population-based study

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INTRODUCTION: The impact of dysphagia in persons with lung cancer is unknown. The objective of this study is to measure the prevalence and survival differences associated with dysphagia in older adults with lung cancer.

MATERIALS AND METHODS: Linked SEER cancer registries - Medicare data, 1991-2009 was utilized to identify 201,674 persons with lung cancer. Most were male (53%), had regional or distant disease (74%), and were aged <80 years (82%). The pre-existing prevalence of dysphagia was identified using claims codes before the lung cancer diagnosis. Survival was analyzed using Kaplan Meier curves and Cox proportional hazard models.

RESULTS: 8517 (4%) had dysphagia prior to their lung cancer diagnoses. Younger age, worse disease stage, more comorbidities, and hospital rurality were associated with higher likelihood of dysphagia. Patients with dysphagia had worse survival (median survival 8 months [95%CI 7,9]) than those without dysphagia (median survival 12 months [95%CI 11,13]). After adjusting for sociodemographic, clinical, and disease characteristics, dysphagia was still associated with worse survival (Hazard ratio of death 1.34, [95%CI 1.28-1.35], p ≤ .0001).

DISCUSSION AND CONCLUSIONS: This is the first Medicare claims-based study of older adults with lung cancer and dysphagia. Pre-existing dysphagia occurred in approximately 1 in 25 patients with lung cancer and was associated with worse survival. Determining the best methods to evaluate and treat dysphagia in patients with lung cancer is an important avenue for future studies.

Original languageEnglish (US)
Pages (from-to)1115-1117
Number of pages3
JournalJournal of Geriatric Oncology
Issue number7
StatePublished - Sep 2020

Bibliographical note

Funding Information:
This work was partially supported by NIH grant K23DC016335 (Misono). These findings do not represent the official views of the National Institutes of Health and the funding source was not involved in this work. S. Cohen serves as a consultant to ZSquare and Syneos on work unrelated to the content of this manuscript. Drs. Marmor, Bhargava, Fujioka and Cho have nothing to disclose.

Publisher Copyright:
© 2020 Elsevier Inc.


  • Dysphagia
  • Lung cancer
  • Survival
  • Swallowing


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