Practice variations in voice treatment selection following vocal fold mucosal resection

Abstract

Objective To characterize initial voice treatment selection following vocal fold mucosal resection in a Medicare population. Study Design Retrospective analysis of a large, nationally-representative Medicare claims database. Methods Patients with >12 months of continuous Medicare coverage who underwent a leukoplakia- or cancer-related vocal fold mucosal resection (index) procedure during calendar years 2004–2009 were studied. The primary outcome of interest was receipt of initial voice treatment (thyroplasty, vocal fold injection, or speech therapy) following the index procedure. We evaluated the cumulative incidence of each post-index treatment type treating the other treatment types as competing risks, and further evaluated post-index treatment utilization using the proportional hazards model for the subdistribution of a competing risk. Patient age, sex and Medicaid eligibility were used as predictors. Results 2041 patients underwent 2427 index procedures during the study period. An initial voice treatment event was identified in 14% of cases. Women were significantly less likely to receive surgical or behavioral treatment compared to men. From age 65–75 years, the likelihood of undergoing surgical treatment increased significantly with each 5-year age increase; after age 75 years, the likelihood of undergoing either surgical or behavioral treatment decreased significantly every 5 years. Patients with low socioeconomic status were significantly less likely to undergo speech therapy. Conclusions The majority of Medicare patients do not undergo voice treatment following vocal fold mucosal resection. Further, the treatments analyzed here appear disproportionally utilized based on patient sex, age and socioeconomic status. Additional research is needed to determine whether these observations reflect clinically explainable differences or disparities in care. Level of Evidence 2c

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“…These data can be extremely important in clinical practice because these SNPs and proteins could be powerful markers for diagnosis and treatment. Treatments for VFL include speech therapy, surgical techniques, vocal fold injection ( 55 ), and the use of drugs ( 56 ). However, there is no effective therapy yet ( 1 ), and more indicators for developing new treatment options are needed.…”

High-Performance Agent-Based Modeling Applied to Vocal Fold Inflammation and Repair

“…Excessive phonatory stress can induce a cell-mediated inflammatory response and structural tissue damage, leading to a pathological condition (Gunter, 2004 ; Li et al, 2013 ; Kojima et al, 2014 ). Patients with phonotraumatic lesions are usually prescribed behavioral voice therapy (Johns, 2003 ; Misono et al, 2016 ) or surgical excision of the lesion in combination with various adjunctive treatments (Hansen and Thibeault, 2006 ; Hirano et al, 2013 ; Ingle et al, 2014 ; Moore et al, 2016 ). Unfortunately, the healing outcome of voice treatments often depend on the lesion, the treatment dose, and the patient's vocal needs (Abbott et al, 2012 ; Roy, 2012 ; Li N.Y. et al, 2014 ).…”