Competing causes of death in the head and neck cancer population
Section snippets
Background
It is estimated that 61,760 individuals will be diagnosed with head and neck squamous cell carcinoma (HNSCC) in the United States in 2016, and 13,190 will die from this disease [1]. In addition to death from HNSCC itself, these patients are at risk of dying from other causes. These alternative etiologies are referred to as competing causes, with associated risk factors termed competing risks, because they compete with the cancer itself to cause death [2], [3], [4]. This has become even more
Data source
Patients were identified from the publicly available Surveillance, Epidemiology, and End Results (SEER) 13 database (http://seer.cancer.gov/data/access.html) [22]. This database is the largest and most comprehensive available in SEER for standardized mortality ratio (SMR) analysis. SEER 13 covered 13.4% of the United States’ population from 1992 to 2011 [23]. HNSCC patients were defined as adults aged ⩾20 years diagnosed from 2004 to 2011 with primary squamous cell carcinoma of upper
Results
A total of 64,598 HNSCC patients met the study criteria. These individuals had a mean age of 62 years (SD: 12.0) and included 24,602 (38.1%) deceased individuals. Median follow up was 2.1 years (SD: 2.4). Deaths included 17,460 (71.0%) attributed to the primary HNSCC and 7142 (29.0%) due to competing causes. The cohort was predominately White (83.0%) and male (76.4%). The majority of tumors were located in the oral cavity (40.9%), larynx (28.9%), and oropharynx (19.3%). Compared to living
Discussion
The purpose of this study was to describe the competing causes of mortality in HNSCC patients, compare them to the general population, and identify risk factors associated with death from these competing causes. Previously, the most common causes of competing mortality for HNSCC patients were reported as cardiovascular, pulmonary and secondary cancers [11], [21]. These previous studies focused on selected competing causes without a detailed analysis of mortality rates. Additionally, Baxi et al.
Conclusion
Traditionally HNSCC care, led by a Head and Neck Surgeon, focuses on cancer treatment and complication management which may neglect patients' comorbid diseases. As HNSCC survival improves, addressing potentially preventable competing causes of death, particularly liver disease and suicide, becomes increasingly important. Increasing comorbidity management and preventive healthcare presents an opportunity to improve overall care and survivorship for HNSCC patients.
Conflictions of interest statement
The authors have no conflicts of interest to disclose.
Disclosures
LD Arnold owns stock in Pfeizer, Inc and Merck & Co, Inc. All remaining authors have declared no conflicts of interest.
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2021, Oral OncologyCitation Excerpt :Non-cancer mortality includes treatment-associated acute or late complications from toxicity, second primary tumors and underlying comorbidities including cardiac and respiratory illness [8,9]. Furthermore, the population demographics of patients with OC-OPSCC include high rates of tobacco and alcohol use, leading to high rates of competing causes of mortality among a subset of OC-OPSCC [3,10,11]. Aspiration, mucositis, dysphagia, and subsequent infections are among the unique late sequelae of chemoradiotherapy and surgery for head and neck cancers [12–14].
Cardiovascular Manifestations From Therapeutic Radiation: A Multidisciplinary Expert Consensus Statement From the International Cardio-Oncology Society
2021, JACC: CardioOncologyCitation Excerpt :RT is an important component of curative-intent treatment for head and neck cancer (HNC), as well as an important treatment option for patients with primary or metastatic brain tumors. A 2017 Surveillance, Epidemiology, and End Results Program analysis reported that cardiac disease represented nearly one third of all competing causes of death for 64,598 patients with HNC (40). Given the close association of carotid sheath structures with lymphatic target structures in the neck (Figure 4), RT for HNC has been associated with increased risk of carotid artery disease, transient ischemic attack, and stroke (6).