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Survivors of head, neck cancer more likely to die of competing causes
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Patients with head and neck cancers die more frequently from competing causes than from primary head and neck cancer in the 5 years following diagnosis, according to a letter published in JAMA Oncology.
“Approximately 436,000 survivors of head and neck cancer currently live in the United States, the number increasing because of decreasing smoking rates and increasing HPV incidence,” Nosayaba Osazuwa-Peters, BD, MPH, CHES, of St. Louis University School of Medicine, and colleagues wrote. “Survivors, however, face several comorbidities that increase their risk [for] death from competing causes other than primary head and neck cancer.”
The researchers reviewed the SEER database for adults who had head and neck squamous cell carcinoma (n = 151,155) from 2000 to 2014. Osazuwa-Peters and colleagues used binomial logistic regression analysis with year of follow-up as a predictor and causes of death as outcome variables, controlling for marital status, sex, race, stage, anatomic site, county-level income and treatment modality.
With each increasing year of survival, the patients’ odds of dying from competing causes rose by 26% (adjusted OR = 1.26; 95% CI, 1.25-1.27).
Several factors, including divorce or separation (adjusted OR = 1.17; 95% CI, 1.11-1.23), male sex (adjusted OR = 1.21; 95% CI, 1.16-1.26) and oral cavity cancer (adjusted OR = 1.06; 95% CI, 1.01-1.11) appeared associated with a greater likelihood for death from competing causes compared with each variable’s reference group. Black patients appeared less likely to die of competing causes than white patients (adjusted OR = 0.93; 95% CI, 0.88-0.98).
Median OS was 80 months, with primary head and neck cancer accounting for the majority of deaths (73.4%) within the first 56 months after diagnosis. Death of competing causes overtook death of head and neck cancer at 57 months (competing cause conditional probability, 0.0023; 95% CI, 0.002-0.0026 vs. head and neck cancer conditional probability, 0.0027; 95% CI, 0.002-0.003). Primary head and neck cancer constituted just 38.8% of deaths at 6 to 10 years after diagnosis and 30.6% of deaths at 11 to 15 years.
The most common competing causes of death included cardiovascular disease, chronic obstructive pulmonary disease and second primary cancers.
As many as 80% of patients with head and neck cancers are current or former smokers, the researchers noted, indicating that quitting tobacco use should be standard care throughout the patient’s lifetime.
“It is critical to develop lifelong surveillance for competing causes of death, which by [11 to 15 years] accounted for greater than two-thirds of deaths,” the researchers wrote. “Besides preventing deaths from competing causes, surveillance could help mitigate treatment-related quality of life issues.” – by Andy Polhamus
Disclosures: The authors report no relevant financial disclosures.
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