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Previous hematologic malignancies increase risk for head and neck cancers
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Individuals previously diagnosed with a hematologic malignancy appeared at higher risk for developing head and neck cancers, according to results of a retrospective study published in JAMA Otolaryngology – Head & Neck Surgery.
A history of hematologic malignancies also appeared associated with worse 2-year and 5-year OS for several head and neck cancer subsites, results showed.
“Hematologic malignant tumors are among the most prevalent cancers in the United States,” Daniel Clayburgh, MD, PhD, and colleagues wrote. “This large population of patients is unfortunately susceptible to future cancers. Studies of hematologic malignant tumors, such as chronic myelogenous leukemia, chronic lymphocytic leukemia or small lymphocytic lymphoma, Hodgkin lymphoma, non-Hodgkin lymphoma and multiple myeloma, have demonstrated long-term elevated risk [for] developing secondary neoplasms. In studies of patients who have undergone hematopoietic stem cell transplant ... there is also a significantly elevated risk [for] second cancers.”
Clayburgh and colleagues analyzed data from the Veterans Affairs Corporate Data Warehouse on 30,939,656 veterans (89.3% men; 45.2% white) born between 1910 and 1969.
Queries of outpatient problem lists revealed 207,322 patients with hematologic malignancies, 1,353 of whom were later diagnosed with head and neck cancer.
Median follow-up for all patients with head and cancer was 51 months (43 months for patients with prior hematologic malignancies, 51 months without; range, 0-308).
Results showed significant associations of prior hematologic malignancies with overall aerodigestive tract cancer (RR = 16; 95% CI, 1.5-1.7), oral cavity cancer (RR = 1.7; 95% CI, 1.5-1.9), oropharynx cancer (RR = 1.7; 95% CI, 1.5-1.9), larynx cancer (RR = 1.3; 95% CI, 1.2-1.5), sinonasal cancer (RR = 3; 95% CI, 2.2-4.1), salivary gland cancer (RR = 2.8; 95% CI, 2.4-3.3), and thyroid cancer (RR = 2.1; 95% CI, 1.9-2.4).
Researchers found that certain subsite cancers had worse 2-year and 5-year OS among patients had previous hematologic malignancies compared with patients who did not.
For instance, 2-year OS rates among patients with aerodigestive tract cancer were 69% for those who did not have a previous hematologic malignancy vs. 61% for patients who did (RR = 0.88; 95% CI, 0.83-0.93). Five-year OS rates for these patients were 45% vs. 34% (RR = 0.76; 95% CI, 0.66-0.84).
Five-year OS also was significantly higher for patients with no history of hematologic malignancy for those with salivary gland tumors (61% vs. 32%; RR = 0.52; 95% CI, 0.41-0.67), oral cavity tumors (45% vs. 37%; RR = 0.83; 95% CI, 0.7-0.97) and thyroid cancer (72% vs. 63%; RR = 0.88; 95% CI, 0.79-0.97).
The large VA database was useful for the study but had several limitations, including a lack of data on certain variables, such as alcohol and tobacco use, researchers noted. Further, VA medical centers do not necessarily represent head and neck surgical oncology practices in the general population.
“This study provided evidence of a positive association between a history of hematologic malignant tumor and subsequent development of head and neck cancer in a VA population,” Clayburgh and colleagues wrote. “Ultimately, this study enriches our understanding of the risk of head and neck cancer for patients with prior hematologic malignant tumors.” – by John DeRosier
Disclosures: Clayburgh reports research funding from AbbVie. The other authors report no relevant financial disclosures.
Perspective
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Cristina P. Rodriguez, MD
This paper is consistent with prior reports associating diagnosis and treatment of various hematologic cancers with higher risk for developing both mucosal and cutaneous malignancies of the head and neck. It is of interest that cancer subsites regarded as biologically distinct from the usual tobacco-associated head and neck cancers — as well as HPV-driven oropharynx cancers, such as nasopharynx and sinonasal — were increased among this population.
The data set was limited regarding demographics, tobacco and viral association of the head and neck cancer, and researchers did not report specifics of therapy. The strength of these observations lies in the large (30 million) patient population, demonstrating the potential of the VA database in identifying survivorship issues among patients with cancer.
Further study of data in terms of primary site-specific associations with potentially modifiable factors — such as occupational and tobacco exposure, vaccination, types of treatment (extent and type of radiation therapy, stem cell transplantation), degree of immunosuppression and presence of graft-versus-host disease — would be instrumental in informing appropriate preventive measures and long-term follow-up for these patients.
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