Head and neck cancer survivors have elevated risk for stroke
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Key takeaways:
- Patients diagnosed before age 40 had a significantly elevated risk for stroke.
- A primary radiation treatment approach also increased stroke risk, compared with a primary surgery approach.
Survivors of head and neck cancer had an elevated risk for stroke — regardless of age, disease site or treatment modality — study findings published in JAMA Network Open showed.
Although the analysis only included patients from Singapore, such an elevated risk still highlights the importance of both early screening and intervention, according to researchers.
“This cross-sectional study found that the incidence of stroke among survivors of [head and neck cancer] was approximately 2.5 times that of the general population in this cohort of individuals in Singapore,” Pui Lam Yip, MBChB, of the department of radiation oncology at National University Hospital in Singapore, and researchers wrote. “These findings highlight the importance of screening and early intervention.”
Background and methodology
Previous studies have established that survivors of head and neck cancer are at an increased risk for stroke, according go background information provided by the study’s investigators.
Yip and colleagues conducted a national cross-sectional study to determine the stroke risk in subpopulations of head and neck cancer survivors in Singapore.
The analysis included 9,803 survivors in Singapore between January 2005 and December 2020 identified through the Singapore Cancer Registry, the Singapore Stroke Registry and the Registry of Birth and Deaths.
Researchers created subgroups of the study population based on patient demographic, disease and treatment factors.
The age-standardized incidence rate ratio (SIRR) and age-standardized incidence rate difference (SIRD) served as study’s main outcome measurements, with the general population of Singapore (n = approx. 4 million) serving as the reference group.
Results, next steps
Of the 9,803 head and neck cancer survivors (median diagnosis age, 58 years; 73.1% men), 337 (3.4%) developed stroke over a median follow-up of 42.5 years (interquartile range, 15-94.5 months).
Researchers noted a SIRR of 2.46 (95% CI, 2.21-2.74) and an overall SIRD of 4.11 (95% CI, 3.37-4.85) strokes per 1,000 person-years. The also reported the cumulative incidence of stroke to be 3% at 5 years and 7% at 10 years after diagnosis of a head and neck cancer.
SIRR appeared highest for individuals diagnosed with a head and neck cancer before age 40 (SIRR = 30.55; 95% CI, 16.24-52.35).
All study population subsets — defined by age, sex, race and ethnicity, head and neck cancer subsites other than the tongue, stage, histology, and treatment modalities — had increased stroke risk compared with the general population.
Additionally, study investigators reported significantly higher SIRR and SIRD among patients who had a primary radiation treatment approach (SIRR = 3.01; [95% CI, 2.64-3.43]; SIRD = 5.12 [95% CI, 4.18-6.29] strokes per 1,000 person-years) compared with a primary surgery approach (SIRR = 1.64 [95% CI, 1.31-2.05]; SIRD = 1.84 [95% CI, 0.92-3.67] strokes per 1,000 person-years).
Researchers noted several study limitations, including a lack of detailed information on comorbid conditions, lifestyle factors and treatment information for head and neck cancer survivors, as well as that the Singapore Cancer Registry did not take HPV status into account, despite HPV being associated with an increased stroke risk among head and cancer patients and survivors.
Although the study data only contains that of head and neck cancer survivors and the general population of Singapore, researchers believe the associations demonstrated call for additional attention to the risk for stroke among this population of cancer survivors. .
“Stroke was prevalent among survivors of [head and neck cancer], with an estimated cumulative incidence of 7% at 10 years after diagnosis,” they wrote.
“Our data indicated that patients diagnosed at younger than 40 years had a striking 30.6-fold increased risk [for] developing stroke,” they added. “This observation is in line with previous reports of high stroke risk in younger survivors of [head and neck cancer].”
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