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Silverman DA, Lin C, Tamaki A, Puram SV, Carrau RL, Seim NB, Eskander A, Rocco JW, Old MO, Kang SY. Respiratory and pulmonary complications in head and neck cancer patients: Evidence-based review for the COVID-19 era. Head Neck 2020; 42:1218-1226. [PMID: 32343013 PMCID: PMC7267530 DOI: 10.1002/hed.26217] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pulmonary complications and infections frequently affect patients with head and neck squamous cell carcinoma (HNSCC). Common characteristics can predispose these patients to the development of severe respiratory illness, which may be particularly relevant during the 2019 coronavirus disease (COVID-19) pandemic. METHODS A scoping review was performed to assess the impact of pulmonary comorbidities and adverse respiratory outcomes in HNSCC patients. RESULTS Advanced age, history of tobacco and alcohol abuse, and cardiopulmonary comorbidities are significant risk factors for the development of adverse respiratory outcomes. Treatment toxicities from radiation or chemoradiation therapy significantly increase these risks. CONCLUSION Respiratory complications are a frequent cause of morbidity and mortality among HNSCC patients, and the COVID-19 pandemic may disproportionately affect this population. Interventions designed to decrease smoking and alcohol use, improve oral hygiene, and aggressively manage medical comorbidities are important to the long-term management and health of these patients.
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Affiliation(s)
- Dustin A Silverman
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Chen Lin
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Akina Tamaki
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery and Department of Genetics, Washington University School of Medicine, Ear, Nose & Throat Center, St. Louis, Missouri, USA
| | - Ricardo L Carrau
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Nolan B Seim
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, USA
| | - James W Rocco
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Matthew O Old
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Stephen Y Kang
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
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2
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Ji F, Yang CQ, Li XL, Zhang LL, Yang M, Li JQ, Gao HF, Zhu T, Cheng MY, Li WP, Wu SY, Zhong AL, Wang K. Risk of breast cancer-related death in women with a prior cancer. Aging (Albany NY) 2020; 12:5894-5906. [PMID: 32250967 PMCID: PMC7185107 DOI: 10.18632/aging.102984] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 03/24/2020] [Indexed: 12/14/2022]
Abstract
The overall risk of developing a second primary cancer is increasing. The purpose of this study was to analyze the survival of patients with breast cancer diagnosed after a prior cancer and identify risk factors of breast cancer death in this population. Using the SEER database, we identified 1,310 woman diagnosed with breast cancer between 2010 and 2015 after a prior cancer as the primary cohort. Clinicopathological characteristics were compared using the Student t-test and chi-square test. Fine and Gray’s regression was used to evaluate the effect of treatments on breast cancer death. After propensity score matching (PSM), 9,845 pairs of patients with breast cancer as the prior or second cancer diagnosed between 2010 and 2011 were included as a second cohort. PSM-adjusted Kaplan-Meier and Cox hazards models were used to evaluate the impact of prior cancer on survival. The results showed that survivors of gynecologic cancers (e.g., ovarian cancer) had a higher risk of developing breast cancer than survivors of gastrointestinal and urinary tract cancers. More patients died of breast cancer than of prior urinary cancer (53.3% vs. 40%, P < 0.05) and melanoma (66.7% vs. 33.3%, P < 0.05). The ratio of breast cancer deaths to prior cancer deaths was significantly higher in patients with diagnoses interval ≥ 3 years than in those with the interval < 3 years (2.67 vs. 0.69, P < 0.001). Breast cancer-specific survival and overall survival rates were significantly lower in women with breast cancer as the second primary cancer than in those with breast cancer as the prior cancer, especially among hormone receptor-positive women. However, breast cancer treatment decreased the risk of breast cancer -specific death (hazard ratio = 0.695, 95% confidence interval: 0.586–0.725, P < 0.001). Breast cancer patients with prior cancers must be carefully considered for clinical trials.
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Affiliation(s)
- Fei Ji
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, P.R. China.,School of Medicine, South China University of Technology, Guangzhou 510006, P.R. China
| | - Ci-Qiu Yang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, P.R. China.,School of Medicine, South China University of Technology, Guangzhou 510006, P.R. China
| | - Xiao-Ling Li
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, P.R. China.,School of Medicine, South China University of Technology, Guangzhou 510006, P.R. China
| | - Liu-Lu Zhang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, P.R. China.,School of Medicine, South China University of Technology, Guangzhou 510006, P.R. China
| | - Mei Yang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, P.R. China.,School of Medicine, South China University of Technology, Guangzhou 510006, P.R. China
| | - Jie-Qing Li
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, P.R. China.,School of Medicine, South China University of Technology, Guangzhou 510006, P.R. China
| | - Hong-Fei Gao
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, P.R. China.,School of Medicine, South China University of Technology, Guangzhou 510006, P.R. China
| | - Teng Zhu
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, P.R. China.,School of Medicine, South China University of Technology, Guangzhou 510006, P.R. China
| | - Min-Yi Cheng
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, P.R. China.,School of Medicine, South China University of Technology, Guangzhou 510006, P.R. China
| | - Wei-Ping Li
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, P.R. China.,School of Medicine, South China University of Technology, Guangzhou 510006, P.R. China
| | - Si-Yan Wu
- Department of Operation Room, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, P.R. China.,School of Medicine, South China University of Technology, Guangzhou 510006, P.R. China
| | - Ai-Ling Zhong
- Department of Operation Room, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, P.R. China.,School of Medicine, South China University of Technology, Guangzhou 510006, P.R. China
| | - Kun Wang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, P.R. China.,School of Medicine, South China University of Technology, Guangzhou 510006, P.R. China
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3
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O'Sullivan B, Hui Huang S, Keane T, Xu W, Su J, Waldron J, Gullane P, Liu FF, Warde P, Payne D, Tong L, Cummings B. Durable therapeutic gain despite competing mortality in long-term follow-up of a randomized hyperfractionated radiotherapy trial for locally advanced head and neck cancer. Clin Transl Radiat Oncol 2020; 21:69-76. [PMID: 32055717 PMCID: PMC7005479 DOI: 10.1016/j.ctro.2020.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 01/14/2020] [Accepted: 01/22/2020] [Indexed: 01/06/2023] Open
Abstract
Purpose/objectives To examine the therapeutic ratio and mortality profile over time in a radiotherapy randomized trial in stage III-IV larynx/pharynx cancer with long-term follow-up. Materials/methods From 1988 to 1995, 331 cases were randomized to either hyperfractionated (HF) (58 Gy/40 fractions, twice daily) or conventional (CF) (51 Gy/20 fractions, once daily) radiotherapy. Overall survival (OS), locoregional (LRC), distant control (DC), ≥Grade 3 late toxicity (LT), and relative mortality risk profile over time were compared between both arms. Results Median follow-up was 13.6 years. HF had a 10% improved OS at 5-years (40% vs 30%, p = 0.04), but the benefit diminished to 3% at 10-years (21% vs 18%). A trend towards higher LRC with HF remained (5-year: 49% vs 40%; 10-year: 49% vs 39%, p = 0.05). DC rates were unchanged (5-year: 87% vs 85%; 10-year: 87 vs 84%, p = 0.56). LT rates were similar (HF vs CF: 5-year: 9% vs 12%; 10-year: 11% vs 14%, p = 0.27). Multivariable analysis confirmed that HF reduced mortality risk by 31% [HR 0.69 (0.55-0.88), p < 0.01] and locoregional failure risk by 35% [HR 0.65 (0.48-0.89), p < 0.01]. Index cancer mortality (5-year: 46% vs 51%; 10-year: 49% vs 55%) was lower in the HF arm. Competing mortality (mostly smoking-related) was also numerically lower with HF at 5-years (14% vs 19%) but became similar at 10-years (30% vs 28%). Conclusions This trial confirms that HF with augmented total dose has a durable 10% effect size on LRC with comparable LT. OS benefit is evident at 5-years (10%) but relative mortality risk profile changes in longer follow-up.
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Affiliation(s)
- Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada.,Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada.,Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Thomas Keane
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada.,Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Jie Su
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Patrick Gullane
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Fei-Fei Liu
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada.,Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - David Payne
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Li Tong
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Bernard Cummings
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada.,Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada
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4
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Cognetti DM, Villaflor VM, Fakhry C, Miller MC, Malloy KM. Survivorship support in head and neck cancer: American Head and Neck Society survey. Head Neck 2020; 42:939-944. [DOI: 10.1002/hed.26066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/24/2019] [Accepted: 12/17/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- David M. Cognetti
- Department of Otolaryngology, Sydney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania
| | - Victoria M. Villaflor
- Department of Medical Oncology, Robert H Lurie Comprehensive Cancer Center of Northwestern University Chicago Illinois
| | - Carole Fakhry
- Department of Otolaryngology, Johns Hopkins University School of Medicine Baltimore Maryland
| | - Matthew C. Miller
- Department of Otolaryngology, University of Rochester School of Medicine Rochester New York
| | - Kelly M. Malloy
- Department of Otolaryngology, University of Michigan Medical School Ann Arbor Michigan
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5
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Dauzier E, Lacas B, Blanchard P, Le QT, Simon C, Wolf G, Janot F, Horiuchi M, Tobias JS, Moon J, Simes J, Deshmane V, Mazeron JJ, Mehta S, Zaktonik B, Tamura M, Moyal E, Licitra L, Fortpied C, Haffty BG, Ghi MG, Gregoire V, Harris J, Bourhis J, Aupérin A, Pignon JP. Role of chemotherapy in 5000 patients with head and neck cancer treated by curative surgery: A subgroup analysis of the meta-analysis of chemotherapy in head and neck cancer. Oral Oncol 2019; 95:106-114. [PMID: 31345376 DOI: 10.1016/j.oraloncology.2019.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/29/2019] [Accepted: 06/02/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the effect of chemotherapy added to a surgical locoregional treatment (LRT) for patients with locally advanced head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS We studied the sub-group of trials with surgical LRT included in the meta-analysis on chemotherapy in head and neck cancer (MACH-NC). Data from published and unpublished randomized trials comparing the addition of chemotherapy to LRT in HNSCC patients were sought using electronic database searching for the period 1965-2000, hand searching and by contacting experts in the field. Trials with less than 60 patients, or preoperative radiotherapy or where the type of LRT could not be individually determined were excluded. All individual patient data were checked for internal consistency, compared with published reports, and validated with trialists. Data were pooled using a fixed-effect model. Heterogeneity was assessed using Cochrane test and I2 statistic. RESULTS Twenty-four trials were eligible (5000 patients). Chemotherapy improved overall survival (HR = 0.92 [95%CI: 0.85-0.99] p = 0.02). There was a significant interaction between treatment effect and timing of chemotherapy (p = 0.08 at pre-specified threshold of 0.10) with a greater effect for concomitant chemotherapy (HR = 0.79, 95%CI: 0.69-0.92). The benefit of chemotherapy was greater in women (HRwomen = 0.63, 95%CI: 0.50-0.80) compared to men (HRmen = 0.96, 95%CI: 0.89-1.04; p for interaction = 0.001). CONCLUSIONS This analysis confirmed the benefit of concomitant chemotherapy added to surgical LRT. The role of induction therapy as yet to be determined as it did not improve OS. Women may benefit more than men from chemotherapy.
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Affiliation(s)
- Etienne Dauzier
- Meta-Analysis Unit, Service de Biostatistique et d'Epidémiologie, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Benjamin Lacas
- Meta-Analysis Unit, Service de Biostatistique et d'Epidémiologie, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Pierre Blanchard
- Meta-Analysis Unit, Service de Biostatistique et d'Epidémiologie, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France; Department of Radiation Therapy, Gustave Roussy Cancer Campus, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Christian Simon
- Department of Otolaryngology and Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Gregory Wolf
- Department of Otolaryngology, University of Michigan, Ann Arbor, USA
| | - François Janot
- Département de Cancérologie Cervico-faciale, Gustave Roussy Cancer Campus, Université Paris Sud, Villejuif, France
| | - Masatoshi Horiuchi
- Department of Otolaryngology, Tokai University School of Medicine, Kanagawa, Japan
| | - Jeffrey S Tobias
- Department of Radiotherapy, University College London Hospital, London, UK
| | - James Moon
- SWOG Statistical Center, Seattle, WA, USA
| | - John Simes
- NHMRC Clinical Trials Center, Camperdown, Australia
| | - Vinay Deshmane
- Surgical Oncology & Breast Diseases, P.D. Hinduja National Hospital & Medical Research Centre, Mumbai, India
| | | | - Samir Mehta
- Department of Surgery, Sarla Hospital, Mumbai, India
| | - Branko Zaktonik
- Department of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Minoru Tamura
- Dept. of Dentistry and Oral Surgery, Shinshu University School of Medicine, Japan
| | - Elizabeth Moyal
- Département de radiothérapie, IUCT Oncopole - CLCC Institut Claudius Regaud, Toulouse, France
| | - Lisa Licitra
- Department of Medical Oncology 3, Fondazione IRCCS-Istituto Nazionale dei Tumori, Milano and University of Milan, Italy
| | | | - Bruce G Haffty
- Dept. of Therapeutic Radiology, Rutgers Robert Wood Johnson and NJ Medical School, NJ, USA
| | | | | | - Jonathan Harris
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, USA
| | - Jean Bourhis
- Department of Radiotherapy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Anne Aupérin
- Meta-Analysis Unit, Service de Biostatistique et d'Epidémiologie, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France.
| | - Jean-Pierre Pignon
- Meta-Analysis Unit, Service de Biostatistique et d'Epidémiologie, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
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6
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An assessment of patient burdens from head and neck cancer survivorship care. Oral Oncol 2018; 82:115-121. [DOI: 10.1016/j.oraloncology.2018.04.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/26/2018] [Accepted: 04/29/2018] [Indexed: 02/06/2023]
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7
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Kim YH, Roh JL, Kim SB, Choi SH, Nam SY, Kim SY. Risk factors for competing non-cancer mortality after definitive treatment for advanced-stage head and neck cancer. Oral Dis 2018; 24:1217-1225. [PMID: 29804327 DOI: 10.1111/odi.12904] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Patients with head and neck cancer (HNC) can die of index tumor progression and second tumor or non-cancer causes. Here, we investigated the risk factors for competing non-cancer mortality (NCM) in a prospective cohort of patients with advanced-stage HNC. MATERIALS AND METHODS A prospective observational study was conducted with 604 patients who underwent definitive treatment for advanced-stage HNC between 2010 and 2015. Main outcomes were NCM and cancer mortality (CM) defined as death from non-cancer causes and HNC or second cancers, respectively. Cumulative incidence and cause-specific hazard functions were used to analyze the risk factors of NCM and CM. RESULTS Age, smoking, Charlson comorbidity index (CCI), performance status, body mass index, rural residence, education and hemoglobin level at diagnosis, and chemotherapy were significantly associated with NCM (all p < 0.05). Multivariate analyses showed that age, CCI, and hemoglobin were independent factors of NCM. Age (≥65 years), CCI (≥2), and hemoglobin (<11 g/dl) were related to 4.5-, 3.2-, and 2.7-fold increased adjusted risk of NCM, respectively. CONCLUSIONS Old age, comorbidity, and hemoglobin at diagnosis were independent predictors of NCM. The risk factors could be used to predict non-cancer death after definitive treatment for advanced-stage HNC.
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Affiliation(s)
- Yong Han Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Lyel Roh
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Bae Kim
- Department of Medicine (Oncology), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Ho Choi
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Yoon Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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8
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Survival after refusal of surgical treatment for locally advanced laryngeal cancer. Oral Oncol 2017; 71:34-40. [DOI: 10.1016/j.oraloncology.2017.05.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 05/22/2017] [Accepted: 05/27/2017] [Indexed: 12/20/2022]
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9
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Massa ST, Osazuwa-Peters N, Christopher KM, Arnold LD, Schootman M, Walker RJ, Varvares MA. Competing causes of death in the head and neck cancer population. Oral Oncol 2016; 65:8-15. [PMID: 28109473 DOI: 10.1016/j.oraloncology.2016.12.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/22/2016] [Accepted: 12/07/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE/OBJECTIVES The increasing survivorship of head and neck squamous cell carcinoma (HNSCC) comes with a risk of death from other causes, known as competing causes. The demographics of HNSCC are also evolving with increasing incidence of Human Papillomavirus (HPV) associated tumors. This study describes competing causes of death for the HNSCC population compared to the general population and identifies associated risk factors. METHODS Adult patients with first mucosal HNSCC (2004-2011) were identified from the Surveillance, Epidemiology and End Result database. Competing causes of death were compared to reference populations using proportion of deaths and Standardized Mortality Ratios (SMR). A multivariable competing risk survival analysis yielded subdistribution hazard ratios (HR) for competing mortality. RESULTS Of 64,598 HNSCC patients, 24,602 (38.1%) were deceased including 7142 deaths (29.0%) from competing causes. The most common were cardiovascular disease, lung cancer, and other cancers. All relative mortality rates were elevated, especially liver disease (SMR 38.7; 95% CI: 29.4-49.3), suicide (SMR 37.1; 95% CI: 26.1-48.6), and subsequent primary cancers (SMR 7.5; 95% CI: 6.78-8.32). Demographic and tumor factors independently increased risk of competing mortality, including age (HR per 5years 1.24; 95% CI: 1.22-1.25), sex (male HR 1.23; 95% CI: 1.16-1.32), race (Black HR 1.17; 95% CI: 1.09-1.26), insurance (uninsured HR 1.28; 95% CI: 1.09-1.50), and marital status (single HR 1.29; 95% CI: 1.21-1.37). CONCLUSION Nearly one in three HNSCC patients died from competing causes. When developing long term survivorship regimens for HNSCC patients, clinicians should be familiar with this population's specific risks.
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Affiliation(s)
- Sean T Massa
- Department of Otolaryngology - Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, MO, United States.
| | - Nosayaba Osazuwa-Peters
- Department of Otolaryngology - Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Kara M Christopher
- Cancer Center, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Lauren D Arnold
- College for Public Health and Social Justice, Department of Epidemiology, Saint Louis University, St. Louis, MO, United States
| | - Mario Schootman
- College for Public Health and Social Justice, Department of Epidemiology, Saint Louis University, St. Louis, MO, United States
| | - Ronald J Walker
- Department of Otolaryngology - Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Mark A Varvares
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States
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10
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Donin N, Filson C, Drakaki A, Tan HJ, Castillo A, Kwan L, Litwin M, Chamie K. Risk of second primary malignancies among cancer survivors in the United States, 1992 through 2008. Cancer 2016; 122:3075-86. [PMID: 27377470 PMCID: PMC6192520 DOI: 10.1002/cncr.30164] [Citation(s) in RCA: 219] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/19/2016] [Accepted: 05/27/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND In the current study, the authors attempted to describe the incidence, most common sites, and mortality of second primary malignancies among survivors of common cancers. METHODS The authors identified patients aged ≥18 years who were diagnosed with a primary malignancy from the 10 most common cancer sites (prostate, breast, lung, colon, rectum, bladder, uterus, kidney, melanoma, and non-Hodgkin lymphoma) between 1992 and 2008 from Surveillance, Epidemiology, and End Results data. Factors associated with the incidence of second primary malignancies were explored using bivariable and multivariable models, and mortality attributable to first and second primary malignancies was examined. RESULTS A cohort of 2,116,163 patients was identified, 170,865 of whom (8.1%) developed a second primary malignancy. Survivors of bladder cancer had the highest risk of developing a second cancer. In a multivariable model controlling for age, race, tumor grade, stage of disease, marital status, educational level, and income, a history of non-Hodgkin lymphoma (hazard ratios of 2.70 and 2.88, respectively, for men and women) and bladder cancer (hazard ratios of 1.88 and 1.66, respectively, for men and women) predicted the highest risk of developing a second cancer. For patients with 2 incident cancers, 13% died of their initial cancer, but greater than one-half (55%) died of their second primary malignancy. Lung cancer was the cause of death in 12% of patients with 2 incident cancers. CONCLUSIONS Nearly 1 in 12 patients diagnosed with a common cancer developed a second malignancy, the most common of which was lung cancer. Greater than one-half of patients with 2 incident cancers died of their secondary malignancy. The findings from the current study may inform care strategies among cancer survivors. Cancer 2016;122:3075-3086. © 2016 American Cancer Society.
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Affiliation(s)
- Nicholas Donin
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Christopher Filson
- Department of Urology, Emory University, Atlanta, Georgia
- Department of Urology, Atlanta Veterans Administration Medical Center, Decatur, Georgia
| | - Alexandra Drakaki
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
- Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California
- Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Hung-Jui Tan
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Alex Castillo
- Department of Epidemiology, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California
| | - Lorna Kwan
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Mark Litwin
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
- Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California
- Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California
| | - Karim Chamie
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
- Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California.
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11
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Kawecki A, Krajewski R. Follow-up in patients treated for head and neck cancer. MEMO-MAGAZINE OF EUROPEAN MEDICAL ONCOLOGY 2014; 7:87-91. [PMID: 25089159 PMCID: PMC4101248 DOI: 10.1007/s12254-014-0143-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 04/29/2014] [Indexed: 12/29/2022]
Abstract
Principles of follow-up management in patients treated for head and neck tumors are not very strictly defined, and practice varies between countries, centers, and specialists. Details of follow-up procedures, including timing of outpatient visits and diagnostic imaging, are specific for tumor types and localizations but also depend on treatment modalities used, availability of diagnostic procedures, and socioeconomic factors. The authors describe general principles of follow-up in head and neck cancer patients. Clinical observation and laboratory and imaging studies in patients who had received radical treatment should focus on early identification of recurrent or second primary tumors to allow for a salvage radical therapy. In patients who initially had received a palliative care, the follow-up should focus on proper management of symptoms.
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Affiliation(s)
- Andrzej Kawecki
- Head and Neck Cancer Department, Cancer Center-M. Sklodowska-Curie Memorial Institute, ul. Roentgena 5, 02-781 Warsaw, Poland
| | - Romuald Krajewski
- Head and Neck Cancer Department, Cancer Center-M. Sklodowska-Curie Memorial Institute, ul. Roentgena 5, 02-781 Warsaw, Poland
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12
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Kwon M, Roh JL, Song J, Lee SW, Kim SB, Choi SH, Nam SY, Kim SY. Noncancer health events as a leading cause of competing mortality in advanced head and neck cancer. Ann Oncol 2014; 25:1208-14. [PMID: 24669018 DOI: 10.1093/annonc/mdu128] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The survival of patients with head and neck squamous cell carcinoma (HNSCC) can be affected by noncancer health events (NCHE) as well as by index cancer progression and second primary cancer (SPC). This study aimed to investigate the risk factors for NCHE and noncancer mortality (NCM) in patients with advanced-stage HNSCC. PATIENTS AND METHODS This cohort study involved 600 consecutive patients with overall stage III to IV HNSCC who were treated between 2001 and 2010 at our tertiary referral hospital. NCHE was defined as re-admission (i.e. after the primary treatments for the index tumors) due to noncancer-related causes. The incidences of NCHE and NCM and their risk factors were analyzed by using cumulative incidence and cause-specific hazard functions. RESULTS During a median follow-up period of 54 months, 224 (37.3%) and 55 (9.2%) of the 600 patients had NCHE and NCM, respectively. The 5-year index cancer mortality, SPC mortality, and NCM rates were 23.8%, 4.2%, and 8.9%, respectively. Multivariate analyses revealed that body mass index <20 kg/m(2) (P = 0.018), Charlson comorbidity index (CCI) ≥1 (P < 0.001), tumor recurrence (P < 0.001), SPC occurrence (P < 0.001), and initial chemotherapy (P = 0.049) were independent NCHE predictors. Older age (P < 0.001), CCI ≥1 (P = 0.008), tumor recurrence (P < 0.001), and SPC occurrence (P = 0.047) were independent NCM predictors. Patients with respiratory NCHE were at a higher risk of NCM than patients with other NCHE types (P < 0.001). CONCLUSIONS One or more comorbidities, tumor recurrence, and SPC occurrence were independent predictors of both NCHE and NCM. Patients with respiratory NCHE had a particularly high risk of NCM.
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Affiliation(s)
- M Kwon
- Department of Otolaryngology
| | - J-L Roh
- Department of Otolaryngology
| | - J Song
- Department of Clinical Epidemiology and Biostatistics
| | - S-W Lee
- Department of Radiation Oncology
| | - S-B Kim
- Department of Internal Medicine (Oncology), Asan Medical Centre, University of Ulsan College of Medicine, Seoul
| | | | - S Y Nam
- Department of Otolaryngology
| | - S Y Kim
- Department of Otolaryngology Biomedical Research Institute, Korea Institute of Science and Technology, Seoul, Republic of Korea
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