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02-02-2012 | Surgery | Article

Head and neck cancer carries substantial comorbidity burden

Abstract

Free abstract

MedWire News: People with head and neck cancer experience a high burden of both acute and chronic comorbidity, shows an analysis of a large Dutch population-based cohort.

The researchers therefore advise clinicians to account for patients' comorbidity burden when assessing the risk-benefit profile for different treatment options.

Sarah Landis (GlaxoSmithKline, London, UK) and co-workers analyzed information on 1499 patients with squamous cell carcinoma of the head and neck (SCCHN) living in the Netherlands.

For each patient they calculated prevalence and incidence rates of eight comorbid conditions: cardiovascular disease, asthma/chronic obstructive pulmonary disease (COPD), liver disease, diabetes, anemia, pneumonia, depression, and other malignant disease.

Rates of the same eight conditions were also calculated in a control population of 5996 cancer-free individuals matched for age and gender.

Writing in the journal Head and Neck, Landis et al report that the mean age of the SCCHN cohort was 62 years and two-thirds were male. The site of cancer was the oral cavity in 610 patients, the pharynx in 317, and the larynx in 572.

The most prevalent comorbidities in patients with SCCHN were cardiovascular disease (41%) and asthma/COPD (12%); the other comorbidities were prevalent in less than 10% of patients.

Notably, in the period of 12 months prior to the index date, patients with SCCHN were between two and four times as likely as cancer-free controls to have any of the comorbidities investigated, the authors remark.

In terms of incidence, rates of all comorbidities (with the exception of other malignant diseases) were generally highest during the first 6 months after SCCHN diagnosis and declined steadily during follow-up.

The researchers then calculated hazard ratios (HRs) for each of the comorbidities. They found that, compared with the healthy control population, patients with SCCHN had a significantly higher risk for all comorbidities except diabetes, with HRs ranging from 2.0 for asthma/COPD to 13.3 for pneumonia.

Interestingly, the increased risks in SCCHN patients persisted throughout the entire follow-up period (median 3.8 years) for anemia, depression, pneumonia, asthma/COPD, and other malignant diseases. By contrast, the risks for cardiovascular diseases and diabetes among patients with SCCHN approached that of cancer-free controls within 12 months of diagnosis.

Landis et al conclude: "This study quantifies the significant burden of comorbidity among patients with SCCHN. Understanding which comorbidities are most likely to arise after diagnosis supports balanced treatment decision making that maximizes patient outcome while limiting the likelihood of side effects or worsening of pre-existing conditions.

"Future longitudinal studies aimed at understanding the impact of specific comorbid events on patient outcome and survival are warranted."

By Joanna Lyford

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