Abstract
PurposeAfter treatment of a head and neck squamous cell carcinoma (HNSCC), patients with an adequate control of the tumor have a decreased overall survival when compared to age- and gender-matched controls in the general population. The aim of our study was to analyze the causes of long-term mortality in patients with HNSCC.MethodsWe carried out a retrospective study of 5122 patients with an index HNSCC treated at our center between 1985 and 2018. We analyzed the survival considering three causes of death: mortality associated with the HNSCC index tumor, mortality associated with a second or successive neoplasm, and mortality associated with a non-cancer cause.ResultsAfter the diagnosis of an HNSCC the most frequent cause of death is the head and neck tumor itself during the first 3.5 years of follow-up. Thereafter, mortality is more frequently associated with competing causes of death, such as second malignancies and non-cancer causes. Mortality associated with second and successive neoplasms was 2.3% per year, a percentage that was maintained constant throughout the follow-up. Likewise, mortality attributable to non-cancer causes was 1.6% per year, which also remained constant. There were differences in the mortality patterns according to the characteristics of the patients.ConclusionThere are differences in the mortality patterns of patients with HNSCC depending on their characteristics. Knowledge of these patterns can help in the design of guidelines to improve the follow-up protocols of this group of patients to optimize the clinical cost-effectiveness.
Highlights
After diagnosis and treatment of head and neck squamous cell carcinomas (HNSCC), patients who achieve an adequate control and cure of the tumor have a decreased overall survival in the medium to long term when compared to ageand gender-matched controls in the general population [1]
Van der Schroeff et al [3] described that surviving patients after HNSCC had between 20 and 25 percent increased risk of death compared to the general population
Three causes of mortality were considered in this analysis: mortality associated with the HNSCC index tumor, mortality associated with a second or successive neoplasm, and mortality associated with a non-cancer cause
Summary
After diagnosis and treatment of head and neck squamous cell carcinomas (HNSCC), patients who achieve an adequate control and cure of the tumor have a decreased overall survival in the medium to long term when compared to ageand gender-matched controls in the general population [1]. Van der Schroeff et al [3] described that surviving patients after HNSCC had between 20 and 25 percent increased risk of death compared to the general population. These differences in survival are largely due to the increased risk of second and other successive malignancies, the burden of comorbidities associated with tobacco and alcohol use in this type of patients, and the morbidity associated with the oncologic treatments used [4,5,6]. Mostly based on population-based registries, provide information on overall or disease-specific survival, but do not detail the causes of mortality [7,8,9], or have a limited followup period [1, 5]
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