Abstract
Cancers of the head and neck have a high mortality rate, and roughly 10% of the patients die within six months of diagnosis. To our knowledge little has been written about this group. We wished to identify risk factors for early death, to predict and monitor patients at risk better and, if possible, avoid unjustified major treatment. This population-based nationwide study from the Swedish Head and Neck Cancer Register (SweHNCR) included data from 2008-2015 and 9733 patients at potential risk of early death. A total of 925 (9.5%) patients died within six months. For every year older the patients became, the risk of early death increased by 2.3% (p<0.001). The relative risk of death was 3.37 times higher (237%) for patients with WHO score 1 compared with WHO score 0. A primary tumour in the hypopharynx correlated with a 24% increased risk over the oral cavity (p<0.024). Patients with stage IV disease had a 3.7 times greater risk of early death than those with stage I (p<0.001). As expected, a 12 times increased risk of early death was noted in the palliative treatment group, compared to the curative group. Limitations to this study were that the actual cause of death was not recorded in the SweHNCR, and that socioeconomic factors, alcohol consumption, smoking habits, and HPV status, were not reported in SweHNCR until 2015. However, the fact that this is a population-based nationwide study including 9733 patients compensates for some of these limitations. Identification of patients at increased risk of early death shows that older patients with advanced disease, increased WHO score, primary tumour in the hypopharynx, and those given palliative treatment, are more likely than the others to die from head and neck cancer within six months of diagnosis.
Highlights
Sweden has a population of about 10 million inhabitants, and in 2016 the overall incidence of cancer was 64 000 in a population of just over 60 000
Identification of patients at increased risk of early death shows that older patients with advanced disease, increased WHO score, primary tumour in the hypopharynx, and those given palliative treatment, are more likely than the others to die from head and neck cancer within six months of diagnosis
Among the 9633 patients with a treatment decision at a multidisciplinary tumour board meeting, 9.1% died within six months, leaving a high rate of early death among patients for whom details of treatment were missing (n = 51, 51%) (Fig 1)
Summary
Sweden has a population of about 10 million inhabitants, and in 2016 the overall incidence of cancer was 64 000 in a population of just over 60 000. Cancer of the head and neck is the sixth most common type worldwide, and most cases (60%) are locally advanced at the time of diagnosis (stage III or IV) [2]. Many of the tumours are aggressive, and the median survival without treatment is reported to be three to five months [3,4,5,6]. Late stages of the disease are linked to poor overall survival, but even patients with early cancers (for example of the mobile tongue) can have dismal prognoses [7, 8]. Cancers of the head and neck have a high mortality rate, and roughly 10% of the patients die within six months of diagnosis. We wished to identify risk factors for early death, to predict and monitor patients at risk better and, if possible, avoid unjustified major treatment
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