Abstract
ObjectivesThe five-year survival rate of head and neck cancer (HNC) after radiotherapy (RT) varies widely from 35% to 89%. Many studies have addressed the effect of socioeconomic status and urban dwelling on the survival of HNC, but a limited number of studies have focused on the survival rate of HNC patients after RT.Materials and methodsDuring the period of 2000–2013, 40,985 working age individuals (20 < age < 65 years) with HNC patients treated with RT were included in this study from a registry of patients with catastrophic illnesses maintained by the Taiwan National Health Insurance Research Database (NHIRD).ResultsThe cumulative survival rate of HNC following RT in Taiwan was 53.2% (mean follow-up period, 3.75 ± 3.31 years). The combined effects of income and geographic effect on cumulative survival rates were as follows: high income group > medium income group > low income group and northern > central > southern > eastern Taiwan. Patients with moderate income levels had a 36.9% higher risk of mortality as compared with patients with high income levels (hazard ratio (HR) = 1.369; p < 0.001). Patients with low income levels had a 51.4% greater risk of mortality than patients with high income levels (HR = 1.514, p < 0.001).ConclusionIn Taiwan, income and residential area significantly affected the survival rate of HNC patients receiving RT. The highest income level group had the best survival rate, regardless of the geographic area. The difference in survival between the low and high income groups was still pronounced in more deprived areas.
Highlights
Approximately 670,000 new diagnoses of head and neck cancer (HNC) and 350,000 HNC-related deaths are reported every year (Ray-Chaudhuri, Shah & Porter, 2013)
Being male was most significantly associated with reduced post-RT survival of HNC patients [hazard ratio (HR) = 2.049, 95% confidence interval (CI) = 1.943–2.162, p < 0.001]
This was followed by oral origin (HR = 1.660, 95% CI [1.609–1.712]); lower income level (HR = 1.514, 95% CI [1.458–1.572]); conventional chemotherapy (HR = 1.504, 95% CI [1.452–1.558]); residential area in Eastern Taiwan (HR = 1.454, 95% CI [1.362–1.552]); timing of RT, mandibulectomy, or maxillectomy (HR = 1.215, 95% CI [1.137–1.299]); and no tumor excision surgery (HR = 1.181, 95% CI [1.120–1.246]; all p < 0.001; Table 4)
Summary
Approximately 670,000 new diagnoses of head and neck cancer (HNC) and 350,000 HNC-related deaths are reported every year (Ray-Chaudhuri, Shah & Porter, 2013). Radiotherapy (RT) can effectively alleviate HNC (Chu et al, 2016; Reeve et al, 2013; Wu et al, 2016); adherence to RT is difficult for patients with severe toxicity associated with RT (Thomas et al, 2017), such as mucositis, taste disturbance, xerostomia, opportunistic infection, trismus, radiation caries, osteonecrosis of the jaw, and progressive periodontal destruction (Cabrera, Yoo & Brizel, 2013; Kuo et al, 2016c). These comorbidities impair chewing, swallowing, and speaking function. Many factors affect the survival of HNC patients after RT, including age (Chang et al, 2013; Unal et al, 2015), sex (Olsen et al, 2015; Osazuwa-Peters et al, 2016), race (OsazuwaPeters et al, 2016), personal habits (e.g., smoking status, alcohol consumption, betel nut chewing) (Chang et al, 2017a), primary tumor site, tumor–node–metastasis stage (Kreppel et al, 2016), human papillomavirus status (Chu et al, 2016), therapy type (Selzer et al, 2015), nutritional status (Chang et al, 2017a), psychiatric disorders (Unal et al, 2015), urbanization (Chang et al, 2013), education (Kjaer et al, 2013), individual and neighborhood socioeconomic status (SES), and geographical area (Chang et al, 2013; Chu et al, 2016; Kjaer et al, 2013; Wu et al, 2016)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
