Abstract
Various treatment modalities are used for head and neck cancer (HNC). This study analyzed the incidence and risks of myocardial infarction (MI) and stroke by cancer site and treatment modality in 22,737 patients newly diagnosed with HNC registered in the Korean National Health Insurance Service database in 2007–2013. An additional 68,211 patients without HNC, stroke, or MI were identified as the control group. The risks for MI (hazard ratio [HR] = 1.38, 95% confidence interval [CI] 1.24–1.53), stroke (HR = 1.48, 95% CI 1.37–1.60), and mortality (HR = 5.30, 95% CI 5.14–5.47) were significantly higher in the HNC group. Analysis by cancer site showed the risk of MI and mortality was highest in hypopharynx cancer, while the risk of stroke was highest in nasopharynx and paranasal sinus cancer. Analysis by treatment modality showed the highest risks for MI (HR = 1.88, 95% CI 1.31–2.69) and mortality (HR = 2.95, 95% CI 2.75–3.17) in HNC patients receiving chemotherapy (CT) alone, while HNC patients receiving CT with surgery had the highest risk for stroke (HR = 1.81, 95% CI 1.14–2.88). Careful attention to MI and stroke risks in HNC patients is suggested, especially those who received both CT and radiotherapy.
Highlights
Various treatment modalities are used for head and neck cancer (HNC)
1 (Ref.) 0.535 (0.488, 0.586)* 2.954 (2.752, 3.17)* 0.974 (0.911, 1.042) 2.257 (1.95, 2.612)* 0.913 (0.833, 0.999) 1.849 (1.742, 1.962)* 2.282 (2.11, 2.468)*. This is the first nationwide study to investigate the relative risks of myocardial infarction (MI), stroke, and mortality incidences among Head and neck cancer (HNC) patients who underwent surgery, CT, and Radiation therapy (RT) compared to a general non-cancer control population matched for age and sex
After adjusting for age, sex, and comorbidities such as hypertension (HTN), diabetes mellitus (DM), and dyslipidemia, the risks of MI, stroke, and mortality were significantly higher in the HNC group compared to those in the control group
Summary
This study analyzed the incidence and risks of myocardial infarction (MI) and stroke by cancer site and treatment modality in 22,737 patients newly diagnosed with HNC registered in the Korean National Health Insurance Service database in 2007–2013. Analysis by cancer site showed the risk of MI and mortality was highest in hypopharynx cancer, while the risk of stroke was highest in nasopharynx and paranasal sinus cancer. Despite advances in various therapeutic options in the treatment of HNC, its mortality rate is high due to the high rates of local recurrence and regional metastasis[4] Since most of these patients are diagnosed at advanced stages, they undergo multimodal therapy, thereby leading to significant acute and chronic side e ffects[5]. We hypothesized that the risk of MI and stroke in HNC patients would vary between cancer site and treatment modality
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