Competing Causes of Death vs Primary Disease in Survivors of Head and Neck Cancer

Key Points

  • Primary head and neck cancer was the most common cause of death among survivors during the first 56 months after diagnosis.
  • It accounted for 38.8% of deaths 6 to 10 years after diagnosis and 30.6% of deaths 11 to 15 years after diagnosis.

In a study reported in JAMA Oncology, Simpson et al found that each year of survival in patients with primary head and neck cancer was associated with a 26% increased risk of death from competing causes, and that competing causes predominated after 5 years postdiagnosis.

Study Details

The study involved data on 151,155 adult patients from the Surveillance, Epidemiology, and End Results (SEER) 18 database from 2000 through 2014 who had head and neck squamous cell carcinoma as first or only cancer with known cause of death.

Competing Causes

It was found that each increasing year of survival was associated with 26% increased odds of death from competing causes (adjusted odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.25–1.27). Male sex (adjusted OR = 1.21, 95% CI = 1.16–1.26), divorced or separated status (adjusted OR = 1.17, 95% CI = 1.11–1.23), and oral cavity cancer (adjusted OR = 1.06, 95% CI = 1.01–1.11) were associated with increased risk of death from competing causes, whereas black vs white race was associated with lower risk of death from competing causes (adjusted OR = 0.93, 95% CI = 0.88–0.98).

Median overall survival time among all patients was 80 months. Primary head and neck cancer accounted for 73.4% of deaths during the first 56 months after diagnosis. However, after 56 months, competing causes of death were more common than death from head and neck cancer, which accounted for 38.8% of deaths 6 to 10 years after diagnosis and 30.6% of deaths 11 to 15 years after diagnosis. The most common competing causes of death were cardiovascular disease, second primary cancers, and chronic obstructive pulmonary disease.

The investigators concluded, “More patients with [head and neck cancer] die from competing causes than primary cancer 5 years after diagnosis, and less than 1 in 3 die from primary [head and neck cancer] 11 years after diagnosis. Our study reaffirms the need for a multidisciplinary focus on [head and neck cancer] competing causes of death.”

Nosayaba Osazuwa-Peters, BDS, MPH, CHES, of Saint Louis University School of Medicine, is the corresponding author for the JAMA Oncology article. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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