Risk of developing new health disorders following head and neck cancer treatment varies significantly by head and neck cancer subsite: An Analysis of the Utah Head and Neck Cancer Survivor’s Study

Presentation: AHNS034
Topic: Survivorship
Type: Oral
Date: Wednesday, April 18, 2018
Session: 3:40 PM - 4:40 PM Survivorship
Authors: Marcus M Monroe, MD1, Sarah Abdelaziz1, Jason Hunt1, Luke Buchmann1, Richard Cannon1, Kerry Rowe2, Shane Lloyd1, Donald Cannon1, Ying Hitchcock1, John Snyder2, Yuan Wan1, Vikrant Deshmukh1, Michael Newman1, Alison Fraser1, Ken Smith1, Kim Herget1, Mia Hashibe, PhD1
Institution(s): 1University of Utah, 2Intermountain Healthcare, Salt Lake City

Objective: To evaluate how the risk of developing new health disorders in head and neck cancer (HNC) survivors varies between cancer subsites

Methods: A cohort study consisting of 1,901 patients with HNC and a general population cohort of 7,796 individuals were identified using the Utah Population Database (UPDB).  The risk of developing new health diagnoses beyond 2 years from diagnosis were compared between cases and matched population controls.  The impact of HNC site on risk of developing late health diagnoses following treatment was analyzed. 

Results: HNC survivors were noted to be at increased risk of being diagnosed with a wide range of new health disorders. Multiple health problems displayed significant variation between survivors of oral cavity, oropharyngeal, and laryngeal cancer subsites. For example, the risk of a new dysphagia diagnosis in years 2-5 following diagnosis was highest among oropharyngeal cancer patients (HR 13.04, 95% CI 7.97-21.33) followed by laryngeal (HR 9.65, 95% CI 5.4-17.24) and oral cavity patients (HR 3.11, 95% CI 1.99-4.87).  This trend continued 5+ years beyond diagnosis. Oropharyngeal cancer survivors in years 2-5 displayed an increased risk of being diagnosed with acute cerebrovascular disease (HR 4.58, 95% CI 1.95 – 10.74), while an elevated risk was not noted in laryngeal or oral cavity cancer survivors.  All subsites displayed increased risk of occlusion or stenosis of precerebral arteries, although this risk was most elevated in oropharyngeal cancer patients in both years 2-5 (HR 14.98, 95% CI 5.51-40.78) and 5+ years (HR 8.28, 95% CI 3.7-18.51) following diagnosis.  Increased risk of cardiovascular, chronic pulmonary disease, pneumonia, and malnutrition remained elevated across disease sites in all time periods examined. 

Conclusions and Relevance:  HNC survivors display elevated risk for the development of a wide range of health disorders.  Risk of late health diagnoses vary by cancer subsite and may provide one method in which to help individualize HNC survivor post-treatment healthcare.