Premium
Prevalence of comorbidities and effect on survival in survivors of human papillomavirus–related and human papillomavirus–unrelated head and neck cancer in the United States
Author(s) -
Eytan Danielle F.,
Blackford Amanda L.,
Eisele David W.,
Fakhry Carole
Publication year - 2019
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.31800
Subject(s) - medicine , comorbidity , incidence (geometry) , epidemiology , population , head and neck cancer , cancer , survivorship curve , disease , environmental health , physics , optics
Background The increasing incidence of human papillomavirus (HPV)–related head and neck cancer (HNC) has led to the increasing prevalence of survivors, yet to the best of the authors’ knowledge the prevalence of comorbidities during the survivorship period and their effects on survival are relatively unknown. Methods In this retrospective cross‐sectional study, individuals with a first incident primary diagnosis of HNC from 2004 through 2011 from the Surveillance, Epidemiology, and End Results (SEER)–Medicare‐linked databases were included in the analysis and classified as patients with HPV‐related or HPV‐unrelated HNC. The presence of 30 comorbid conditions of interest was identified. Associations between comorbidity and treatment group as well as overall survival were evaluated. Results The study population consisted of 8025 patients with HPV‐unrelated HNC and 2499 patients with HPV‐related HNC. Hypertension, congestive heart failure, cerebrovascular disease, and chronic obstructive pulmonary disease all were found to be highly prevalent at the time of the cancer diagnosis and increased over time for both groups. These comorbidities were found at significantly lower rates in the HPV‐related HNC population, yet were associated with an increased risk of death in both groups. The probabilities of developing cancer‐related comorbidities such as pneumonia, dysphagia, weight loss, malnutrition, and dental issues rose significantly in both groups after treatment but were more likely in patients with HPV‐related HNC. In both groups of patients, the presence of each comorbidity either at the time of diagnosis or during survivorship was associated with a significantly increased risk of death. Conclusions There is a large burden of comorbidities in both patients with HPV‐related and HPV‐unrelated HNC, both of which are associated with decreased survival. Oncologic surveillance should not be limited to the evaluation of disease status, but also should include screening for the highly prevalent conditions associated with the risk of death.