Risk factors for competing non‐cancer mortality after definitive treatment for advanced‐stage head and neck cancer

Objective Patients with head and neck cancer ( HNC ) can die of index tumor progression and second tumor or non‐cancer causes. Here, we investigated the risk factors for competing non‐cancer mortality ( NCM ) in a prospective cohort of patients with advanced‐stage HNC . Materials and Methods A prospective observational study was conducted with 604 patients who underwent definitive treatment for advanced‐stage HNC between 2010 and 2015. Main outcomes were NCM and cancer mortality ( CM ) defined as death from non‐cancer causes and HNC or second cancers, respectively. Cumulative incidence and cause‐specific hazard functions were used to analyze the risk factors of NCM and CM . Results Age, smoking, Charlson comorbidity index ( CCI ), performance status, body mass index, rural residence, education and hemoglobin level at diagnosis, and chemotherapy were significantly associated with NCM (all p  <   0.05). Multivariate analyses showed that age, CCI , and hemoglobin were independent factors of NCM . Age (≥65 years), CCI (≥2), and hemoglobin (<11 g/dl) were related to 4.5‐, 3.2‐, and 2.7‐fold increased adjusted risk of NCM , respectively. Conclusions Old age, comorbidity, and hemoglobin at diagnosis were independent predictors of NCM . The risk factors could be used to predict non‐cancer death after definitive treatment for advanced‐stage HNC .