Predictors of Competing Mortality in Advanced Head and Neck Cancer

Abstract

PURPOSE Death from noncancer causes (competing mortality) is an important event in head and neck cancer, but studies identifying predictors of this event are lacking. We sought to identify predictors of competing mortality and develop a risk stratification model for competing events. PATIENTS AND METHODS Cohort study of 479 patients with stage III to IV carcinoma of the head and neck diagnosed between August 1993 and November 2004. Patients were treated on consecutive prospective clinical trials involving organ-preserving chemoradiotherapy and surgery. We used multivariable competing risks regression models to analyze factors associated with the cumulative incidence of competing mortality, locoregional and distant failure, and second malignancies as first events. Results Median follow-up was 52 months median for survivors. The 5-year cumulative incidence of competing mortality was 19.6% (95% CI, 15.8 to 23.4). On multivariable analysis, competing mortality was associated with female sex (hazard ratio [HR], 1.72; 95% CI, 1.13 to 2.63), increasing age (HR, 1.30; 95% CI, 1.04 to 1.62), increasing Charlson Comorbidity Index (HR, 1.24; 95% CI, 1.05 to 1.47), decreasing body mass index (HR, 0.33; 95% CI, 0.13 to 0.84), and decreasing distance traveled to the treating center (HR, 0.65; 95% CI, 0.44 to 0.98). Patients with zero, one, two, and > or = three risk factors had 5-year competing mortality of 8.9% (95% CI, 3.0% to 14.8%), 12.4% (95% CI, 7.0% to 17.8%), 22.1% (95% CI, 14.5% to 29.7%), and 39.3% (95% CI, 28.6% to 50.1%), respectively. CONCLUSION Competing mortality in advanced head and neck cancer is associated with several demographic and health status characteristics. Analyses of risk factors for competing mortality may be useful in outcomes reporting and designing clinical trials.

Tobacco smoking and alcohol drinking at diagnosis of head and neck cancer and all‐cause mortality: Results from head and neck 5000, a prospective observational cohort of people with head and neck cancer

“…Previous studies suggest that death from non‐cancerous causes (competing mortality) and second primary malignancies are important events in HNC52 and could provide greater insight into the biological mechanisms that underlie the associations of smoking and drinking with survival. The cause of death information on a death certificate is often inaccurate however 53.…”

Sepsis in head and neck cancer patients treated with chemotherapy and radiation: Literature review and consensus

“…However, competing causes of mortality (e.g. acute and late toxicities) are increased and substantially reduce the overall survival benefit [3,4].…”

Elderly Patients With Squamous Cell Carcinoma of the Head and Neck and the Benefit of Multimodality Therapy

“…Of those studies that exist, several have shown that elderly patients can achieve outcomes similar to those of younger patients if treated with similar therapies [2][3][4][5][6][7][8][9]. Others have noted worse outcomes in older patients but have concluded that the higher risk of mortality is entirely due to higher comorbidity status and competing causes of mortality rather than chronological age [10,11], whereas others have suggested that age is an independent prognostic variable [11,12]. Multiple studies have also concluded that geriatric patients with head and neck cancer frequently receive nonstandard and less aggressive therapies than their younger counterparts [13][14][15].…”