Comorbidities affect survival of patients with head, neck cancer

Current estimates for head and neck cancer survival are largely inaccurate because they widely disregard many of the most common diseases patients have in addition to their primary cancer, according to Jay Piccirillo, MD, a head and neck specialist at Washington University School of Medicine, St. Louis.

Researchers reviewed the medical records of 183 patients with squamous cell carcinoma of the oral cavity, throat and larynx who were treated in 1997 and 1998 at Barnes-Jewish Hospital, St. Louis, which has tracked comorbidities since 1995. The study was published in the Archives of Otolaryngology, Head and Neck Surgery.

Comorbid ailments in these patients included heart attack, coronary artery disease, tumors other than the primary tumor, psychiatric disease, lung disease, stroke, diabetes and alcohol abuse. Many of these disorders can be traced to smoking or alcohol consumption, the same behaviors that may contribute to the occurrence of head and neck cancer, said Dr. Piccirillo, director of the Clinical Outcomes Research Office at Washington University School of Medicine and a professor of otolaryngology.

The study results showed that 33 percent of patients with head and neck cancer developed new comorbidities or a worsening of existing comorbid ailments in the time after their initial diagnosis and treatment. Patients with severe comorbidities during the follow-up period had, on average, a 6.7 times greater risk of dying.

The most common comorbidities that developed or worsened after diagnosis were malignant tumors unrelated to the original tumor and psychiatric illnesses. The type of treatment patients received鈥攃hemotherapy, radiation therapy, surgery or some combination of these鈥攎ade no difference in the number or severity of comorbidities.

“For decades, we have used a cancer staging system based on tumor size, lymph node involvement and whether cancer has spread to other parts of the body when estimating a patient’s survival while mostly ignoring how sick patients are from other diseases,” Dr. Piccirillo said. “In fact, national databases used to estimate cancer survival don’t account for co-morbidities, and as a result, we don’t have very accurate estimates of how long patients are likely to survive their cancers.”