Burden of comorbidities is higher among elderly survivors of oropharyngeal cancer compared with controls

Abstract

Background The prevalence of survivors of oropharyngeal cancer (OPC) is increasing due to improved survival for individuals with human papillomavirus (HPV)–related disease. Although elderly survivors of OPC are known to have a high burden of comorbidities, to the authors' knowledge it is unknown how this compares with a similar cohort without a history of cancer. Methods The current retrospective, cross‐sectional study included individuals with a first incident primary diagnosis of OPC from 2004 through 2011 from the Surveillance, Epidemiology, and End Results (SEER)–Medicare‐linked databases and matched controls. The baseline prevalence and subsequent incidence of comorbid conditions were identified. The association between comorbidity and overall survival was evaluated. Results A total of 2497 eligible patients with OPC were matched to 4994 noncancer controls. Baseline comorbidity was higher in cases (Charlson Comorbidity Index >0 for 48.5% of cases vs 35.8% of controls). At 5 years, cases were more likely than controls to develop comorbidities. Survivors of OPC were at high risk (≥20% cumulative prevalence by 5 years) of developing several comorbidities, including cardiovascular diseases, cerebrovascular disease, chronic obstructive pulmonary disease, and tobacco abuse, and were at moderately high risk (10%‐19% cumulative prevalence) of developing other conditions including carotid artery occlusive stroke, alcohol abuse, depression, and anxiety. In both cases and controls, the presence of the majority of comorbidities either at the time of diagnosis or during the follow‐up period was associated with worse survival. Conclusions Patients with OPC have a higher comorbidity burden compared with matched controls, both at baseline and during survivorship, the majority of which are associated with decreased survival. Oncologic surveillance of survivors of OPC should include screening for highly prevalent conditions.

Incidence of stroke in the first year after diagnosis of cancer—A systematic review and meta-analysis

“…Due to the low number of studies that reported the incidence of ischemic stroke and ICH at 1, 3, and 6 months, we only evaluated the cumulative incidence of total stroke (i.e., sum of events) at these timepoints. Five studies reported the incidence of stroke at 1 month ( 12 , 16 , 35 – 37 ), four reported the incidence of stroke at 3 months ( 12 , 31 , 35 , 36 ), and eight reported the incidence of stroke at 6 months ( 12 , 14 , 16 , 17 , 31 , 35 , 36 , 38 ). Their respective pooled incidences at 1, 3, and 6 months are 1.6% (95% CI 0.2–10.8%; I 2 = 99.78%), 1.0% (95% CI 0.3–2.8%; I 2 = 99.95%), and 1.3% (95% CI 0.6–2.9%; I 2 = 99.96%) ( Supplementary Figure 1 ).…”

“…Out of 22 studies that reported the combined incidence of ischemic and hemorrhagic stroke at 1 year, eight were cohort studies that included multiple types of cancer ( Supplementary Figure 3 ) ( 12 , 14 , 15 , 25 , 27 , 31 , 33 , 34 ). The remaining 14 studies were limited to specific cancer subtypes including head and neck cancer ( n = 3) ( 16 , 24 , 28 ), hematologic malignancies ( n = 2) ( 19 , 29 ), breast cancer ( n = 2) ( 21 , 23 ), and thyroid cancer ( n = 2) ( 26 , 32 ). There was only one study for each of the following subtypes of cancer: pancreatic, cervical, prostate, colorectal, and hepatic ( 17 , 18 , 20 , 22 , 30 ).…”

“…The discrepancy reported in our study may reflect the heterogeneity that is present in baseline patient characteristics and cancer subtypes across studies. Using visual inspection of the forest plot, it is evident that the higher incidence of stroke in the United States cohort may be largely driven by three studies: Bigelow (study ID 420), Hong (study ID 2599) and B. Navi (study ID: 2397) ( Supplementary Figure 5 ) ( 16 , 24 , 31 ). Two of these studies (Hong and Bigelow) were specifically investigating the risk of stroke in elderly patients with glottic and oropharyngeal cancer—the respective median/mean ages of cancer subjects include in these two cohort studies were 72 (IQR 69–77) and 73.8 (no standard deviation reported) ( 16 , 24 ).…”

“…Using visual inspection of the forest plot, it is evident that the higher incidence of stroke in the United States cohort may be largely driven by three studies: Bigelow (study ID 420), Hong (study ID 2599) and B. Navi (study ID: 2397) ( Supplementary Figure 5 ) ( 16 , 24 , 31 ). Two of these studies (Hong and Bigelow) were specifically investigating the risk of stroke in elderly patients with glottic and oropharyngeal cancer—the respective median/mean ages of cancer subjects include in these two cohort studies were 72 (IQR 69–77) and 73.8 (no standard deviation reported) ( 16 , 24 ). The population from the 2015 study by Navi selectively included patients with breast, colorectal, lung, pancreatic, or prostate cancer from the Surveillance Epidemiology and End-Results (SEER) Medicare database—the authors chose these cancer types a priori because pancreatic cancer is the cancer type most commonly reported in association with thromboembolic events, and the remaining four represent the most common cancers reported in the United States population ( 31 ).…”

Reply to Survivors of cancer despite poor quality of care are heroes

“…We would like to thank Dr. Braillon for his response to our article. 1 He has thoughtfully highlighted several important issues.…”