Cardiac comorbidity in head and neck cancer patients and its influence on cancer treatment selection and mortality: a prospective cohort study

Abstract

Comorbidity assessment and a profound cardiac examination were implemented into pre-treatment diagnostics to analyze their influence on head and neck squamous cell carcinoma (HNSCC) therapy selection and short-term mortality. Comorbidity was measured prospectively in 49 HNSCC patients using standard indices between 2012 and 2013. Cardiac examinations included electrocardiogram, echocardiography, and bicycle ergometry. Most patients had stage IV tumors (61 %), smoked (61 %), and showed alcohol abuse (57 %); 38 patients (78 %) received a multimodal therapy; 65 % had an adult comorbidity evaluation 27 index ≥2, 59 % a Charlson comorbidity index (CCI) ≥4, and 12 % a revised cardiac risk index (RCRI) ≥2. Additional cardiac examinations revealed moderate to severe cardiovascular pathologies in 32 % of the patients and led to recommendations for additional therapy in 4 patients (8 %) necessary only after cancer treatment. RCRI was associated with CCI and cardiac examinations (p = 0.009, p = 0.030). Chemotherapy, stroke history, and RCRI ≥2 were risk factors for early mortality within first 2 years after cancer therapy (p = 0.037; p = 0.012; p = 0.015). Although one-third of a strongly smoking and drinking patient cohort had relevant cardiac morbidity, extended unselected cardiac diagnostics had only low impact on HNSCC therapy selection. The risk of early mortality after HNSCC cancer treatment seems to be sufficiently reflected by the RCRI.

Racial and rural–urban disparities in cardiovascular risk factors among patients with head and neck cancer in a clinical cohort

“…Even though patients with oropharynx and larynx cancer were more likely to have prevalent CVD clinical risk factors at baseline, the opposite was observed for risk of incident CVD clinical risk factors at 1‐year post HNSCC diagnosis. Previous studies have reported higher risk of CVD in patients with head and neck cancer receiving radiation and or chemotherapy 39,40 . CVD complications following HNC surgery have also been reported 41,42 .…”

“…Previous studies have reported higher risk of CVD in patients with head and neck cancer receiving radiation and or chemotherapy. 39,40 CVD complications following HNC surgery have also been reported. 41,42 However, association of CVD risk factors with HNSCC treatment is inconclusive.…”

Deciphering excess healthcare burden in head and neck cancer patients with cardiovascular comorbidity

“…Common comorbid ailments in head and neck cancer patients include coronary artery disease, heart attack, lung diseases, psychiatric diseases, tumors other than the primary tumor, alcohol abuse, and diabetes 10 . Because of the strong causal relationship between these comorbid ailments and alcohol and tobacco abuse (two main risk factors for some head and neck cancer), major cardiovascular complications are not unexpected in patients with head and neck cancer, who require major lengthy surgeries 11 . Furthermore, about half of the patients with newly diagnosed head and neck cancer are older than 60 years of age 12 .…”

“…10 Because of the strong causal relationship between these comorbid ailments and alcohol and tobacco abuse (two main risk factors for some head and neck cancer), major cardiovascular complications are not unexpected in patients with head and neck cancer, who require major lengthy surgeries. 11 Furthermore, about half of the patients with newly diagnosed head and neck cancer are older than 60 years of age. 12 Older age itself is correlated with higher comorbidity.…”

Evaluation of Cardiac-Vascular Complications Risk in Out-of-Cardiac Surgery: Comorbidity and Use of Clinical Evaluation Scale

“…Это, по-жалуй, наиболее часто используемый клинический индекс. Он включен в алгоритмы рекомендаций по предопераци-онной оценке сердечно-сосудистого риска, кроме того, его зачастую используют для описания тяжести той или иной когорты оперируемых пациентов [16,17]. Суть применения данного индекса в выявлении у пациента, планирующего-ся на внесердечное вмешательство, шести факторов риска, каждому из которых присваивается 1 балл.…”