Predictors of stage at presentation and outcomes of head and neck cancers in a university hospital setting

Introduction Poor oral health has emerged as a risk factor for squamous cell carcinoma of the head and neck (HNSCC) but its impact on survival has not been examined. We sought to estimate the impact of oral health indicators on survival in a population-based HNSCC cohort. Materials and Methods Cases (n=1381) and age-, sex- and race-matched controls (n=1396) were participants in the Carolina Head and Neck Cancer Epidemiologic Study (CHANCE). Vital status was determined via linkage with the National Death Index. Survival was considered at 5 years post-diagnosis or study-enrollment for controls. Oral health was assessed using self-reported indicators including frequency of routine dental exams and tooth brushing. We used Kaplan-Meyer analyses and Cox regression to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI). Results Routine dental visits during the preceding 10 years were associated with decreased mortality risk (>10 visits: HR=0.6, 95% CI=0.4–0.8) after adjusting for confounders. This effect was most pronounced for oral cavity cancer—(e.g., >10 visits: HR=0.4, 95% CI=0.2–0.9). Dental visits were also positively associated with survival among controls. No other routine health screening (e.g., eye exams) was associated with survival. Conclusion We found significant associations between markers of oral health and survival among both HNSCC cases and controls. This association was most pronounced for sites closer to the dentition. Oral health may have a direct effect on tumor biology due to the associated immune or inflammatory response. It may also represent a proxy for wellness or unmeasured social determinants of health.

show abstract

“…7–11 These include tobacco and alcohol consumption, p16 status, demographics, and socioeconomic status. 2,7–10,12–14 …”

Section: Introductionmentioning

confidence: 99%

Poor oral health affects survival in head and neck cancer

et al. 2017

View full text Add to dashboard Cite

show abstract

“…These demographics may mediate increased comorbidity prevalence, delays in diagnosis, and decreased initiation or completion of ideal treatment. Social support, especially from marriage, is also associated with earlier stage of presentation, more complete and timely treatment, and ultimately improved prognosis . Despite extensive literature on demographic predictors of HNSCC survival, specific demographic predictors have not been assessed in the elderly.…”

Section: Introductionmentioning

confidence: 99%

Demographic predictors of head and neck cancer survival differ in the elderly

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…Two objectives of the Healthy People 2020 initiative relate to improving the early detection of and increasing survival rates for patients with HNC . Both of these objectives are inextricably linked with decreasing the rate of diagnosis of late‐stage disease because stage of disease at the time of presentation is critical to the prognostication of HNC . The results of the current study demonstrated that, rather than decreasing, there has been an increase in the incidence of late‐stage HNC in the United States within the last decade, and the increase is driven by race.…”

Section: Discussionmentioning

confidence: 74%

Rising incidence of late‐stage head and neck cancer in the United States

Thompson‐Harvey

Yetukuri

Hansen

et al. 2019

Cancer

Self Cite

View full text Add to dashboard Cite

Background The current study was conducted to determine whether the incidence of late‐stage head and neck cancer (HNC) is decreasing and to estimate the risk of late‐stage HNC diagnosis based on race and sex. Methods Age‐adjusted incidence rates for patients aged ≥18 years with stage IV HNC were abstracted from the Surveillance, Epidemiology, and End Results database (2004‐2015). Rates were stratified by race, sex, and age. Joinpoint regression estimated annual percent changes (APCs) in rates over time, and logistic regression estimated adjusted odds ratios (aORs). Results There were 57,118 patients with stage IV HNC in the current study cohort, with an average age of 61.9 years. From 2004 to 2015, the age‐adjusted incidence rates for stage IV HNC significantly increased by 26.1% (6.11 per 100,000 person‐years in 2004 to 7.70 per 100,000 person‐years in 2015). White and Asian/Pacific Islander/American Indian/Alaska Native patients had significant increases in incidence (APC for white patients, 3.03 [P < .01] and APC for other races, 1.95 [P < .01]), whereas rates among black patients remained stable but were highest across racial groups. Incidence was higher among males compared with females. When restricted only to patients with stage IVC (metastatic) HNC, there remained a significant increase in incidence, especially for oropharyngeal cancer, which showed a 22.9% increase (0.21 per 100,000 person‐years in 2004 vs 0.25 per 100,000 person‐years in 2015). Despite a decreasing overall incidence of stage IV HNC in black patients (aOR, 1.28; 95% CI, 1.22‐1.34) they, along with males (aOR, 3.95; 95% CI, 3.80‐4.11), had significantly increased risks of being diagnosed with late‐stage HNC. Conclusions There is an increasing incidence of late‐stage HNC in the United States, with male patients and black individuals faring the worst.

show abstract

Predictors of stage at presentation and outcomes of head and neck cancers in a university hospital setting

Abstract: Disparities, such as race and health insurance status, are important predictors of stage at presentation of patients with head and neck cancer. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1826-E1832, 2016.

Cited by 49 publications

References 50 publications

Poor oral health affects survival in head and neck cancer

Poor oral health affects survival in head and neck cancer

Demographic predictors of head and neck cancer survival differ in the elderly

Rising incidence of late‐stage head and neck cancer in the United States

Contact Info

Product

Resources

About