Overall Health of Head and Neck Cancer Patients Highly Susceptible

Release: May 12, 2000
Contact: Kenneth Satterfield, 407-238-4161 (as of 5/12/2000)

OVERALL HEALTH OF HEAD AND NECK CANCER PATIENTS HIGHLY SUSCEPTIBLE TO THE PRESENCE OF OTHER DISEASES

A new research study assesses the impact of comorbidity on various cancers

Orlando, FL -- According to the estimates for 1990, cancer is the second leading cause of death in the United States with over 550,322 deaths annually. Patients with cancer often have other diseases, illnesses, or conditions in addition to their cancer. These other non-cancerous conditions are generally referred to as comorbidities, Although not a feature of the cancer itself, comorbidity is an important attribute of the patient. In many cancers, comorbidity is more important to the care of the patient than the cancer itself. The present system of cancer classification is based primarily on tumor morphology and does not consider important patient-based factors, such as comorbidity. The continued exclusion of comorbidity measures cannot be justified since several valid comorbidity instruments are now available.

The research objective was to demonstrate the importance of comorbidity in head and neck cancer, one of the most insidious of all cancers. Specific goals included:

(1) Demonstrating the burden of comorbidity among head and neck cancer patients by comparing the incidence of None, Mild, Moderate, and Severe comorbidity among these patients to patients with colorectum, lung, breast, gynecologic, or prostate cancers.

(2) Assess the independent impact of comorbidity on overall survival

(3) Characterize the importance of comorbidity on the assessment of initial treatment effectiveness.

The author of the research study, "The Importance of Comorbidity in Head and Neck Cancer," is Jay F Piccirillo, MD, Department of Otolaryngology, Washington University Medical School, St. Louis, MO. His findings were presented before The American Laryngological, Rhinological and Otological Society (Triological Society), meeting May 15-17, in Orlando, FL.

Methodology: This was a prospective cohort study of the impact of comorbidity on head and neck cancer patients presenting for treatment between January 1995 and December 1996. To initiate this effort, the author, in 1994, trained cancer registrars at an academic teaching hospital to code comorbidity from the medical record of new patients using a standard comorbidity index.

Standard statistical techniques, including multi variable analysis, were used to compare and contrast the burden of comorbidity for patients with different cancers. Life survival techniques and multi variable logistic regression analysis were used to assess the independent prognostic impact of comorbidity. Finally, the technique of conjunctive consolidation was used to augment the TNM classification system with comorbidity information to more completely assess the impact of different initial treatments for patients with head and neck cancers.

The review of patients established a cohort consisting of 3,378 cancer patients. Head and neck cancers numbered -- 341: colorectum -- 307; lung -- 655: breast-- 483; gynecological sites -- 482; , and prostate --1,110.

Results: Of the 3,378 patients, the average age was 62.8 years with a range of 18 to 95. There were 1,859 (55 percent) men and the majority was white 2,786 (82.5 percent). The distribution of severity of comorbidity was None 1,895 (56.1 percent), Mild 795 (23.5 percent), Moderate 511 (15.1 percent), and Severe 177 (5.2 percent). Full one-year survival information was obtained on 98 percent (3,328/3,378) and two-year information was available on 56 percent (1,893/3,378).

Other findings include:

(1) Distribution of Comorbidity within Different Cancer Sites. The distribution of severity of comorbidity varied greatly across different cancer sites. For example, the percentage of patients with Moderate or Severe comorbidity ranged from 40 percent for cancers of the lung to 12 percent for cancer of the prostate. The percentage of patients with no comorbidity ranged from 63 percent for cancers of the breast and prostate to 38 percent for cancers of the lung. Patients with cancers of the head and neck had a 21 percent rate of Moderate or Severe comorbidity and 55 percent rate of no comorbidity. In terms of the burden of comorbidity (sum of Moderate and Severe comorbidity), the cancer sites are ranked (from highest to lowest): lung (40 percent), head and neck (21 percent), colorectal (25 percent), breast and gynecological (16 percent each), and prostate (12 percent).

Prognostic Implications of Comorbidity. The impact of comorbidity on overall survival reveals there is a significant relationship between level of severity of comorbidity and survival. The relationship between overall survival and level of severity is clinically impressive and statistically significant (Log Rank Test ˜2 = 177.4; p <0.0001). This relationship between the level of severity of comorbidity and overall survival for the head and neck cancer patients is significant.

Group Comparisons. Strong mortality risks were observed for the elderly (greater than 70 years old), black patients, and patients with Moderate or Severe comorbidity. Head and neck cancer patients had approximately the same risk of mortality as patients with breast or gynecological cancers. As judged by the standardized estimate, comorbidity has the largest impact in cancers of the breast. The remaining cancer sites are listed in the decreasing order of importance for comorbidity: prostate, head and neck, colorectal, gynecological, and lung. In cancers of the head and neck, lung, breast, and prostate, comorbidity remained a statistically significant independent prognostic factor.

Conclusion: The study results demonstrate that comorbidity is an important feature in treating the overall health of the head and neck cancer patient. Severity can be measured; doing so will allow physicians to abandon an adherence to a treatment protocol based solely on cancer while ignoring other present medical conditions.

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