Simple Things Improve Head and Neck Cancer Survival

Veronica Hackethal, MD

May 12, 2015

There are some simple measures and circumstances that can improve overall survival in head and neck cancer, according to a single-center study published online May 27 in JAMA Otolaryngology.

Complying with posttreatment follow-up, quitting smoking, and living within 200 miles of the medical center were all linked to improved survival in the study.

The findings are important because head and neck cancer has a very high mortality rate, with 5-year survival of about 50%, mostly owing to high levels of persisting or recurrent disease, write the authors, led by Michael Deutschmann, MD, at the University of Kansas Medical Center (KUMC), in Kansas City.

The authors observed that other studies have shown that follow-up can help identify about half of recurrences and secondary tumors. But the frequency and total number of follow-up visits remained open to question. Plus, how much follow-up improves outcomes was uncertain.

The new research showed not only what factors correlated with improved survival but also who was at high risk for poorer survival.

"High-risk patients included those who had not attended all follow-up appointments, continued tobacco use, lived in middle or moderate census tract income levels, or lived more than 200 miles from KUMC," write the authors.

The investigators retrospectively looked at a cohort of 332 patients with squamous cell carcinoma of the head and neck who were treated at KUMC.

They reviewed medical records dating from March 2003 to December 2008 and assessed compliance on the basis of attendance at follow-up visits.

They defined compliance as attending all follow-up appointments within 4 weeks of the recommended visit, partial compliance as missing one or two appointments, and noncompliance as missing three or more appointments or being lost to follow-up after the first visit (this included patients whose care was transferred to other institutions). Current smokers received smoking cessation counseling at every follow-up visit.

Results suggested that compliance with follow-up significantly improved survival (P = .001). Other factors linked to improved survival included higher income levels (P = .001), quitting smoking (P = .01), and living within 200 miles of the medical center (P = .02).

Factors associated with increased risk for death included more advanced disease (hazard ratio [HR], 1.76; 95% confidence interval [CI], 1.21 - 2.58; P = .003), middle income level (HR, 1.64; 95% CI, 1.13 - 2.39; P = .009), moderate income level (HR, 1.90; 95% CI, 1.18 - 3.06; P = .008), and older age (HR, 1.03; 95% CI, 1.01 - 1.04; P < .001).

Patients who quit smoking and lived less than 200 miles from the medical center had significantly better compliance (P = .003 and P = .008, respectively).

The lowest income group included only nine people, which could have limited the findings. In addition, the study design did not allow for investigation of the causes of loss to follow-up and whether living farther away from the medical center played a role. Finally, patients self-reported smoking cessation and may not have always told the truth about it.

The authors mention that requiring more frequent follow-up visits may not necessarily be the answer to improving survival in head and neck cancer. More visits would add extra stress, as well as increase travel time and costs, they point out.

Rather, they suggest closer follow-up for high-risk patients selected on an individual basis. The factors found in this study ― advanced disease, older age, lower income levels, and being a smoker ― could be used to identify high-risk patients who need closer follow-up.

Physicians might increase compliance by emphasizing its impact on improving survival and early detection of recurrences, say the authors.

The authors report no relevant financial relationships.

JAMA Otolaryngol Head Neck Surg. Published online May 7, 2015. Full text

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