Sabine Stordeur1, Viki Schillemans2, Isabelle Savoye3, Katrijn Vanschoenbeek4, Roos Leroy5, Gilles Macq6, Leen Verleye7, Cindy De Gendt8, Sandra Nuyts9, Jan Vermorken10, Claire Beguin11, Vincent Grégoire12, Liesbet Van Eycken13. 1. Belgian Health Care Knowledge Centre (KCE), Boulevard du Jardin Botanique 55, B-1000 Brussels, Belgium. Electronic address: sabine.stordeur@kce.fgov.be. 2. Belgian Cancer Registry, Rue Royale 215, B-1210 Brussels, Belgium. Electronic address: viki.schillemans@kankerregister.org. 3. Belgian Health Care Knowledge Centre (KCE), Boulevard du Jardin Botanique 55, B-1000 Brussels, Belgium. Electronic address: isabelle.savoye@kce.fgov.be. 4. Belgian Cancer Registry, Rue Royale 215, B-1210 Brussels, Belgium. Electronic address: katrijn.vanschoenbeek@kankerregister.org. 5. Belgian Health Care Knowledge Centre (KCE), Boulevard du Jardin Botanique 55, B-1000 Brussels, Belgium. Electronic address: roos.leroy@kce.fgov.be. 6. Belgian Cancer Registry, Rue Royale 215, B-1210 Brussels, Belgium. Electronic address: gilles.macq@registreducancer.org. 7. Belgian Health Care Knowledge Centre (KCE), Boulevard du Jardin Botanique 55, B-1000 Brussels, Belgium. Electronic address: leen.verleye@kce.fgov.be. 8. Belgian Cancer Registry, Rue Royale 215, B-1210 Brussels, Belgium. Electronic address: Cindy.DeGendt@kankerregister.org. 9. University of Leuven, KU Leuven, Department of Radiotherapy-Oncology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium. Electronic address: sandra.nuyts@uzleuven.be. 10. Department of Medical Oncology, Antwerp University Hospital, Wilrijkstraat 10, B-2650 Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium. Electronic address: JanB.Vermorken@uza.be. 11. Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, B-1200 Woluwé-Saint-Lambert, Belgium. Electronic address: claire.beguin@uclouvain.be. 12. Centre Léon Bérard, 28 rue Laennec, F-69373 Lyon, France. Electronic address: vincent.GREGOIRE@lyon.unicancer.fr. 13. Belgian Cancer Registry, Rue Royale 215, B-1210 Brussels, Belgium. Electronic address: elizabeth.vaneycken@kankerregister.org.
Abstract
OBJECTIVES: This study aims to investigate the relationship between comorbidities and therapeutic delay, post-treatment mortality, overall and relative survival in patients diagnosed with squamous cell carcinoma of the head and neck (HNSCC). PATIENTS AND METHODS: 9245 patients with a single HNSCC diagnosed between 2009 and 2014 were identified in the Belgian Cancer Registry. The Charlson Comorbidity Index (CCI) was calculated for 8812 patients (95.3%), distinguishing patients having none (0), mild (1-2), moderate (3-4) or severe comorbidity (>4). The relationship between CCI and therapeutic delay was evaluated using the Spearman correlation. Post-treatment mortality was modelled with logistic regression, using death within 30 days as the event. The association between comorbidity and survival was assessed using Cox proportional hazard models. RESULTS: Among 8812 patients with a known CCI, 39.2% had at least one comorbidity. Therapeutic delay increased from 31 to 36 days when the CCI worsened from 0 to 4 (rho = 0.087). After case-mix adjustment, higher baseline comorbidity was associated with increased post-surgery mortality (mild, OR 3.52 [95% CI 1.91-6.49]; severe, OR 18.71 [95% CI 6.85-51.12]) and post-radiotherapy mortality (mild, OR 2.23 [95% CI 1.56-3.19]; severe, OR 9.33 [95% CI 4.83-18.01]) and with reduced overall survival (mild, HR 1.39, [95% CI 1.31-1.48]; severe, HR 2.41 [95% CI 2.00-2.90]). That was also the case for relative survival in unadjusted analyses (mild, EHR 1.77 [95% CI 1.64-1.92]; severe, EHR = 4.15 [95% CI 3.43-5.02]). CONCLUSION: Comorbidity is significantly related to therapeutic delay, post-treatment mortality, 5-year overall and relative survival in HNSCC patients. Therapeutic decision support tools should optimally integrate comorbidity.
OBJECTIVES: This study aims to investigate the relationship between comorbidities and therapeutic delay, post-treatment mortality, overall and relative survival in patients diagnosed with squamous cell carcinoma of the head and neck (HNSCC). PATIENTS AND METHODS: 9245 patients with a single HNSCC diagnosed between 2009 and 2014 were identified in the Belgian Cancer Registry. The Charlson Comorbidity Index (CCI) was calculated for 8812 patients (95.3%), distinguishing patients having none (0), mild (1-2), moderate (3-4) or severe comorbidity (>4). The relationship between CCI and therapeutic delay was evaluated using the Spearman correlation. Post-treatment mortality was modelled with logistic regression, using death within 30 days as the event. The association between comorbidity and survival was assessed using Cox proportional hazard models. RESULTS: Among 8812 patients with a known CCI, 39.2% had at least one comorbidity. Therapeutic delay increased from 31 to 36 days when the CCI worsened from 0 to 4 (rho = 0.087). After case-mix adjustment, higher baseline comorbidity was associated with increased post-surgery mortality (mild, OR 3.52 [95% CI 1.91-6.49]; severe, OR 18.71 [95% CI 6.85-51.12]) and post-radiotherapy mortality (mild, OR 2.23 [95% CI 1.56-3.19]; severe, OR 9.33 [95% CI 4.83-18.01]) and with reduced overall survival (mild, HR 1.39, [95% CI 1.31-1.48]; severe, HR 2.41 [95% CI 2.00-2.90]). That was also the case for relative survival in unadjusted analyses (mild, EHR 1.77 [95% CI 1.64-1.92]; severe, EHR = 4.15 [95% CI 3.43-5.02]). CONCLUSION: Comorbidity is significantly related to therapeutic delay, post-treatment mortality, 5-year overall and relative survival in HNSCC patients. Therapeutic decision support tools should optimally integrate comorbidity.
Authors: Rosanne C Schoonbeek; Julius de Vries; Linda Bras; Grigory Sidorenkov; Boudewijn E C Plaat; Max J H Witjes; Bernard F A M van der Laan; Johanna G M van den Hoek; Boukje A C van Dijk; Johannes A Langendijk; György B Halmos Journal: Eur J Cancer Care (Engl) Date: 2022-04-19 Impact factor: 2.328