Stroke Risk in Survivors of Head and Neck Cancer.

JAMA Netw Open

Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore.

Published: February 2024

AI Article Synopsis

  • - Survivors of head and neck cancers (HNC) in Singapore have a higher risk of stroke, and a study aimed to understand this risk among different subpopulations of HNC survivors from January 2005 to December 2020.
  • - The study used data from national cancer and stroke registries, focusing on demographic and treatment factors to analyze stroke outcomes over a median follow-up period of about 42.5 months.
  • - Out of nearly 10,000 HNC survivors studied, 3.4% suffered a stroke, showing a significant stroke risk increase with an SIRR of 2.46, indicating they were over twice as likely to have a stroke compared to the general population.

Article Abstract

Importance: Survivors of head and neck cancers (HNC) have increased risk of stroke. A comprehensive report using standardized methods is warranted to characterize the risk and to inform on survivorship strategy.

Objective: To determine the stroke risk in subpopulations of survivors of HNC in Singapore.

Design, Setting, And Participants: This national, registry-based, cross-sectional study aimed to estimate stroke risk in subgroups of the HNC population between January 2005 and December 2020. Participants were identified from the Singapore Cancer Registry, the Singapore Stroke Registry, and the Registry of Birth and Deaths using relevant International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes. HNC subgroups were defined based on patient demographic, disease, and treatment factors. Data were analyzed from September 2022 to September 2023.

Exposure: Diagnosis of HNC.

Main Outcomes And Measures: Both ischemic and hemorrhagic stroke were studied. The age-standardized incidence rate ratio (SIRR) and age-standardized incidence rate difference (SIRD) were reported. The Singapore general population (approximately 4 million) served as the reference group for these estimations.

Results: A total of 9803 survivors of HNC (median [IQR] age at diagnosis, 58 [49-68] years; 7166 [73.1%] male) were identified. The most common HNC subsites were nasopharynx (4680 individuals [47.7%]), larynx (1228 individuals [12.5%]), and tongue (1059 individuals [10.8%]). A total of 337 individuals (3.4%) developed stroke over a median (IQR) follow-up of 42.5 (15.0-94.5) months. The overall SIRR was 2.46 (95% CI, 2.21-2.74), and the overall SIRD was 4.11 (95% CI, 3.37-4.85) strokes per 1000 person-years (PY). The cumulative incidence of stroke was 3% at 5 years and 7% at 10 years after HNC diagnosis. The SIRR was highest among individuals diagnosed at younger than 40 years (SIRR, 30.55 [95% CI, 16.24-52.35]). All population subsets defined by age, sex, race and ethnicity, HNC subsites (except tongue), stage, histology, and treatment modalities had increased risk of stroke compared with the general population. The SIRR and SIRD were significantly higher among individuals who had a primary radiation treatment approach (SIRR, 3.01 [95% CI, 2.64-3.43]; SIRD, 5.12 [95% CI, 4.18-6.29] strokes per 1000 PY) compared with a primary surgery approach (SIRR, 1.64 [95% CI, 1.31-2.05]; SIRD, 1.84 [95% CI, 0.923.67] strokes per 1000 PY).

Conclusions And Relevance: In this cross-sectional study of survivors of HNC, elevated stroke risks were observed across different age, subsites, and treatment modalities, underscoring the importance of early screening and intervention.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10865145PMC
http://dx.doi.org/10.1001/jamanetworkopen.2023.54947DOI Listing

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