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Consideration of Competing Events Important for Survival

Factors identify head and neck cancer patients at higher risk of dying from non-cancer causes

TUESDAY, Dec. 1 (HealthDay News) -- Several risk factors may help predict the chances of competing mortality -- or death from non-cancer causes -- in patients with head and neck cancer, according to research published online Nov. 23 in the Journal of Clinical Oncology.

Loren K. Mell, M.D., of the University of California San Diego in La Jolla, and colleagues analyzed data from 479 patients with stage III to IV head and neck cancer. All were treated with chemoradiotherapy, and some had limited organ-sparing surgery. Patients were followed for a median 52 months.

The researchers found that the group had a 19.6 percent five-year cumulative incidence of competing mortality. Factors associated with higher risk of competing mortality included female sex (hazard ratio, 1.72), older age (hazard ratio, 1.30), and increasing Charlson Comorbidity Index (hazard ratio, 1.24). Patients with greater numbers of risk factors had a higher risk of five-year competing mortality. Also, patients at highest risk of competing mortality were more likely to die of non-cancer causes than have a recurrence of their disease.

"Our findings indicate that in evaluating disease-free survival, it is important to consider the incidences of competing events comprising this end point, to permit a more complete interpretation of results," the authors write. "In addition to testing new cancer therapies, multimodality therapy for head and neck cancer should focus on ameliorating treatment toxicity and improving management of comorbid diseases. Such efforts have potential to improve disease-free survival and should be actively pursued."

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