title: Increase in stroke risk in patients with head and neck cancer: a retrospective cohort study.
abstract: BACKGROUND
  This study investigated the stroke risk in patients with head and neck cancers (HNCs) using population-based data.
  
  
  METHODS
  From claims collected in the Taiwan National Health Insurance database, we identified 13,390 HNC patients with diagnosis made in 2000-2002. A reference cohort of 53,517 non-cancer individuals matched for age, gender, and stroke risk factors was used for assessing stroke risk in follow-up to 2008.
  
  
  RESULTS
  The overall stroke incidence was 1.44-fold higher in the HNC than in the reference cohort (11.4 vs 7.9 per 1000 person-years). Adjusted hazard ratios (HRs) were 1.54 (95% confidence interval (CI): 1.40-1.68) for ischaemic stroke and 1.36 (95% CI: 1.09-1.69) for haemorrhagic stroke. The cancer-to-reference stroke incidence rate ratio was age dependent and the highest in the age group younger than 40 years (5.45, 95% CI: 3.78-7.87) and decreased with aging. Comparing different therapeutic modalities, HNC patients receiving both radiotherapy (RT) and chemotherapy (CT) had the highest stroke risk (HR: 1.46, 95% CI: 1.22-1.74), followed in sequence by those who had CT alone, RT alone, and without therapy.
  
  
  CONCLUSIONS
  Patients with HNC are at increased risk of developing stroke, especially in the young age group and in those who received both RT and CT.
authors.affiliation: Department of Radiation Oncology, China Medical University Hospital and College of Medicine, Taichung 404, Taiwan.
authors.forename: C-N
authors.initials: CN
authors.lastname: Chu
authors.forename: S-W
authors.initials: SW
authors.lastname: Chen
authors.forename: L-Y
authors.initials: LY
authors.lastname: Bai
authors.forename: C-H
authors.initials: CH
authors.lastname: Mou
authors.forename: C Y
authors.initials: CY
authors.lastname: Hsu
authors.forename: F-C
authors.initials: FC
authors.lastname: Sung
mesh_terms: D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D013624:Taiwan / Q000453:epidemiology