title: Noncancer health events as a leading cause of competing mortality in advanced head and neck cancer.
abstract: BACKGROUND
  The survival of patients with head and neck squamous cell carcinoma (HNSCC) can be affected by noncancer health events (NCHE) as well as by index cancer progression and second primary cancer (SPC). This study aimed to investigate the risk factors for NCHE and noncancer mortality (NCM) in patients with advanced-stage HNSCC.
  
  
  METHODS
  This cohort study involved 600 consecutive patients with overall stage III to IV HNSCC who were treated between 2001 and 2010 at our tertiary referral hospital. NCHE was defined as re-admission (i.e. after the primary treatments for the index tumors) due to noncancer-related causes. The incidences of NCHE and NCM and their risk factors were analyzed by using cumulative incidence and cause-specific hazard functions.
  
  
  RESULTS
  During a median follow-up period of 54 months, 224 (37.3%) and 55 (9.2%) of the 600 patients had NCHE and NCM, respectively. The 5-year index cancer mortality, SPC mortality, and NCM rates were 23.8%, 4.2%, and 8.9%, respectively. Multivariate analyses revealed that body mass index <20 kg/m(2) (P = 0.018), Charlson comorbidity index (CCI) ≥1 (P < 0.001), tumor recurrence (P < 0.001), SPC occurrence (P < 0.001), and initial chemotherapy (P = 0.049) were independent NCHE predictors. Older age (P < 0.001), CCI ≥1 (P = 0.008), tumor recurrence (P < 0.001), and SPC occurrence (P = 0.047) were independent NCM predictors. Patients with respiratory NCHE were at a higher risk of NCM than patients with other NCHE types (P < 0.001).
  
  
  CONCLUSIONS
  One or more comorbidities, tumor recurrence, and SPC occurrence were independent predictors of both NCHE and NCM. Patients with respiratory NCHE had a particularly high risk of NCM.
authors.affiliation: Department of Otolaryngology.
authors.forename: M
authors.initials: M
authors.lastname: Kwon
authors.affiliation: Department of Otolaryngology rohjl@amc.seoul.kr.
authors.forename: J-L
authors.initials: JL
authors.lastname: Roh
authors.affiliation: Department of Clinical Epidemiology and Biostatistics.
authors.forename: J
authors.initials: J
authors.lastname: Song
authors.affiliation: Department of Radiation Oncology.
authors.forename: S-W
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine (Oncology), Asan Medical Centre, University of Ulsan College of Medicine, Seoul.
authors.forename: S-B
authors.initials: SB
authors.lastname: Kim
authors.affiliation: Department of Otolaryngology.
authors.forename: S-H
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Department of Otolaryngology.
authors.forename: S Y
authors.initials: SY
authors.lastname: Nam
authors.affiliation: Department of Otolaryngology Biomedical Research Institute, Korea Institute of Science and Technology, Seoul, Republic of Korea.
authors.forename: S Y
authors.initials: SY
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D016609:Neoplasms, Second Primary / Q000453:epidemiology; D012307:Risk Factors; D000077195:Squamous Cell Carcinoma of Head and Neck
keywords: comorbidities; competing mortalities; head and neck squamous cell carcinoma; noncancer health event; risk factors