title: Cardiac comorbidity in head and neck cancer patients and its influence on cancer treatment selection and mortality: a prospective cohort study.
abstract: Comorbidity assessment and a profound cardiac examination were implemented into pre-treatment diagnostics to analyze their influence on head and neck squamous cell carcinoma (HNSCC) therapy selection and short-term mortality. Comorbidity was measured prospectively in 49 HNSCC patients using standard indices between 2012 and 2013. Cardiac examinations included electrocardiogram, echocardiography, and bicycle ergometry. Most patients had stage IV tumors (61 %), smoked (61 %), and showed alcohol abuse (57 %); 38 patients (78 %) received a multimodal therapy; 65 % had an adult comorbidity evaluation 27 index ≥2, 59 % a Charlson comorbidity index (CCI) ≥4, and 12 % a revised cardiac risk index (RCRI) ≥2. Additional cardiac examinations revealed moderate to severe cardiovascular pathologies in 32 % of the patients and led to recommendations for additional therapy in 4 patients (8 %) necessary only after cancer treatment. RCRI was associated with CCI and cardiac examinations (p = 0.009, p = 0.030). Chemotherapy, stroke history, and RCRI ≥2 were risk factors for early mortality within first 2 years after cancer therapy (p = 0.037; p = 0.012; p = 0.015). Although one-third of a strongly smoking and drinking patient cohort had relevant cardiac morbidity, extended unselected cardiac diagnostics had only low impact on HNSCC therapy selection. The risk of early mortality after HNSCC cancer treatment seems to be sufficiently reflected by the RCRI.
authors.affiliation: Department of Cardiology and Internal Intensive Care Medicine, Helios-Klinikum, Erfurt, Germany.|Department of Cardiology, Helios-Klinikum, Überlingen, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Simeoni
authors.affiliation: Department of Otorhinolaryngology, Helios-Klinikum, Erfurt, Germany.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Breitenstein
authors.affiliation: Department of Otorhinolaryngology, Helios-Klinikum, Erfurt, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Eßer
authors.affiliation: Department of Otorhinolaryngology, Jena University Hospital, Lessingstrasse 2, 07740, Jena, Germany. orlando.guntinas@med.uni-jena.de.
authors.forename: Orlando
authors.initials: O
authors.lastname: Guntinas-Lichius
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000628:therapy; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003131:Combined Modality Therapy; D015897:Comorbidity / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D012307:Risk Factors; D000077195:Squamous Cell Carcinoma of Head and Neck; D015996:Survival Rate / Q000639:trends
keywords: Cardiac disease; Comorbidity; Head and neck cancer; Survival