Six-month mortality has decreased for patients with curative treatment for head and neck cancer in Sweden

BackgroundIn general, survival outcome for head and neck cancer (HNC) patients has improved. However, mortality within six months after diagnosis with curative intent remains high. The aim of this study was to identify risk factors for early death among patients with curative treatment, and furthermore, to analyze whether the risk of early death changed over the recent years. Material and MethodThis real-world, population-based, nationwide study from the Swedish Head and Neck Cancer Register (SweHNCR) included 16,786 patients with curative treatment decision at the multidisciplinary tumor board from 2008 to 2020. ResultsDuring the study period a total of 618 (3.7%) patients with curative-intended treatment died within six months from diagnosis. Patients diagnosed between 2008-2012 had a six-month mortality rate of 4.7% compared to 2.5% for patients diagnosed 2017-2020, indicating a risk reduction of 53% (p <0.001) for death within six months. The mean time to radiation therapy in the 2008-2012 cohort was 38 days, compared to 22 days for the 2017- 2020 cohort, (p<0.001). The mean time to surgery from diagnosis was 22 days in 2008-2012, compared to 15 days for the 2017-2020 cohort, (p <0.001). Females had a 20% lower risk of dying within six months compared to males (p =0.013). For every year older the patient was at diagnosis, a 4.8% (p <0.001) higher risk of dying within six months was observed. Patients with a WHO score of 1 had approximately 2.4-times greater risk of early death compared to WHO 0 patients (p <0.001). The risk of early death among WHO 4 patients was almost 28 times higher than for WHO 0 patients (p <0.001) ConclusionsWe found that the risk of early death decreased significantly from 2008 to 2020. During this period the mean time to the start of treatment, was significantly reduced both for surgery and oncological treatment regimes. Among patients with a curative treatment intention, increased risk of early death was associated with male sex, older age, advanced disease, increased WHO score, and a hypopharyngeal tumor site. Brief description*The risk of early death decreased significantly from 2008 to 2020. *Time from diagnosis to treatment decreased between 2008 to 2020. *Among patients with a curative treatment intention, increased risk of early death was associated with male sex, older age, advanced disease, increased WHO score, and a hypopharyngeal tumor site. Ethical ConsiderationsThe Regional Ethical Review Board in Gothenburg and Lund reviewed and approved the study, (Gothenburg, number 299-14, T230-17 and Lund 2020-01972). This study was carried out in accordance with the current Helsinki Declaration of the World Medical Association from 2013. Data are available upon request.