Cause-specific mortality in patients with head and neck cancer: Long-term follow-up of a population-based cohort from 1986 to 2012 accounting for competing risks.

OBJECTIVES: Recent recommendations for treating head and neck cancer (HNC) patients favor an individualized approach. Expected long-term survival - together with short-term survival - after diagnosis is the primary focus in assessing the treatment modality and follow-up scheme. "Disease-specific" survival up to five years is often used for measuring the prognosis and for assessing treatment methods. However, especially long-term survival is strongly affected by competing causes of death among HNC patients. MATERIALS AND METHODS: The long-term prognosis of patients with HNC in terms of mortality from both cancer and competing causes was analyzed according to recent methodological guidelines by examining cumulative incidence functions and models for cause-specific hazards and sub-distribution hazards in a population based cohort of 220 patients treated in a tertiary care center in Northern Finland. RESULTS: In addition to well-known tumor-related factors, mortality from HNC was associated with older age. The mortality from other causes of death was strongly dependent on age and Charlson's Comorbidity Index, but less on gender. When demonstrating the importance of individualized approach in simulated patients, the mortality was highly variable across patients with similar cancer status, but with different comorbidities or age. CONCLUSION: The overall survival pattern of HNC patients depends not only on their cancer characteristics, but also varies greatly according to their age and comorbidities. Our findings support the need for individualized treatment and follow-up protocols, and active management of comorbid diseases. Appropriate methods for analyzing competing risks should be used when presenting survival estimates of cancer patients.

Predictive factors of a beneficial quality of life outcome in patients undergoing primary sinonasal surgery: a population-based prospective cohort study.

PURPOSE: To assess predictive factors of a beneficial quality of life (QoL) outcome after primary sinonasal surgery. METHODS: A population-based prospective cohort study among 160 adult patients undergoing primary sinonasal surgery (76 septoplasties, SP; 84 endoscopic sinus surgeries, ESS) was conducted. We collected QoL data using the Sinonasal Outcome Test-22 (SNOT-22) before and after surgery. A beneficial QoL outcome was defined as a SNOT-22 score change ≥ 9 points 12 months after surgery. Various demographic, clinical and symptom-related factors predicting a beneficial QoL outcome were sought using binary logistic regression analysis. RESULTS: The mean age of the patients was 39 years (range 18-61) and 82 (51%) were males. The SNOT-22 score change varied markedly after SP (range - 17 to + 80) and ESS (range - 20 to + 58), but on average it improved (median + 15 after SP and + 16 after ESS). 41 patients (64%) achieved beneficial QoL outcome after SP and 46 (66%) after ESS. In a multivariate analysis, poor QoL before surgery (preoperative SNOT-22 ≥ 20 points) predicted a beneficial QoL outcome after SP and ESS (adjusted odds ratio 10; 95% confidence interval 1.6-64 and 12; 2.5-55, respectively) and a senior surgeon operating after SP (9.9; 1.5-67). On receiver operating characteristic curve analysis, the integer threshold value for the preoperative SNOT-22 score that gave the highest sensitivity (74%) and specificity (70%) was 30. CONCLUSIONS: QoL change after primary SP and ESS varies. A preoperative SNOT-22 score of at least 30 best predicted a beneficial QoL outcome after both procedures.

Quality of life before and after sinonasal surgery: a population-based matched cohort study.

A population-based matched cohort study was conducted to explore how the quality of life (QoL) changes in patients with septal deviation or recurrent/chronic rhinosinusitis after septoplasty (SP) and endoscopic sinus surgery (ESS). We also compared the QoL of the surgical cohort with that of a concurrently collected healthy cohort. We collected data on QoL in a population-based surgical cohort of 160 patients residing in one health care district (population 405,000) in Northern Finland, and in a control cohort comprised of 206 age- and sex-matched randomly selected subjects residing in Finland (population 5,470,000). QoL was assessed at entry and 12 months later with the Sino-Nasal Outcome Test-22 (SNOT-22) and the RAND-36 generic instruments. Seventy-six SP and 84 ESS patients and 206 controls were enrolled. At entry, the mean SNOT-22 scores of the SP and ESS groups were similar (34.9 and 35.1, respectively) and both were significantly worse than the control group (17.7). At 12 months, the mean SNOT-22 score had improved after SP [change 15.7, 95 % confidence interval (CI) 11.4-19.9] and ESS (change 18.0, 95 % CI 12.4-20.9) and almost reached that of the control group, which remained unchanged. The benefit was similar regardless of the surgical indication. At 12 months, mean RAND-36 scores had improved in most domains in both patient groups and remained unchanged in the controls. After appropriate surgical criteria, both SP and ESS are effective in enhancing QoL on the population level, and postoperative QoL almost reaches the level of the control population.

Characteristics and medical-care-seeking of head and neck cancer patients: a population-based cross-sectional survey.

OBJECTIVES: Well-known risk factors, such as smoking and alcohol consumption, easily denounce head and neck cancer patients as smokers, alcohol abusers, and persons who are socially excluded and have low socioeconomic status. To diagnose these patients as early as possible, we should not have a prejudiced assumption of their characteristics. MATERIALS AND METHODS: We collected detailed data on patient characteristics and health behavior and explored whether these traits had any effect on seeking medical advice in a population-based cross-sectional study involving 85 patients with head and neck cancer diagnosed between January 2003 and December 2007, residing in two health care districts (population 1,600,000) in Finland. The data were gathered from patient charts and questionnaires. The questionnaire data were compared with the general population in Finland. RESULTS: We found these patients to be ordinary elderly people whose demographic and social features resembled those of the general population. They smoked more often, but otherwise had a rather healthy lifestyle. Only half were aware that smoking and alcohol consumption were risk factors of head and neck cancer. In a multivariate analysis, fear of physicians (adjusted odds ratio 11.0; 95% confidence interval 1.2-103), medical-care-seeking for symptoms other than pain (18.5; 2.2-156), and not suspecting cancer (11.2; 1.7-75.1) were independent risk factors for delayed consultation (combined appraisal and help-seeking interval over 3 months). CONCLUSION: Head and neck cancer patients deviated from the same-aged general population only in excessive smoking. Fear of doctors, having no pain, and no suspicion of cancer resulted in delayed medical-care-seeking.