Patients with H&N cancer carry the highest risk of secondary primary cancers. Determining the underlying cause of death is conflicting in presence of multiple primary cancer sites, and the actual burden of H&N cancers may be underestimated by causes of death statistics.
Using the French National Hospital Discharge (PMSI) database, we identified all adult patients residing in Metropolitan France and diagnosed with H&N cancer (ICD-10: C00-C06; C09-C14; C30.0; C31; C32) in 2008-2012. Overall death was ascertained from in-hospital mortality with use of imputation methods to estimate death outside hospital in 2008-2012. Among deceased patients, we considered advanced H&N cancer (stage III/IV at diagnosis or relapse in the follow-up) as a cause of death. A competing cause of death from other primary cancer sites was categorized according to its timing relative to the index date of H&N cancer: former (180 days) cancers. Study results were compared to National causes of death statistics (CEPIDC) with use of the same ICD-10 definitions.
Of 131,965 French patients identified with H&N cancer in 2008-2012, 58,562 (44.4%) died in the same period including 46,463 (79.3%) deaths recorded at hospital. Of 58,562 deceased patients, 50,910 (86.9%) were recorded with advanced H&N cancer and involved 82.4% male patients at a median (IQR) age of 64 (57-74) at death. Overall, 20,926 (41.1%) patients had another primary cancer site than H&N cancer recorded before death: 4,751 (9.3%) former, 11,030 (21.7%) synchronous, and 5,145 (10.1%) metachronous cancers were recorded with increasing likelihood to be considered as the underlying cause of death. The death toll of H&N cancers represented 0.96% of all-cause mortality (2.65% of all premature deaths before 65 years old) in France and increased annually by 6.1% on average. In National causes of death statistics, only 25,647 deaths were attributed to H&N cancers in 2008-2012 without time trends.
The study results suggest that National causes of death statistics underestimate the burden of H&N cancer. It may be explain by the frequency of secondary primary cancers.
Clinical trial identification
Legal entity responsible for the study
THEN (Translational Health Economics Network)
C. Even, Y. Pointreau, L. Geoffrois, M. Schwarzinger, F. Huguet, S. Témam, S.P. Thiébaut: Corporate-sponsored research. M. Bec, C. Godard: MSD employee.