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Stroke Risk in Survivors of Head and Neck Cancer
Pui Lam Yip1, Huili Zheng2, Timothy Cheo1
1Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore.
JAMA Network Open
|February 13, 2024
Summary
Survivors of head and neck cancers (HNC) face a significantly higher risk of stroke, particularly those treated with radiation. Early screening and intervention are crucial for this high-risk population.
Area of Science:
- Oncology
- Neurology
- Public Health
Background:
- Head and neck cancer (HNC) survivors have an elevated risk of stroke.
- Comprehensive data on stroke risk in HNC survivor subpopulations is needed for effective survivorship strategies.
Purpose of the Study:
- To determine the stroke risk in various subpopulations of head and neck cancer survivors in Singapore.
- To identify specific demographic, disease, and treatment factors associated with increased stroke risk.
Main Methods:
- A national, registry-based, cross-sectional study utilized data from the Singapore Cancer Registry and Singapore Stroke Registry (2005-2020).
- International Classification of Diseases codes (ICD-9-CM, ICD-10-AM) were used to identify HNC survivors and stroke diagnoses.
- Age-standardized incidence rate ratios (SIRR) and differences (SIRD) were calculated comparing HNC survivors to the general Singapore population.
Main Results:
- 9803 HNC survivors were analyzed; 3.4% developed stroke during follow-up.
- Overall stroke risk was significantly elevated (SIRR=2.46, SIRD=4.11 per 1000 person-years).
- Younger survivors (<40 years) had a markedly higher risk (SIRR=30.55).
- Increased stroke risk was observed across most HNC subsites, stages, and treatment modalities.
- Radiation therapy was associated with a higher stroke risk (SIRR=3.01) compared to surgery (SIRR=1.64).
Conclusions:
- Head and neck cancer survivors exhibit a substantially increased risk of both ischemic and hemorrhagic stroke.
- This elevated risk spans various demographic and clinical subgroups, emphasizing the need for tailored surveillance.
- Findings highlight the critical importance of early stroke screening and proactive intervention strategies for HNC survivors, especially those receiving radiation therapy.
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