Risk Factors for Early Mortality in Head and Neck Cancer Patients Undergoing Definitive Chemoradiation

Introduction: Head and neck cancer (HNC) afflicts >16,000 people in Hong Kong annually. Non-operative treatment for HNC typically involves radiotherapy (with or without concurrent systemic therapy) and is associated with significant acute toxicity. Demography, tumour factors, and co-morbidities each influence treatment outcome and prognosis, but their role in predicting 90-day mortality is less well-known. Methods: Demographic, clinical, and co-morbidity data of 725 non-metastatic HNC patients (9.4% stage I/II, 90.6% stage III/IV), who had undergone definitive radiotherapy from 1 January 2016 to 1 March 2020 were collected. Predictors for 90-day mortality were evaluated by simple and multivariable logistic regression. Results: We report a 4.6% 90-day mortality rate. Age >60 years (odds ratio [OR] = 3.453, 95% confidence interval [CI] = 1.195-9.928; p = 0.022), Eastern Cooperative Oncology Group performance status (OR = 2.184, 95% CI = 1.071-4.454; p = 0.032) and pre-treatment haemoglobin level (OR = 0.764, 95% CI = 0.596-0.979; p = 0.034) were significant predictors of 90-day mortality on multivariable analysis. Of the eight co-morbidity scores studied, the Adult Comorbidity Evaluation-27 (ACE-27) [OR = 2.177, 95% CI = 1.397-3.393; p = 0.001] and the Taipei Medical University-concurrent chemoradiotherapy Mortality Predictor Score (TMU-CCRT) [OR = 1.501, 95% CI = 1.134-1.986; p = 0.004) were the most significant predictors of 90-day mortality. Conclusion: Both clinical factors and co-morbidities predict early mortality in HNC patients. ACE-27 and TMU-CCRT are appropriate for co-morbidity assessment in relation to early mortality. Further studies to develop prospective models that identify accurately patients at risk of early mortality during treatment are necessary.