Trends in epidemiology and treatment and outcome for head and neck cancer: A population-based long-term analysis from 1996 to 2011 of the Thuringian cancer registry

Introduction: The objective of this study was to examine patterns of care and survival in a population-based sample of patients with head neck cancer (HNC) who were treated in Thuringia, a federal state in Germany, between 1996 and 2011. Methods: Data of 6291 patients with primary HNC from the Thuringian cancer registry were used to evaluate for patient's characteristics, tumor stage, incidence, and trends in treatment and overall survival (OS). Results: The distribution between stages I-IV did not change significantly during the observation period. Crude incidences of HNC increased significantly between 1996 and 2011 from 13.77 to 20.39 (relative risk [RR] = 1.34; 95% confidence interval [CI] = 1.25-1.45). This increase was mainly driven by a significant increase of oropharynx cancer (from 3.29 to 5.85; RR = 1.67; 95% CI = 1.49-1.88) and cancer of the oral cavity (3.41-5.90; RR = 1.5; 95% CI = 1.33-1.69). The relative frequency of multimodal therapy increased (RR = 1.42; 95% CI = 1.3-1.55). The use of cetuximab increased (RR = 473.32; 95% CI = 51.57-4344.51). The 5-year and 10-year OS for the entire cohort was 49.1% and 34.1%, respectively. The multivariable analysis has proven that male gender, age >= 60 years, therapy without surgery, and TNM stage were independent significant negative risk factors for OS (all p < 0.0001). Conclusions: OS did not improve during the study period. Incidence of oral cancer is significantly increasing. Although modern treatment strategies have been included in routine HNC care over the time, outcome has not improved significantly. (C) 2014 Elsevier Ltd. All rights reserved.