Risk of Stroke in Survivors of Head and Neck Cancer

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In a Singaporean study reported in JAMA Network Open, Yip et al found that survivors of head and neck cancer were at an increased risk of stroke compared with the general population.

Study Details

The registry-based cross-sectional study involved 9,803 survivors—excluding those with a history of stroke prior to head and neck cancer diagnosis—who had been diagnosed with head and neck cancer between January 2005 and December 2020. Risk of stroke was calculated as age-standardized incidence rate ratio and age-standardized incidence rate difference compared with the general population of Singapore.

Key Findings

Among the 9,803 survivors, 337 (3.4%) had a stroke during a median follow-up of 42.5 months (interquartile range [IQR] =15.0–94.5 months). The overall standardized incidence rate ratio was 2.46 (95% confidence interval [CI] = 2.21–2.74) strokes per 1,000 person-years, and the overall standardized incidence rate difference was 4.11 (95% CI = 3.37–4.85) strokes per 1,000 person-years. The cumulative incidence of stroke was 3% at 5 years and 7% at 10 years after head and neck cancer diagnosis.

The standardized incidence rate ratio was highest among individuals diagnosed with head and neck cancer at age < 40 years (30.55, 95% CI = 16.24–52.35, strokes per 1,000 person-years). All subgroups defined by age, sex, race/ethnicity, head and neck cancer subsites (except tongue), stage, histology, and treatment modalities had an increased risk of stroke vs the general population.

Compared with patients treated with a primary surgery approach (surgery only; surgery and radiation therapy; surgery and chemotherapy; or surgery, radiation therapy, and chemotherapy within 6 months of head and neck cancer diagnosis), those with a primary radiation therapy approach (radiation therapy only or radiation therapy and chemotherapy within 6 months of head and neck cancer diagnosis) had a higher standardized incidence rate ratio (3.01 vs 1.64 strokes per 1,000 person years) and higher standardized incidence rate difference (5.12 vs 1.84 strokes per 1,000 person-years).

The investigators concluded, “In this cross-sectional study of survivors of head and neck cancer, elevated stroke risks were observed across different age, subsites, and treatment modalities, underscoring the importance of early screening and intervention.”

Teng Hwee Tan, MBBS, of the Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, is the corresponding author for the JAMA Network Open article.

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