Head and neck cancer: patient characteristics, medical care seeking and long-term prognosis

Thesis event information

Date and time of the thesis defence

Place of the thesis defence

Oulu University Hospital, lecture hall 6. Remote access: https://oulu.zoom.us/j/61028697876?pwd=RCtwU29SUlpmMzBtOFZDd29IVytmUT09

Topic of the dissertation

Head and neck cancer: patient characteristics, medical care seeking and long-term prognosis

Doctoral candidate

M.D. Janne Väisänen

Faculty and unit

University of Oulu Graduate School, Faculty of Medicine, PEDEGO

Subject of study

ear-, nose- and throat diseases

Opponent

Professor Jaakko Pulkkinen, Turku University Hospital

Custos

Professor Olli-Pekka Alho, University of Oulu

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Patient characteristics, medical care-seeking, and long-term prognosis in head and neck cancer

In head and neck cancer (HNC) survival is impaired by delay in diagnosis, recurrence of the cancer, and competing causes of death. Patient-related factors that may lead to delayed medical-care-seeking in HNC are still partly unknown. There is also limited data on recurrence patterns and outcome after recurring HNC, and on the impact of competing causes of death on survival of HNC patients.

The intent of this work was to assess the patient characteristics associated with delayed medical care-seeking in HNC, to explore the patterns and outcome in recurring laryngeal cancer (LC), and the competing causes of death and their impact on survival in long term follow-up of patients with HNC. There were three patient groups in this work. 85 patients with HNC were studied on patient characteristics and delayed medical care seeking. On 316 patients the patterns and outcome of recurring LC were explored. 220 patients with cancers of oral cavity, pharynx, and larynx, were studied to get data on competing causes of death and their impact on long term survival.

General fear of physicians, symptom other than pain, and patient not suspecting cancer were associated with delayed medical care-seeking. In LC, impaired physical performance status, neck metastasis at primary phase, and non-surgical treatment were predictors of recurrence. In patients with other than local recurrence, and in recurring supraglottic tumours, survival was poor. Regarding competing causes of death, advanced age and high comorbidity predicted death due to non-HNC causes. Large tumour, old age, pharynx carcinoma, and advanced nodal status were predictors of HNC death. HNC patients lost significant number of life years even if they survived from their cancer. Lung was the most common site for second primary cancer after index HNC, with very high mortality.

The results of this work suggest that HNC patients are often ordinary elderly people, and symptoms indicative of HNC should not be overlooked by healthcare professionals. Also, there seems to be need for more health education on symptoms of HNC. In LC, sufficiently aggressive primary treatment in especially supraglottic cancer should be advocated. There is also need for more studies on optimal treatment modalities in LC. HNC patients face excessive risk of mortality even if they survive from their cancer, most likely because of smoking.
Last updated: 1.10.2021