Patients facing a new diagnosis of cancer universally discuss the important subject of prognosis with their physicians. Survival statistics for patients with specific types of cancers are often published in a way that reveals survival of a population of patients only from the time of diagnosis. This may not be helpful later on when patients have survived free of their disease for a period of time because patients with some types of cancer have an increasingly greater likelihood of surviving their disease as time goes on. Oregon Health & Science University Cancer Institute researchers are part of a team that has found that this is true for most patients with head and neck cancers.
The research was published in the American Cancer Society journal, Cancer. Samuel Wang, M.D., Ph.D., Holman Pathway Resident in the Department of Radiation Medicine, OHSU School of Medicine, is one of the lead investigators. This new research, if confirmed by additional studies, may help patients and their physicians better understand patients' risk from their head and neck tumors.
"Using the results of this study, we can now tell head and neck cancer survivors how their prognoses may change over time. This often will be good news for patients because we found that most patients' prognosis improved after they survived longer periods of time from when they were first diagnosed and treated," Wang said.
Clifton David Fuller, M.D., the first author, explained their findings: "Let's use the example of a patient diagnosed with squamous cell cancer of the middle ear. When she was diagnosed two years ago, she had a less than 50 percent chance of surviving another five years. After treatment, her tests show no evidence of the cancer. Her oncologist wonders, 'Are this patient's chances of surviving another five years still 50 percent?' We now know that the answer is, 'no,' her risk profile has changed. Her likelihood of survival has increased to about a two in three chance of surviving five years from today." Fuller is a resident in the Department of Radiation Oncology and a trainee in Human Imaging/Radiobiology, in the Division of Radiological Sciences at the University of Texas Health Science Center at San Antonio.
While most head and neck cancer patients showed improvement in survival for the first one to three years after diagnosis, after about three years, little additional improvement in survival likelihood was seen. This three-year risk plateau was not true for all head and neck cancers, however. For cancer of the nasopharynx (an area in the back of the mouth and the nasal passages) the risk of death increased each year. For lip cancer, the news was better: the outlook for surviving improved with each year survived.
The researchers looked at data from 76,181 patients in Surveillance, Epidemiology and End Results (SEER), a program of the National Cancer Institute. The SEER program currently collects and publishes cancer incidence and survival data from population-based cancer registries covering approximately 26 percent of the U.S. population.
The next step will be to confirm these findings with additional large databases. With those results, the researchers hope to create an online tool that will let physicians determine what a patient's estimated survival is in real time. Patients and their physicians will then have this information to be better able to tailor treatment on an individual basis and also how frequently the patient needs to be monitored afterward. This will be a big leap forward for patients with head and neck cancers," Wang said.
"There is a great need in head and neck cancer for tools like the online risk calculator Wang has proposed, which exists already for breast and prostate cancers. As doctors, we always are looking to add information that, combined with the patient's risk profile, current health concerns, and patient desires, will allow us to better treat a patient's individual situation. It is important to note that this study has both radiation oncologists and head and neck cancer surgeons involved as co-authors, which speaks to the need for better tools to help cancer patients and their physicians," Fuller said.
Head and neck cancers account for more than 5 percent of all cancers in the United States. These cancers are more common in men and in people older than age 50. It is estimated by the American Cancer Society that about 39,000 men and women in this country developed head and neck cancer last year.
Charles R. Thomas Jr., M.D., chairman of the Department of Radiation Oncology and member of OHSU Cancer Institute; Henry Hoffman, M.D., Department of Otolaryngology and Head and Neck Surgery at the University of Iowa; Randal Weber, M.D., Department of Head and Neck Surgery, University of Texas M.D. Anderson Cancer Center; and David Rosenthal, M.D., Department of Radiation Oncology, M.D. Anderson Cancer Center, are co-authors of the study.