medwireNews: Head and neck cancer (HNC) survivors have an increased risk for stroke, suggest the findings of a Singaporean registry-based study.
“[E]levated stroke risks were observed across different age, subsites, and treatment modalities, underscoring the importance of early screening and intervention,” note Teng Hwee Tan (National University Hospital, Singapore) and team.
They explain in JAMA Network Open that “several studies have reported an increased risk of stroke in patients treated for HNC,” but heterogeneity due to the use of different measures and populations “has impeded clinicians from effectively using the findings to provide targeted counselling for specific HNC subpopulations.”
The researchers therefore analyzed data from the Singapore cancer, stroke, and death registries on 9803 patients without a history of stroke who were diagnosed with HNC between January 2005 and December 2020. The patients were aged a median of 58 years at HNC diagnosis and the majority (73.1%) were men. The most common HNC subsite was the nasopharynx, in 47.7%, followed by the larynx and tongue, in 12.5% and 10.8%, respectively.
Over a median follow-up of 42.5 months, 3.4% of patients had a stroke. The risk for stroke was significantly higher among patients with HNC than the general population, with a standardized incidence rate ratio (SIRR) of 2.46 and a standardized incidence rate difference (SIRD) of 4.11 strokes per 1000 patient–years.
The estimated cumulative incidence of stroke at 5 and 10 years after HNC diagnosis was 3% and 7%, respectively.
“Although we observed elevated stroke risks irrespective of age, sex, race and ethnicity, subsite, stage, and treatment modality, more pronounced stroke risks were identified in certain subpopulations,” say Tan and colleagues.
For instance, the SIRR was highest among individuals diagnosed with HNC below the age of 40 years, at 30.55, decreasing markedly to 5.84 among those aged 40–49 years at diagnosis and to 1.41 among those aged 80 years and older.
“While the exact mechanism of this differential association of age with stroke is largely unknown, it is possible that complications from HNC treatments, including cisplatin-induced vascular toxic effects and radiation-induced carotid artery pathologies, pose a significant stroke risk in younger individuals,” writes the team.
Another difference was observed with respect to treatment modality, such that patients undergoing primary radiation treatment had an SIRR of 3.01 compared with those not receiving such treatment, which was higher than the SIRR of 1.64 for patients undergoing versus not undergoing a primary surgery approach. The corresponding SIRDs were 5.12 and 1.84 strokes per 1000 patient–years.
Tan et al note that “[m]any studies have postulated that radiation may induce carotid pathology, which could be linked to increased stroke.” They caution, however, that the findings could also be impacted by factors such as the underlying HNC subsites, lifestyle factors, and “physicians’ bias to recommend radiation-based treatment for patients with more medical comorbidities, who are also at higher risk for stroke.”
The authors conclude that “[s]urvivorship programs should focus on active screening and management of modifiable cerebrocardiovascular risk factors,” but given the “paucity of evidence on specific stroke prevention measures in HNC,” more research is needed.
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