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Risk of Head and Neck Cancer in Patients With Prior Hematologic Malignant Tumors

Educational Objective
To determine a possible association between previously diagnosed hematologic malignant disease and the development of head and neck cancer.
1 Credit CME
Key Points

Question  Is there an association between increased risk and worse survival outcomes in patients with head and neck cancer and a history of hematologic malignant tumors?

Findings  In a study of 30 939 656 patients, prior hematologic malignant tumors were associated with the development of head and neck cancer at multiple subsites; 2-year and 5-year overall survival rates were also worse among patients with a history of hematologic malignant tumors for several head and neck cancer subsites.

Meaning  The findings suggest that patients with hematologic malignant tumors are at higher risk of developing head and neck cancers and that overall survival may be worse for patients with head and neck cancer and a history of hematologic malignant tumors.


Importance  More than 1.3 million people in the United States have a hematologic malignant tumor currently or in remission. Previous studies have demonstrated an increased risk of secondary neoplasms in patients with hematologic malignant tumors, but research specifically on the risk of head and neck solid tumors in patients with prior hematologic malignant tumors is limited.

Objectives  To examine a possible association between prior hematologic malignant tumors and risk of head and neck cancer and to assess the overall survival (OS) among these patients.

Design, Setting, and Participants  This retrospective analysis used the Veterans Affairs (VA) Corporate Data Warehouse (CDW) to identify patients with diagnoses of hematologic malignant tumors and head and neck cancers. All patients in the VA CDW with a birthdate between January 1, 1910, and December 31, 1969, were included, for a cohort of 30 939 656 veterans. Data analysis was performed from August 15, 2018, to January 31, 2019.

Exposures  Outpatient problem lists were queried for diagnoses of hematologic malignant tumor and associated malignant tumors using International Classification of Diseases, Ninth Revision (ICD-9) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes to categorize patients by history of hematologic malignant tumors.

Main Outcomes and Measures  Presence of head and neck cancer was determined from ICD-9 and ICD-10 codes of outpatient problem lists, and cancers were grouped by subsite. The OS was determined from date of death or last outpatient visit date.

Results  Of 30 939 656 patients (27 636 683 [89.3%] male; 13 971 259 [45.2%] white), 207 322 patients had a hematologic malignant tumor, of whom 1353 were later diagnosed with head and neck cancer. A history of hematologic malignant tumors was significantly associated with overall aerodigestive tract cancer, with a relative risk (RR) of 1.6 (95% CI, 1.5-1.7), as well as oral cavity (RR, 1.7; 95% CI, 1.5-1.9), oropharynx (RR, 1.7; 95% CI, 1.5-1.9), larynx (RR, 1.3; 95% CI, 1.2-1.5), nasopharynx (RR, 2.8; 95% CI, 2.1-3.9), sinonasal (RR, 3.0; 95% CI, 2.2-4.1), salivary gland (RR, 2.8; 95% CI, 2.4-3.3), and thyroid (RR, 2.1; 95% CI, 1.9-2.4) tumors on subsite analysis. A prior hematologic malignant tumor was also negatively associated with 2-year and 5-year OS for multiple subsites.

Conclusions and Relevance  A prior diagnosis of hematologic or associated malignant tumors was associated with an increased risk of solid head and neck cancers in a range of subsites. In addition, for several head and neck cancer subsites, patients with prior hematologic malignant tumors had worse 2-year and 5-year OS. These results indicate that a prior hematologic malignant tumor may be an adverse risk factor in the development and progression of head and neck cancer.

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Article Information

Accepted for Publication: April 2, 2019.

Corresponding Author: Daniel Clayburgh, MD, PhD, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Mail Code PV01, Portland, OR 97239 (clayburg@ohsu.edu).

Published Online: May 2, 2019. doi:10.1001/jamaoto.2019.1012

Author Contributions: Drs Mowery and Clayburgh had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Mowery, Clayburgh.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Mowery, Clayburgh.

Administrative, technical, or material support: Conlin.

Supervision: Conlin, Clayburgh.

Conflict of Interest Disclosures: Dr Clayburgh reported receiving grants from Abbvie Inc outside the submitted work. No other disclosures were reported.

Meeting Presentation: This article was presented in part at the Annual Meeting of the American Head and Neck Society; May 2, 2019; Austin, Texas.

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