Aspiration pneumonia after concurrent chemoradiotherapy for head and neck cancer

Abstract

Background: Aspiration pneumonia represents an under-reported complication of chemoradiotherapy in patient with head and neck cancer. The objective of the current study was to evaluate the incidence, risk factors, and mortality of aspiration pneumonia in a large cohort of patients with head and neck cancer who received concurrent chemoradiotherapy.

Methods: Patients who had head and neck cancer diagnosed between 2000 and 2009 were identified from the Surveillance, Epidemiology, and End Results-Medicare database. Aspiration pneumonia was identified from Medicare billing claims. The cumulative incidence, risk factors, and survival after aspiration pneumonia were estimated and compared with a noncancer population.

Results: Of 3513 patients with head and neck cancer, 801 developed aspiration pneumonia at a median of 5 months after initiating treatment. The 1-year and 5-year cumulative incidence of aspiration pneumonia was 15.8% and 23.8%, respectively, for patients with head and neck cancer and 3.6% and 8.7%, respectively, for noncancer controls. Among the patients with cancer, multivariate analysis identified independent risk factors (P < .05) for aspiration pneumonia, including hypopharyngeal and nasopharyngeal tumors, male gender, older age, increased comorbidity, no surgery before radiation, and care received at a teaching hospital. Among the patients with cancer who experienced aspiration pneumonia, 674 (84%) were hospitalized; and, of these, 301 (45%) were admitted to an intensive care unit. The 30-day mortality rate after hospitalization for aspiration pneumonia was 32.5%. Aspiration pneumonia was associated with a 42% increased risk of death (hazard ratio, 1.42; P < .001) after controlling for confounders.

Conclusions: The current results indicated that nearly 25% of elderly patients will develop aspiration pneumonia within 5 years after receiving chemoradiotherapy for head and neck cancer. A better understanding of mitigating factors will help identify patients who are at risk for this potentially lethal complication.

Keywords: End Results Program; Epidemiology; Medicare; Surveillance; aspiration pneumonia; chemoradiotherapy; head and neck neoplasms.

Figure 1

Cumulative incidence of aspiration pneumonia in patients with head-and-neck cancer (N=3,513) compared to non-cancer matched pairs (N=3,513).

Figure 2

Cumulative incidence of aspiration pneumonia among head-and-neck cancer patients by tumor site (A), Charlson comorbidity score (B), patient age at diagnosis (C) and care received at a teaching hospital (D).

Figure 3

Kaplan-Meier curves for overall survival. Figure 3A represents survival from the date of aspiration pneumonia among head-and-neck cancer patients who developed aspiration pneumonia (N=801). Figure 3B represents survival from the date of diagnosis among patients with head-and-neck cancer stratified by whether patients developed aspiration pneumonia (N=801) or not (N=2,712).