Increasing Mean Age of Head and Neck Cancer Patients at a German Tertiary Referral Center

Abstract

Background: The impact of demographic change on the age at diagnosis in German head and neck cancer (HNC) patients is unclear. Here we present an evaluation of aging trends in HNC at a tertiary referral center.

Methods: Retrospective cohort study on aging trends at the initial diagnosis of newly diagnosed patients with HNC between 2004 and 2018 at the head and neck cancer center Ulm in relation to demographic data of the catchment area.

Results: The study population consisted of 2450 individuals diagnosed with HNC with a mean age of 62.84 (±11.67) years. We observed a significant increase in annual incidence rates and mean age over time. Mean age among HNC patients increased significantly more than among the population in the catchment area. Whereas the incidence rate of patients <50 years did not change, the incidence of HNC patients aged ≥70 years increased the most. The mean patient age in the main tumor sites increased significantly. Surprisingly, HPV-positive patients were not younger than HPV-negative patients, but showed a non-significant trend towards a higher mean age (63.0 vs. 60.7 years).

Conclusions: Increasing incidence rates in older patients pose a challenge for health care systems. A nationwide study is needed to assess the dynamics and impact of aging on the incidence of HNC.

Keywords: HPV; aging; demographics; epidemiology; head and neck cancer.

Figure 1

Total and main catchment area of the patient cohort. (A) Patient numbers were graphed to the map of Germany based on their postal codes using Excel. The colors indicate the number of patients per dot as indicated in the figure legend. (B) The main catchment area was defined based on county borders to be able to obtain demographic population data of the main catchment area (indicated in red).

Figure 2

Development of the age at diagnosis and newly diagnosed cases between 2004 and 2018. (A) The mean age of the 2450 patients diagnosed between 2004 and 2018 is graphed on the left y-axis as a violin plot showing all individual values. The median and quartiles are indicated by red horizontal bars. Significant changes in the mean age compared to 2004 are indicated by asterisks. The incidence rate of newly diagnosed cases per 100,000 is graphed on the right y-axis in the form of a blue line. * adjusted p-value < 0.05, ** adjusted p-value < 0.01, *** adjusted p-value < 0.001. (B) Linear regression model of the mean age in the HNC patient cohort and the population in the main catchment area. The mean age ± standard deviation is indicated by the symbols and the linear regression model is shown as the connecting line with the upper and lower 95% confidence interval indicated by broken lines.

Figure 3

Absolute and relative numbers of HNC patients between 2004 and 2018. All data are plotted showing the mean. (A–D): Incidence rates of HNC patients per 100,000 in the respective population at risk are graphed on the y-axis and the year of diagnosis on the x-axis by (A) T-status (T1/T2 vs. T3/T4), (B) nodal status (N0 vs. N+), (C) gender and (D) age (<50, ≥50 <70 and ≥70 years). The lines indicate the linear regression model and the broken lines the upper and lower 95% confidence interval.

Figure 4

Grouped scatter plots and linear regression of age and year of diagnosis separated by the primary tumor site. (A). The mean age of patients diagnosed from 2004 to 2018 by primary tumor site is graphed on the left y-axis as a violin plot showing all individual values. Patient subgroups were ordered by the median age. Median and quartiles are indicated by red horizontal bars. (B). The mean age ± standard deviation for the most prevalent four primary tumor sites (oropharynx, hypopharynx, larynx and oral cavity) is graphed on the y-axis over time on the x-axis. The lines indicate the linear regression model and the broken lines the upper and lower 95% confidence interval.

Figure 5

Age at diagnosis for the subgroup of oropharyngeal cancers with known HPV-status. (A) The mean age of patients diagnosed from 2004 to 2018 HPV-status is graphed on the left y-axis as a violin plot showing all individual values. The median and quartiles are indicated by red horizontal bars. Mean age at diagnosis was not significantly different. HPV-negative: n = 196, HPV-positive: n = 132. (B) Mean age with standard deviation of a subgroup of patients diagnosed between 2012 and 2018 for who the HPV-status was available. Only diagnosis years with ≥5 patients in both subgroups were included in this analysis.