Epithelial head and neck cancer survival in Europe: Geographical variation, time trends and long term survival.
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BACKGROUND: Head and neck cancers (HNC) are a heterogeneous group of rare cancers with known risk factors also associated with other tumours and pathologies. Treatment protocols are fast evolving. This paper, within the EUROCARE-6 project, aims to update geographical survival differences, survival progression over time and, for the first time, incorporates other causes of mortality in estimating long-term survival. METHODS: We analysed 587,358 primary HNC cases, subdivided into several epithelial cancer entities (squamous cell carcinoma of oral cavity, oropharynx, nasopharynx, nasal cavities, hypopharynx, larynx, epithelial major salivary glands and salivary gland type tumour of the head and neck) from 99 population-based cancer registries. Cases were diagnosed between 1998 and 2013 and followed-up to 2014. Relative survival (RS) was estimated by sex, age, country and period of diagnosis up to 15 years following diagnosis. We also estimated the risk of dying from causes other than HNC, using cause-of-death data from of a selection of cancer registries. RESULTS: Overall, 15-year RS survival for HNC was 30 % for men and 40 % for women. Five-year RS significantly improved over the period (2002-2013), the major increases for oropharyngeal epithelial tumours and for salivary type glands tumour of head and neck. Across European countries discrepancies remained, with poorer survival outcomes in Baltic and Eastern European countries. HNC patients were 2.1 times more likely to die from other causes compared to the general population. CONCLUSIONS: HNC are rare tumours which require complex treatment and centralization of care. The European Reference Network must work to reduce geographical discrepancies. The higher risk of death from non-HNC causes may be due to poorer overall health and greater levels of comorbidity associated with tobacco and alcohol use.