Head and neck cancer in the south west of England, Hampshire, and the Isle of Wight: trends in survival 1996-2008

There are reasons why survival may have improved in people with head and neck cancer, but few studies have reported on trends in the UK, and results are not consistent. We examined recent trends in survival for people diagnosed with head and neck cancer in the south west of England. Patients were identified over four one-year audits in a population (roughly 6.5 million) served by five cancer networks, and the work was collated by the South West Public Health Observatory (SWPHO) tumour panel. The SWPHO cancer registry provided data on death. Prognostic data, including stage, time to treatment, and deprivation index were extracted or derived from clinical records. A total of 2164 cases of oral, laryngeal, and pharyngeal squamous cell carcinomas (SCC) were diagnosed. Crude total 5-year mortality decreased from 55% (95% CI 50.3-59.4) in people diagnosed in 1996 to 44% (95% CI 37.9-46.4) in those diagnosed in 2003 (p<0.001). Adjusted hazard ratios (HRs) for death within five years of diagnosis for surveys 2, 3, and 4 (compared with survey 1), respectively, were reduced in subsequent groups: HR 0.79 (95% CI 0.64-0.98), HR 0.70 (95% CI 0.56-0.87), and HR 0.72 (95% CI 0.58-0.90) (chi square for trend, p<0.001). Improvements over time were most pronounced among those with late-stage disease and with pharyngeal tumours. We have shown that survival has improved for people with head and neck cancer. Further large prospective studies are required to understand how quality of care, treatment, aetiology of tumour, individual risk, and behaviour contribute to survival.