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Purpose/objectives: The increasing survivorship of head and neck squamous cell carcinoma (HNSCC) comes with a risk of death from other causes, known as competing causes. The demographics of HNSCC are also evolving with increasing incidence of Human Papillomavirus (HPV) associated tumors. This study describes competing causes of death for the HNSCC population compared to the general population and identifies associated risk factors.Methods: Adult patients with first mucosal HNSCC (2004-2011) were identified from the Surveillance, Epidemiology and End Result database. Competing causes of death were compared to reference populations using proportion of deaths and Standardized Mortality Ratios (SMR). A multivariable competing risk survival analysis yielded subdistribution hazard ratios (HR) for competing mortality.Results: Of 64,598 HNSCC patients, 24,602 (38.1%) were deceased including 7142 deaths (29.0%) from competing causes. The most common were cardiovascular disease, lung cancer, and other cancers. All relative mortality rates were elevated, especially liver disease (SMR 38.7; 95% CI: 29.4-49.3), suicide (SMR 37.1; 95% CI: 26.1-48.6), and subsequent primary cancers (SMR 7.5; 95% CI: 6.78-8.32). Demographic and tumor factors independently increased risk of competing mortality, including age (HR per 5years 1.24; 95% CI: 1.22-1.25), sex (male HR 1.23; 95% CI: 1.16-1.32), race (Black HR 1.17; 95% CI: 1.09-1.26), insurance (uninsured HR 1.28; 95% CI: 1.09-1.50), and marital status (single HR 1.29; 95% CI: 1.21-1.37).Conclusion: Nearly one in three HNSCC patients died from competing causes. When developing long term survivorship regimens for HNSCC patients, clinicians should be familiar with this population's specific risks. [ABSTRACT FROM AUTHOR]

Importance: United States military personnel during the Vietnam Era were potentially exposed to Agent Orange, a known carcinogen. The link between Agent Orange and head and neck cancers is largely unknown; laryngeal cancer is currently the only subsite with sufficient evidence of an Agent Orange association.Objective: We aim to determine the relationship between Agent Orange exposure and the incidence of head and neck cancers in Vietnam Era veterans as well as any relationship with head and neck cancer survival.Materials and Methods: The present study utilizes the Veterans Affairs Corporate Data Warehouse (VA CDW) to identify Vietnam Era veterans, their Agent Orange exposure status, limited demographic data, presence of head and neck cancer, and survival data.Results: Of 8,877,971 Vietnam Era veterans, 22% self-reported exposure to Agent Orange, and 54,717 had a diagnosis of head and neck cancer. Agent Orange exposure significantly predicted upper aerodigestive tract carcinoma, with a relative risk (RR) of 1.10. On subsite analysis, Agent Orange exposure (as well as race, gender, and substance use) was significantly associated with oropharyngeal (RR 1.16), nasopharyngeal (RR 1.22), laryngeal (1.11), and thyroid (1.24) cancers. Agent Orange exposure was associated with improved 10-year overall survival in upper aerodigestive tract cancer patients.Conclusions and Relevance: Self-reported Agent Orange exposure correlated with increased risks of oropharyngeal, nasopharyngeal, laryngeal, and thyroid cancers, and predicted improved survival in upper aerodigestive tract cancer patients. These findings broaden our understanding of the risks of Agent Orange exposure. [ABSTRACT FROM AUTHOR]