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Information about place and time of death can help patients, carers, general medical practitioners, and multi-professional teams to put palliation for oral cancer into context, particularly the aspirations of patients about where they die. Aintree Regional Maxillofacial Unit treated 487 consecutive patients for primary oral squamous cell carcinoma between 2006 and 2010. Mortality was ascertained from the Office for National Statistics. A total of 65 (13%) patients were treated with palliative intent, and median (IQR) survival was 4.3 months (2.1-8.0). The most common reasons for palliation were inoperability (33%) and extensive disease associated with serious comorbidity (18%). A total of 22 died in hospital, 14 in a hospice, 14 in their own home, 14 in a nursing, residential, or old people's home, and one elsewhere. Most patients given palliative care do not die in hospital and survival is short. Their needs and those of their carers can be better met through integrated care that is linked to the primary sector., (Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

There is a growing elderly population presenting with, and surviving, oral cancer. Making decisions about treatment is complex, and is influenced in part by prognosis and expected outcomes for health-related quality of life (HRQoL). We used the University of Washington Head and Neck Quality of Life scale (UWQoL) to compare HRQoL in patients by age group at a time closest to one year after primary surgery. Survival was analysed using data from the Office for National Statistics. A consecutive series of 1091 patients treated curatively for oral squamous cell carcinoma (SCC) at the regional maxillofacial unit at Aintree University Hospital between 1992 and 2009 were included in the main analysis. UWQoL data for 638 patients were available from about one year after treatment. Older patients (65 years or over) reported better physical and emotional function notably in regard to appearance, speech, saliva (75 years and over), pain, shoulder, mood, and anxiety than younger patients with head and neck cancer treated by operation. In conclusion, older patients seem to cope and adjust well to treatment and this is reflected in their HRQoL scores, which are higher in many domains than those of younger patients with head and neck cancer., (Copyright © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Understanding how variations in individual patients and perioperative events alter risk is fundamental to a useful audit of outcome. Many surgical scoring systems have been developed to allow for case-mix adjustment when reporting outcome data. To our knowledge this is the first report of the use of the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM and P-POSSUM) by a maxillofacial unit. We audited 360 operations in 245 patients between 2005 and 2008. The POSSUM morbidity equation showed reasonable discrimination (C Statistic 0.74), as did the P-POSSUM mortality equation (C Statistic 0.75), but neither showed a significant degree of goodness-of-fit (morbidity p=0.0001; mortality p=0.019). Analysis of subgroups of all elective and major operations showed no improvement in the accuracy of scores used to identify risk of complications. The need for a standard of care index for the audit of mortality and morbidity in major head and neck surgery has not yet been met., (Copyright © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Cancer mortality has been examined among ethnic South Asian migrants in England and Wales, but not by generation of migration., Methods: Using South Asian mortality records, identified by a name-recognition algorithm, and census information, age-standardised rates among South Asians, and South Asian vs non-South Asian rate ratios, were calculated., Results and Conclusions: All-cancer rates in ethnic South Asians were half of those in non-South Asians in first-generation (all-cancer-standardised mortality ratio (SMR) in males 0.51 and in females 0.56) and subsequent-generation South Asians (SMR in males 0.43 and in females 0.36). The higher mortality in first-generation South Asians for liver (both sexes), oral cavity and gallbladder cancer (females), particularly marked among Bangladeshis, was reduced in subsequent generations.

Aim: The aim of this paper was to compare demographics, treatment and outcomes from two large prospective audits of head and neck cancer patients in two disparate regions of the UK., Methods: In the Scottish Audit of Head and Neck Cancer (SAHNC) a total of 1910 patients with new head and neck cancers were registered in a two year period from September 1999 to August 2001. The South and West Audit of Head and Neck Cancer (SWAHN) was carried out in three phases between 1996 and 2002 with a total of 2050 cases., Results: There were more men in SAHNC than SWAHN (71% vs 67%, p<0.01) and patients in SAHNC presented at a younger age (76% aged 45-74 compared with 64%, p<0.001). Significantly more patients in Scotland had advanced (stage III/IV) laryngeal cancer (44% vs 30%, p<0.001). The overall disease specific five year survival was 54.5 for SAHNC and 54.2 for SWAHN., Conclusion: This comparison of large head and neck cancer cohorts provides important data to base UK head and neck cancer care and hypotheses regarding pathogenesis and the effects of treatment processes. Given the heterogeneity in disease, patient and healthcare characteristics between the two regions, the similarities in survival and process outcomes are striking.

The main aims of this article are to report the overall and disease-specific survival of a consecutive series of patients presenting with oral cancer from 1992 to 2002 and to relate survival to clinical and pathological factors. The article uses population-based age-sex mortality rates in the North-West of England to highlight differences in overall and disease-specific survival. 541 patients with oral squamous cell carcinoma presented to the Regional Maxillofacial Unit from 1992 to 2002. Curative treatment favoured radical primary surgery, 10% (52) received primary radiotherapy. These patients were on average 8 years older with more advanced tumours and overall poorer survival at 5 years, 23% (SE 7%). The remainder of the results refer to 489 patients who had primary curative surgery, 40% (194) of whom received adjuvant radiotherapy. The overall survival (OS) was 56% (SE 2%) and the disease-specific survival (DSS) was 74% (SE 2%). There was a local recurrence rate of 10% (50) and the loco-regional recurrence rate was 21% (103). The second primary rate was 7% (35). Survival figures had improved over the 10-year period from 63% DSS for the first 4 years of the study (1992-1995) compared to 81% for the last 3 years (2000-2002). In stepwise Cox regression the two predictors selected for disease-specific survival were pN status and margins (both p<0.001). Age-sex mortality rates for the North-West indicate that 15.0% of the 489 primary surgery patients might have been expected to die within 5 years if they were typical of the general population and the observed difference between all causes and oral-cancer specific survival was 18.3%. These data emphasise the value of disease-specific survival as an indicator of successful treatment in a cohort that tends to be elderly, from social deprived backgrounds, with life styles and comorbidity that influence overall survival.

The incidence rate of oral cancer among young people in the UK has been increasing since 1970s. The objective of this study was to compare relative survival of young people (under 45 years of age) diagnosed with oral cancer with that of older people (45 years and older) resident in South East England. Between 1986 and 2002, 5 year relative survival was higher among young people compared with the older group, suggesting age was a strong independent predictor of survival. Apart from age other independent predictors of survival included stage, treatment and affluence but residence was not a significant predictor of survival in either age group. For the young age group (0-44 years) mean relative survival for the period under study was relatively constant but consistently higher in younger women than in younger men.

Previous research has shown that south Asians residing in the south east of England have greater incidence rates of oral cancer than the majority population but little is known as to whether there are also differences in oral cancer survival. We compared the survival from oral cancer in the south Asian population of south-east England relative to the non-south Asian population and, after adjustment for potential confounders, we did not find any evidence of decreased survival. Indeed there was evidence that British south Asian males have significantly better survival than their non-south Asian peers in the south east of England.

Deprivation influences the incidence and outcome of patients with cancer. Health-related quality of life (HR-QoL) is an important measure of outcome but there is little on this subject and its correlation with deprivation in patients with oral and oropharyngeal cancer. Our aim was to ascertain the extent of deprivation in a cohort of patients who had operations for primary oral and oropharyngeal cancer and how deprivation affected HR-QoL in these patients during and after their treatment. A total of 278 consecutive patients who were operated on for oral and oropharyngeal cancer were included in this study. Validated measures of deprivation scores (Townsend, Carstairs, Jarman and Index of Multiple Deprivation 2000) were calculated, as well as patient-based indicators of social circumstances (marital status, smoking habit, alcohol intake). Comparison was made with the University of Washington-Quality of Life (UW-QoL) scores before and after treatment (6, 12, and 24 months).

This chapter summarizes accumulated data on the presence, magnitude and consistency of socioeconomic differentials in mortality and incidence of all malignant neoplasms and 24 individual types of neoplasms in 37 populations in 21 countries. More or less consistent excess risks in men in lower social strata were observed for all respiratory cancers (nose, larynx and lung) and cancers of the oral cavity and pharynx, oesophagus, stomach, and, with a number of exceptions, liver, as well as for all malignancies taken together. For women, low-class excesses were consistently encountered for cancers of the oesophagus, stomach, cervix uteri and, less consistently, liver. Men in higher social strata displayed excesses of colon and brain cancers and skin melanoma. In the two Latin American populations for which data were available, lung cancer was more frequent in higher social strata. Excesses in high female socioeconomic strata were seen in most populations for cancers of the colon, breast and ovary and for skin melanoma. Longitudinal data from England and Wales suggested widening over time of social class differences in men for all cancers combined and for cancers of the lung, larynx and stomach, and in women for all cancers combined and for cervical cancer.

Objectives: To examine the epidemiology of oral cancer in England and Wales from 1901 to 1990 using trends in mortality and incidence rates., Setting: Data were obtained from OPCS archives for mortality and incidence of malignant neoplasia of the oral cavity (ICD 141, 143-146). Age-specific and age-standardised rates were calculated for both genders. Mortality data were available from 1901 but national incidence figures only commenced in 1962., Results: Despite overall reductions for oral cancer in England and Wales during this century, significant increases in mortality and incidence have occurred in younger males during the last 30 years. These are associated with clear birth cohorts. No such cohort effects are apparent in females, despite similar though less pronounced trends., Conclusions: These results support similar studies in other parts of the UK and Europe. In the future there may be a substantial increase in the burden of new cases of oral cancer as birth cohorts with rising incidence rates enter age groups with higher disease frequencies. It is possible that raised alcohol consumption during the last 40 years may be responsible for the increases. This report reinforces the necessity to evaluate preventive programmes for oral cancer in the UK.

Objectives: To explore a suspected hazard of lung cancer in butchers and cooks., Methods: 4018 male butchers and 2062 male cooks were identified from the 1961 census of England and Wales. 4857 (79.9%) of these men were traced through the National Health Service Central Register, and 3518 deaths were recorded during follow up to the end of 1992. Mortality from lung cancer and other causes was compared with that of the general population by the person-years method., Results: Mortality from all causes was significantly below that of the national population in both butchers (standardized mortality ratio (SMR) 0.94, 95% confidence interval (95% CI) 0.90-0.98) and cooks (SMR 0.89, 95% CI 0.84-0.95). When allowance was made for a latency of 20 years from entry to follow up, the deficit in butchers was reduced, but that in cooks persisted, and was largely explained by a shortfall of deaths from cancer and circulatory disease. Mortality from lung cancer was close to expectation in the butchers (SMR 1.01, 95% CI 0.90-1.13) and below expectation in the cooks (SMR 0.93, 95% CI 0.75-1.13). Cooks had increased mortality from cancers of the oral cavity (SMR 5.57) and pharynx (SMR 2.66)., Conclusions: The findings provide no support for an occupational hazard of lung cancer in either butchers or cooks. The possibility of excess risk in sub-groups of these occupations cannot be discounted. The high rates of oral and pharyngeal cancer in cooks are probably a consequence of high alcohol consumption.

This study reveals that changes are occurring in the pattern of oral cancer. Despite decreases in the number of lip and salivary gland cases, intra-oral cancer is increasing. The number of new cases is rising, especially in females, and it is presenting at a younger age in males. Intra-oral cancer deaths have increased, with females showing a 40% rise. The mortality rate has deteriorated to 62%. It is possible that these increases could be attributed to continued lack of public awareness of the disease and a considerable rise in alcohol consumption per head of population in the UK.

A survey is presented of all known cases of cancer of the mouth in a population of nearly half a million in a relatively isolated part of Yorkshire, with the results of treatment of squamous carcinoma, adeno-carcinoma, lympho-sarcoma, malignant tumours of odontogenic origin and sarcomas.

Because of apparent inconsistencies in the two trials of neutron therapy carried out under its auspices, the MRC in 1982 requested a comparative review of the data in the Hammersmith and Edinburgh trials in so far as the clinical material allowed of such comparison. It was clear that the two trials were not only not contemporaneous (Hammersmith 1971-75; Edinburgh 1977-82) but that they differed in site and stage of disease as well as in the parameters of radiation dosage. Only a fraction of the patients were comparable and this review, which sets out the differences in design and conduct of the two trials, focuses on squamous-cell carcinoma in the four sites--oral cavity, oropharynx, larynx and hypopharynx--which were common in both. The first 120 patients entered into the Edinburgh trial have been compared with the 95 patients selected from 161 in the Hammersmith trial who would have been eligible at Edinburgh by reason of the site of disease and histology. Thus, Hammersmith patients with tumours of salivary glands, sinuses and neck nodes were, of necessity, excluded. Within such limitations the data on case distribution, tumour size and stage, the parameters of radiation dosage and the outcome in terms of tumour control, survival and treatment morbidity have been subjected to rigorous assessment and analysis. The important aspects in which the two investigations had differed included the stage of disease (more advanced at Hammersmith, with 63% of patients having fixed nodes, compared with 27% at Edinburgh); radiation dosage (the median neutron dose being 5% lower at Edinburgh than at Hammersmith while the median photon dose was l0% higher at Edinburgh); the "photon arm" of the Edinburgh trial being on site whereas that at Hammersmith had been at multiple centres; and the years in which the trials had been carried out. The two series are comparable in terms of treatment failure (local recurrence or late radiation death) following local tumour control. The results are also consistent in associating an increased incidence of late severe radiation morbidity and of intercurrent deaths with neutron therapy. In three other respects the results of the two series differ. At Edinburgh there was advantage to the photon-treated patients in terms of overall mortality, whereas at Hammersmith the advantage was to those treated with neutrons. The incidence of tumour regression for patients randomised to photons was much lower in the Hammersmith trial than for neutrons, whereas in Edinburgh the two modalities gave similar results.