Incidence and Outcomes of Head and Neck Cancer in Patients With Schizophrenia.

Objective: We sought to determine the incidence and outcomes of head and neck cancer (HNC) among patients with schizophrenia.

Study design: Cohort study utilizing TriNetX, a database containing millions of deidentified clinical records.

Setting: Multicenter study utilizing records from 68 healthcare organizations.

Methods: A cohort of patients with schizophrenia was analyzed for the annual incidence of HNC diagnosis between 2011 and 2021. TriNetX was queried for adult patients with HNC with and without schizophrenia (or long-term antipsychotic use, as a surrogate). Cohorts were 1:1 propensity-matched based on sociodemographic variables to produce matched cohorts of 25,077 patients each. Outcomes included mortality, recurrence in lymph nodes and lung, systemic treatment, failure to thrive, and hospice enrollment. Outcomes are reported as hazard ratio (HR; Cox proportional hazards model) and odds ratio (OR) with 95% CI.

Results: Incidence of HNC in patients with schizophrenia peaked at 0.061% in 2012. HNC patients with schizophrenia have a significantly increased risk of mortality (HR 1.37, 95% CI 1.10-1.72), locoregional recurrence (OR 1.36, 95% CI 1.30-1.43), distant metastases to the lung (OR 1.72, 95% CI 1.59-1.87), chemotherapy (OR 4.26, 95% CI 3.88-4.69), radiation (OR 2.47, 95% CI 2.19-2.78), failure to thrive (OR 2.41, 95% CI 2.32-2.73), and hospice enrollment (OR 3.17, 95% CI 2.66-3.76) compared to HNC patients without schizophrenia.

Conclusion: HNC patients with schizophrenia have a significant increase in risk of mortality, recurrence, and poor outcomes compared to those without schizophrenia. These findings support a renewed focus on ensuring safety nets for this vulnerable population to ensure appropriate cancer screening and care.