Increased risk of dementia in patients with nasopharyngeal cancer treated with radiation therapy: A nationwide population-based cohort study

I-Wen Penn; Chi-Hsiang Chung; Yen-Chun Huang; Ming-Chih Chen; Chien-An Sun; Ping-Keung Yip; Wu-Chien Chien

doi:10.1016/j.archger.2020.104303

Increased risk of dementia in patients with nasopharyngeal cancer treated with radiation therapy: A nationwide population-based cohort study

Arch Gerontol Geriatr. 2021 Mar-Apr:93:104303. doi: 10.1016/j.archger.2020.104303. Epub 2020 Nov 22.

Authors

I-Wen Penn¹, Chi-Hsiang Chung², Yen-Chun Huang³, Ming-Chih Chen⁴, Chien-An Sun⁵, Ping-Keung Yip⁶, Wu-Chien Chien⁷

Affiliations

¹ School of Medicine, College of Medicine, Fu Jen Catholic University, Xinzhuang District, New Taipei City, 24205, Taiwan (R.O.C.); Department of Physical Medicine and Rehabilitation, Fu Jen Catholic University Hospital, Fu Jen Catholic University, Taishan District, New Taipei City, 24352, Taiwan (R.O.C.). Electronic address: 138851@mail.fju.edu.tw.
² School of Public Health, National Defense Medical Center, Neihu District, Taipei City, 11490, Taiwan (R.O.C.).
³ Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Xinzhuang District, New Taipei City, 24205, Taiwan (R.O.C.).
⁴ Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Xinzhuang District, New Taipei City, 24205, Taiwan (R.O.C.). Electronic address: 081438@mail.fju.edu.tw.
⁵ Big Data Research Center, College of Medicine, Fu Jen Catholic University, Xinzhuang District, New Taipei City, 24205, Taiwan (R.O.C.); Department of Public Health, College of Medicine, Fu Jen Catholic University, Xinzhuang District, New Taipei City, 24205, Taiwan (R.O.C.). Electronic address: 040866@mail.fju.edu.tw.
⁶ College of Medicine, Fu Jen Catholic University, Xinzhuang District, New Taipei City, 24205, Taiwan (R.O.C.). Electronic address: 049782@mail.fju.edu.tw.
⁷ School of Public Health, National Defense Medical Center, Neihu District, Taipei City, 11490, Taiwan (R.O.C.); Graduate Institute of Life Sciences, National Defense Medical Center, Neihu District, Taipei City, 11490, Taiwan (R.O.C.); Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Neihu District, Taipei City, 11490, Taiwan (R.O.C.); Taiwanese Injury Prevention and Safety Promotion Association, Neihu District, Taipei City, 11490, Taiwan (R.O.C.). Electronic address: chienwu@mail.ndmctsgh.edu.tw.

PMID: 33302001
DOI: 10.1016/j.archger.2020.104303

Abstract

Purpose: We evaluated the risk of dementia in patients with nasopharyngeal cancer (NPC) after undergoing radiation therapy (RT).

Methods: Between January 1, 2000, and December 31, 2015, 594 patients newly diagnosed with NPC and treated with RT (NPC cohort) were identified from the Longitudinal Health Insurance Database (LHID) for this nationwide population-based matched cohort study. LHID is a subset of the National Health Insurance Research Database of Taiwan. We selected 2376 controls (non-NPC comparison cohort) using a four-fold propensity score-matched by sex, age, comorbidities, education level, tobacco abuse, and index date (the date when the patient received first RT). After adjusting for confounding factors, Fine and Gray's competing risk analysis compared dementia development between the NPC study cohort and non-NPC comparison cohort over the observation period from 2000 to 2015.

Results: Dementia development was 6.57% (39 of 594) and 4.42% (105 of 2376) in the NPC study cohort and non-NPC comparison cohort, respectively. Patients with NPC receiving RT were more likely to develop dementia than the comparison cohort, with a crude hazard ratio (HR) of 1.63 [95% confidence interval (CI) = 1.25-2.13, P < 0.001]. After adjusting for age, sex, education level, tobacco abuse, comorbidity, geographic area, urbanization level of the residence, and care level, the adjusted HR was 1.91 (95% CI = 1.42-2.51, P < 0.001).

Conclusions: Patients with NPC receiving RT had a 1.91-fold higher risk of dementia than the non-NPC comparison controls.

Keywords: Cohort study; Dementia; Nasopharyngeal cancer; National Health Insurance Database; Population-based study; Radiation therapy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cohort Studies
Comorbidity
Dementia* / epidemiology
Dementia* / etiology
Humans
Nasopharyngeal Neoplasms* / epidemiology
Nasopharyngeal Neoplasms* / radiotherapy
Proportional Hazards Models
Retrospective Studies
Risk Factors
Taiwan / epidemiology