Pre-Treatment Performance Status and Stage at Diagnosis in Patients with Head and Neck Cancers

  • Krishnatreya, Manigreeva (Department of Cancer Registry, Epidemiology and Biostatistics, Dr.B Borooah Cancer Institute) ;
  • Rahman, Tashnin (Department of Head and Neck Oncology, Dr.B Borooah Cancer Institute) ;
  • Kataki, Amal Chandra (Department of Cancer Registry, Epidemiology and Biostatistics, Dr.B Borooah Cancer Institute) ;
  • Sharma, Jagannath Dev (Department of Cancer Registry, Epidemiology and Biostatistics, Dr.B Borooah Cancer Institute) ;
  • Nandy, Pintu (Department of Cancer Registry, Epidemiology and Biostatistics, Dr.B Borooah Cancer Institute) ;
  • Baishya, Nizara (Department of Head and Neck Oncology, Dr.B Borooah Cancer Institute)
  • Published : 2014.10.23


Performance status (PS) is a key factor in the selection of treatment in head and neck cancer patients (HNC). There is a probability in the development of an unfavorable PS with HNC advancing stages. This retrospective study was done on data of patients registered during the period from January 2010 to December 2012 at a cancer registry in the North Eastern India. PS was recorded according to the WHO scale. Multinomial logistic regression analysis was conducted to assess the probability of poor performance status with advancing stage. Out of 3,593 patients, there were 78.9% (2,836) males and 21.1% (757) females. Average PS0 was seen in 57.4% of all HNCs, less than 1% of all cases in HNCs with poor PS3-4 except in cases with thyroid, parotid and nose and PNS cancers, 0.7% stage IV (${\pm}M1$) HNC with PS4, favorable PS0-1 was seen in 84% to 100% of cases, RR=57.1 (CI=21.2-154.1) in M1 for PS4 and with advancing stages the probability of worsening of PS0 to PS4 was 3 times (P=0.021, 95% CI= 1.187-8.474). In HNC, the majority of patients presents with a favorable PS0-1 with different odds of worsening of PS with advancing stages and the presence of metastasis in stage IV is significantly associated with a poor PS.


Head and neck cancer;performance status;pre treatment;stage at diagnosis


  1. Eisenhauer EA, Therasse P, Bogaerts J, et al (2009). New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Eur J Cancer, 45, 228-47.
  2. Albano PM, Salvador CL, Orosa J, et al (2013).Overall survival of Filipino patients with squamous cell carcinoma of the head and neck: a single-institution experience. Asian Pac J Cancer Prev, 14, 4769-74.
  3. Dimery IW, Hong WK (1993). Overview of combined modality therapies for head and neck cancer. J Natl Cancer Inst, 85, 95-111.
  4. Edge S, Byrd DR, Compton CC, et al (2010). AJCC Cancer Staging Manual. 7th ed. Bangalore: Springer-Verlag.
  5. Ferlito A, Shaha AR, Silver CE, Rinaldo A, Mondin V (2001). Incidence and sites of distant metastases from head and neck cancer. ORL J Otorhinolaryngol Relat Spec, 63, 202-7.
  6. Joshi A, Patil V M, Noronha V, et al (2013). Is there a role of induction chemotherapy followed by resection in T4b oral cavity cancers? Indian J Cancer, 50, 349-55.
  7. Mishra A, Meherotra R (2014). Head and neck cancer: global burden and regional trends in India. Asian Pac J Cancer Prev, 15, 537-50.
  8. National Cancer Registry Programme (2013). Consolidated report of Population Based Cancer Registries of India. 2009-2011, ICMR: NCDIR, Bangalore.
  9. Pandey KC, Revannasiddaiah S, Pant NK, Bhatt HC (2014). Stage-wise presentation of non-metastatic head and neck cancer: an analysis of patients from the Kumaon hills of India. Asian Pac J Cancer Prev, 15, 4957-61.
  10. Patel KN, Shaha AR (2005). Locally advanced thyroid cancer. Curr Opin Otolaryngol Head Neck Surg, 13, 112-6.
  11. Peus D, Newcomb N, Hofer S (2013). Appraisal of the Karnofsky performance Status and proposal of a simple algorithmic system for its evaluation. BMC Med Inform Decis Mak, 13,72.
  12. Pruegsanusak K, Peeravut S, Leelamanit V et al, (2012). Survival and prognostic factors of different sites of head and neck cancer: an analysis from Thailand. Asian Pac J Cancer Prev, 13, 885-90.
  13. Shitara K, Muro K, Matsuo K, et al (2009). Chemotherapy for patients with advanced gastric cancer with performance status 2. Gastrointest Cancer Res, 3, 220-4.
  14. Vokes EE, Weichselbaum RR (1990). Concomitant chemoradiotherapy: Rationale and clinical experience in patients with solid tumors. J Clin Oncol, 8, 911-934.
  15. Vokes EE, Weichselbaum RR, Lippman SM, Hong WK (1993). Head and neck cancer. N Engl J Med, 328, 184-194.
  16. West HJ (2013). Patients with advanced non-small-cell lung cancer and marginal performance status: Walking the tight rope towards improved survival. J Clin Oncol, 31, 2841-3.

Cited by

  1. Educational Levels and Delays in Start of Treatment for Head and Neck Cancers in North-East India vol.15, pp.24, 2015,
  2. Radiotherapy and Concurrent Chemo-Radiotherapy in Locally Advanced Hypopharyngeal Cancers - A Hospital Registry Based Analysis vol.16, pp.11, 2015,