International Journal of Neuroscience

ISSN: 0020-7454 (Print) 1543-5245 (Online) Journal homepage: http://www.tandfonline.com/loi/ines20

Increasing risks of ischemic stroke in oral cancer patients treated with radiotherapy or chemotherapy: a nationwide cohort study Yu-Ting Wu, Chung-Yu Chen, Wen-Ter Lai, Chen-Chun Kuo & Yaw-Bin Huang To cite this article: Yu-Ting Wu, Chung-Yu Chen, Wen-Ter Lai, Chen-Chun Kuo & Yaw-Bin Huang (2015) Increasing risks of ischemic stroke in oral cancer patients treated with radiotherapy or chemotherapy: a nationwide cohort study, International Journal of Neuroscience, 125:11, 808-816, DOI: 10.3109/00207454.2014.967351 To link to this article: http://dx.doi.org/10.3109/00207454.2014.967351

Accepted author version posted online: 18 Sep 2014. Published online: 22 Oct 2014. Submit your article to this journal

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Date: 05 November 2015, At: 18:18

International Journal of Neuroscience, 2015; 125(11): 808–816 Copyright © 2014 Taylor and Francis ISSN: 0020-7454 print / 1543-5245 online DOI: 10.3109/00207454.2014.967351

RESEARCH ARTICLE

Increasing risks of ischemic stroke in oral cancer patients treated with radiotherapy or chemotherapy: a nationwide cohort study Yu-Ting Wu,1,∗ Chung-Yu Chen,2 Wen-Ter Lai,3 Chen-Chun Kuo,5,∗ and Yaw-Bin Huang1,4,5 Downloaded by [Australian National University] at 18:18 05 November 2015

1

School of Pharmacy, Master Program in Clinical Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan; 2 Department of Administration, Cigu District Office, Taiwan, Taiwan; 3 Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 4 School of Pharmacy, College of Pharmacy, Kaohsiung Medical University Kaohsiung, Taiwan; 5 Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Background: Several studies have identified correlations between cancer and increased risks of ischemic stroke (IS), particularly following radiotherapy (RT) or chemotherapy (CT). However, data regarding relative risks of IS in oral cancer are limited. The aim of this study was to compare hazard ratios (HR) of IS among oral cancer patients treated with and without RT, CT, or both (CCRT). Methods: We analyzed data collected by the Taiwan National Health Insurance Research Database (NHIRD) from 1996 to 2009, which covered approximately 99.5% of the medical claims submitted nationally. A total of 21,853 patients diagnosed with oral cancer from 2000 to 2008 were included. The Cox proportional hazard model was used to estimate the HRs of IS among different treatment modalities and a matched cohort. Results: The overall risk of IS was1.24-fold greater in patients treated with RT/CT/CCRT than those treated with surgery alone and 1.08-fold greater for surgery with adjuvant therapy (radiotherapy or chemotherapy after surgery) after adjusting for confounding factors. The incidence of IS was 0.23-fold lower in matched control group than in the oral cancer cohort. In subgroup analysis, patients who received RT/CT/CCRT and aged