Radiotherapy or chemoradiation of squamous cell carcinoma of the head and neck produces high survival rates, but it is commonly associated with substantial toxicity. However, there are no widely accepted quality metrics for early mortality in radiation oncology. This study was aimed to investigate the temporal distribution, risk factors, and trends of overall and non-cancer mortality in HNSCC patients to assess early mortality’s applicability as a clinical quality indicator. The data on all patients treated with RT/CRT intended to cure in Denmark between 2000-2017 was obtained from the national Danish Head and Neck Cancer Group clinical database.

The data from 11,419 cancer patients were extracted and analyzed. In total, 90-day mortality risk was 3% whereas that of 180-day was calculated to be 7%. In the analysis, multiple variables were chosen such as increasing age, performance, stage of cancer, earlier treatment, and hypopharyngeal cancer were associated with an increased risk. The risk factor estimates were comparable for mortality and overall versus non-cancer mortality. There was a decrease in mortality rate between the years 2000-17, which can be attributed to the reduction in overall cancer-related events. However, no indications of an early period of high-risk after beginning the treatment procedure. In essence, introducing early mortality as a medical quality indicator is still debatable.