Alteration of smoking habit at time of first diagnosis influences survival of patients with HNSCC

Abstract

The impact of smoking on survival in patients with squamous cell carcinoma of the head and neck is well established, despite some conflicting data in the literature. However, data on alterations of smoking habit following cancer diagnosis is sparse. In the present study, the effect of reduction of smoking compared with cessation on the course of disease was studied. Data from 643 patients with HNSCC from the tumor documentation registry of the Department of Otorhinolaryngology, Head and Neck Surgery of the Christian-Albrechts-University Kiel were collected and statistically analyzed, looking at pre- and post-treatment smoking habit and survival. Alteration of smoking at the first diagnosis of HNSCC led to a significantly beneficial effect on survival outcomes compared with continued smoking, without significant differences between reduction and cessation of smoking. Detailed analysis revealed that this effect was solely dependent on patients treated by surgery only. Lifelong non-smokers exhibited a significant survival advantage compared with active and former smokers, with no difference in survival between these last two groups. The positive influence of altered smoking habit following first time diagnosis on disease-specific survival paralleled the negative direct effect of active smoking on therapy, which is predominantly attributed to peritumoral tissue hypoxia leading to impaired efficacy of radiochemotherapy (RCT). In the present study cohort, the positive effect of smoking habit alterations were primarily observed in patients treated by surgery only instead of RCT, possibly due to fewer perioperative complications. These findings indicated that patients should be encouraged to at least minimize smoking following cancer diagnosis. Furthermore, for survival estimates and therapy planning, former smokers should be considered as active smokers.

Traditional risk factors and cancer-related factors associated with cardiovascular disease risk in head and neck cancer patients

“…It is possible that tobacco use was under-reported in our study. It is also possible that altered tobacco habit following HNSCC diagnosis might have impacted CVD risk to some extent ( 44 ). However, more studies are needed to determine if the same is true for tobacco use in other HNSCC populations.…”

Relevance of Human Papillomaviruses in Head and Neck Cancer—What Remains in 2021 from a Clinician’s Point of View?

“…Analyzing the association of smoking habit, co-morbidity, and achievement on planned R(C)T dosage in 643 HNSCC patients, we only recently confirmed the significant association between increased tobacco consumption and presence of co-morbidities (applying various co-morbidity indices as the CCI); however, we did not see a correlation between smoking and/or co-morbidities and an impaired achievement of R(C)T dosages [ 68 , 82 ]. Moreover, we found that former smokers showed survival rates as bad as active smokers.…”

Prognosefaktoren für das Gesamtüberleben bei Oropharynxkarzinomen in Abhängigkeit vom HPV-Status

“…Niedrigerer Noxenkonsum ist mit einem besseren Gesundheitszustand und mit weniger Komorbiditäten vergesellschaftet [1,7] und erklärt zum Teil den Überlebensvorteil der Patienten mit einem HPV-positiven OSCC [11]. Die Patienten sollten jedoch ermutigt wer-den, auch nach der Erstdiagnose den Nikotinkonsum zumindest zu reduzieren, da eine aktuelle Studie aus Deutschland zeigte, dass die Reduktion oder die komplette Einstellung des Tabakkonsums die Prognose verbessert [8]. [17].…”