Does Quitting Smoking Make a Difference Among Newly Diagnosed Head and Neck Cancer Patients?

Abstract

Introduction: To determine if smoking after a cancer diagnosis makes a difference in mortality among newly diagnosed head and neck cancer patients. Methods: Longitudinal data were collected from newly diagnosed head and neck cancer patients with a median follow-up time of 1627 days (N = 590). Mortality was censored at 8 years or September 1, 2011, whichever came first. Based on smoking status, all patients were categorized into four groups: continuing smokers, quitters, former smokers, or never-smokers. A broad range of covariates were included in the analyses. Kaplan-Meier curves, bivariate and multivariate Cox proportional hazards models were constructed. Results: Eight-year overall mortality and cancer-specific mortality were 40.5% (239/590) and 25.4% (150/590), respectively. Smoking status after a cancer diagnosis predicted overall mortality and cancer-specific mortality. Compared to never-smokers, continuing smokers had the highest hazard ratio (HR) of dying from all causes (HR = 2.71, 95% confidence interval [CI] = 1.48-4.98). Those who smoked at diagnosis, but quit and did not relapse-quitters-had an improved hazard ratio of dying (HR = 2.38, 95% CI = 1.29-4.36) and former smokers at diagnosis with no relapse after diagnosis-former smokers-had the lowest hazard ratio of dying from all causes (HR = 1.68, 95% CI = 1.12-2.56). Similarly, quitters had a slightly higher hazard ratio of dying from cancer-specific reasons (HR = 2.38, 95% CI = 1.13-5.01) than never-smokers, which was similar to current smokers (HR = 2.07, 95% CI = 0.96-4.47), followed by former smokers (HR = 1.70, 95% CI = 1.00-2.89). Conclusions: Compared to never-smokers, continuing smokers have the highest HR of overall mortality followed by quitters and former smokers, which indicates that smoking cessation, even after a cancer diagnosis, may improve overall mortality among newly diagnosed head and neck cancer patients. Health care providers should consider incorporating smoking cessation interventions into standard cancer treatment to improve survival among this population. Implications: Using prospective observational longitudinal data from 590 head and neck cancer patients, this study showed that continuing smokers have the highest overall mortality relative to never-smokers, which indicates that smoking cessation, even after a cancer diagnosis, may have beneficial effects on long-term overall mortality. Health care providers should consider incorporating smoking cessation interventions into standard cancer treatment to improve survival among this population.

Capture of tobacco use among population‐based registries: Findings from 10 National Program of Cancer Registries states

“…The percentages of never, current, and former tobacco users in our study were similar to national results from past studies . In 2015, 15.1% of US adults reported being current cigarette smokers in the NHIS, whereas 17.6% of adults in this study were current cigarette smokers .…”

“…A telephone interview study of 20,891 patients with breast cancer during 1988‐2008 reported a cigarette smoking prevalence of 20%, whereas in our study, 17.6% of breast cancer cases were current cigarette users. Past literature has reported cigarette use prevalence above the national average in patients with tobacco‐associated cancers such as lung and laryngeal cancers . A 2012 study by Park et al reported that 38.7% of patients with lung cancer had reported current smoking at diagnosis, and 90.2% were ever smokers; these figures are comparable to those for current (36.4%) and ever smokers (85.1%) among cases with tracheal, lung, or bronchus cancer in our study.…”

Pilot randomized controlled trial of a comprehensive smoking cessation intervention for patients with upper aerodigestive cancer undergoing radiotherapy

“…Radiation‐induced cell death is dependent on oxygen present in tumor tissues . Carbon monoxide from cigarette smoking leads to carboxyhemoglobin formation, reducing the oxygen‐carrying capacity of hemoglobin, and resulting in tissue hypoxia that hampers the ability of radiation to kill cancer cells, which is termed “hypoxic radioresistance.” Clinical studies of patients with head and neck cancer undergoing radiation who were smokers before treatment have demonstrated an association of smoking during radiation with worse survival and locoregional control . This both supports the hypoxic radioresistance theory and highlights other ill effects of cigarette smoking on tumor biology and patients' ability to tolerate treatment .…”

“…Despite abundant evidence that smoking is associated with worse outcomes for patients with cancer and strong recommendations that cessation support be integrated into cancer treatment, clinical support for smoking cessation is inconsistent. Many U.S. cancer treatment centers lack tobacco dependence treatment services and few oncologists report providing support beyond advising patients to quit .…”

Factors associated with continued smoking after treatment of oral cavity cancer: An age and survival time‐matched study

“…There is a definitive link between use of tobacco products and development of oral cavity cancer (Lubin et al., ; Wyss et al., ). Moreover, people who continue to smoke after cancer treatment may experience greater cancer recurrence, poor treatment response, treatment‐related toxicity and increased cancer‐specific mortality (Choi et al., ; US Department of Health and Human Services ).…”