Heterogeneous impact of alcohol consumption according to treatment method on survival in head and neck cancer: A prospective study

Abstract

Alcohol consumption is an established risk factor, and also a potential prognostic factor, for squamous cell carcinoma of the head and neck (HNSCC). However, little is known about whether the prognostic impact of alcohol consumption differs by treatment method. We evaluated the association between alcohol drinking and survival by treatment method to the primary site in 427 patients with HNSCC treated between 2005 and 2013 at Aichi Cancer Center Central Hospital (Nagoya, Japan). The impact of alcohol on prognosis was measured by multivariable Cox regression analysis adjusted for established prognostic factors. Among all HNSCC patients, the overall survival rate was significantly poorer with increased levels of alcohol consumption in multivariable analysis (trend P = 0.038). Stratification by treatment method and primary site revealed that the impact of drinking was heterogeneous. Among laryngopharyngeal cancer (laryngeal, oropharyngeal, and hypopharyngeal cancer) patients receiving radiotherapy (n = 141), a significant dose–response relationship was observed (trend P = 0.034). In contrast, among laryngopharyngeal cancer patients treated with surgery (n = 80), no obvious impact of alcohol was observed. This heterogeneity in the impact of alcohol between surgery and radiotherapy was significant (for interaction, P = 0.048). Furthermore, among patients with oral cavity cancer treated by surgery, a significant impact of drinking on survival was seen with tongue cancer, but not with non‐tongue oral cancer. We observed a significant inverse association between alcohol drinking and prognosis among HNSCC patients, and its impact was heterogeneous by treatment method and primary site.

Alcohol‐related head and neck cancer: Summary of the literature

“…Negative effects of continued alcohol consumption go beyond the development of second primary cancers and recurrences, however. Evidence suggests that HNC survivors who continue to use alcohol are at an increased risk of needing gastrostomy tube feeding in the future, experiencing osteoradionecrosis of the jaw, poor prognosis as well as social effects such as unemployment and work disability . Indeed, other research has shown that the absence of alcohol use by HNC survivors was significantly associated with better quality of life …”

Socioeconomic disparities and comorbidities, not race, affect salivary gland malignancy survival outcomes

“…Major efforts to improve the survival of patients with head and neck cancer begin with identifying and reducing disparities of modifiable risk factors. Classically, the incidence and outcome of head and neck cancers have been associated with smoking and alcohol use, stage at presentation, age at diagnosis, and the presence of the human papillomavirus for oropharyngeal cancers . Now, studies are increasingly establishing the role of psychosocial factors in cancer survival.…”

“…Classically, the incidence and outcome of head and neck cancers have been associated with smoking and alcohol use, stage at presentation, age at diagnosis, and the presence of the human papillomavirus for oropharyngeal cancers. [1][2][3][4][5][6][7][8][9][10][11] Now, studies are increasingly establishing the role of psychosocial factors in cancer survival. That patients who are nonwhite or of lower socioeconomic status (SES) often fare worse than their counterparts is becoming more clear and has caught the interest of the field.…”

Tobacco smoking and alcohol drinking at diagnosis of head and neck cancer and all‐cause mortality: Results from head and neck 5000, a prospective observational cohort of people with head and neck cancer

“…Evidence of an association between pre-treatment alcohol use and HNC mortality risk is conflicting. Some studies report an inverse association between alcohol intake and survival, 13,[19][20][21] whilst others have found little or no evidence of an effect. 17,22 Consequently, it is unclear whether any association of alcohol consumption with HNC cancer mortality is genuine, or the result of residual confounding by smoking (or other factors).…”

“…17,22 Consequently, it is unclear whether any association of alcohol consumption with HNC cancer mortality is genuine, or the result of residual confounding by smoking (or other factors). Recently, it was suggested that the effects of alcohol intake on HNC survival may differ by treatment method and primary site, 21 but this study only included 427 individuals from a single cancer centre in Japan, emphasising the need for further research in this area.…”