Impact of smoking cessation on clinical outcomes in patients with head and neck squamous cell carcinoma receiving curative chemoradiotherapy: A prospective study

Abstract

Background We hypothesized that patients with head and neck squamous cell carcinoma (HNSCC) with smoking cessation during curative chemoradiotherapy (CRT) had fewer complications and lower tumor progression risks. Methods Sixty‐three patients with nonmetastatic HNSCC who were smokers at diagnosis (carbon monoxide [CO] breath concentrations ≥3 ppm) and underwent curative CRT were prospectively enrolled. Successful smoking cessation throughout CRT was confirmed by CO breath concentrations <3 ppm at CRT completion. Results Forty‐one patients (65%) successfully discontinued smoking throughout CRT. With a median 33‐month follow‐up, patients with successful smoking cessation during CRT had significantly fewer, greater, and lower probabilities of grade ≥3 acute toxicities (P = .01), progression‐free survival (P = .03), and permanent gastrostomy or tracheostomy (P = .04), respectively, than those continuing smoking throughout CRT. In multivariate analysis, successful smoking cessation during CRT significantly reduced tumor progression risks (hazard ratio: 0.4, P = .05). Conclusion Smoking cessation during curative CRT reduced treatment‐related toxicities and tumor progression risks in patients with HNSCC.

Impact of a tobacco treatment program on abstinence and survival rates among current smokers with head and neck squamous cell carcinoma

“…For example, several retrospective and prospective HNC cohort studies with variable or unspecified times of outcome assessment have reported high abstinence rates ranging from 46% to 65%. [6][7][8][9]30,31 High cessation rates were also reported by the Collaborative Breast Cancer and Women's Longevity Study: among 20 961 patients with breast cancer followed for a median of 12 years, only 10% of women who smoked within 1 year of diagnosis continued smoking after diagnosis (n = 434/4059). On the other hand, a large observational study of currently smoking thoracic center patients (n = 342) at the Roswell Park Cancer Institute described much lower cessation rates: 20% of patients reported smoking cessation at an average follow-up of 49 days.…”

“…A proliferation of primarily observational studies have reported nonstandardized, wide‐ranging abstinence outcomes for all cancer types. For example, several retrospective and prospective HNC cohort studies with variable or unspecified times of outcome assessment have reported high abstinence rates ranging from 46% to 65% 6‐9,30,31 . High cessation rates were also reported by the Collaborative Breast Cancer and Women's Longevity Study: among 20 961 patients with breast cancer followed for a median of 12 years, only 10% of women who smoked within 1 year of diagnosis continued smoking after diagnosis (n = 434/4059).…”

“…In the general population, African American smokers and younger smokers were less likely to enroll in a tobacco cessation trial 35 . Other studies have also identified notable predictors of abstinence among patients with HNC including lower pack‐year tobacco exposure, 31 no home exposure to cigarettes, no spousal smoking, lower peer smoking, and seeing a family physician 30 . Additionally, a cross‐sectional survey of patients with HNC found current or recent smokers had higher rates of unemployment, uninsured status and clinical symptoms 36 .…”

Smoking‐induced radiation laryngeal necrosis after definitive radiotherapy alone for T1a glottic squamous cell carcinoma: A case report

“…Chen et al's prospective study demonstrated smoking cessation during curative chemoradiotherapy for 63 patients with head and neck squamous cell carcinoma. 12 Forty-one patients (65%) successfully discontinued smoking throughout chemoradiotherapy (CRT). During a median 33-month follow-up period, the patients with successful smoking cessation during CRT presented significantly fewer acute toxicities (p = .01) and reduced tumor progression risks (hazard ratio: 0.4, p = .05).…”

“…In their study, heavy smokers (>1 pack/day) had significantly poorer outcomes of 5‐year locoregional control (44 vs. 65%, p = .001), disease‐specific (56 vs. 77%, p = .003), and overall survival (39 vs. 66%, p = .0004) compared to non‐smokers. Chen et al's prospective study demonstrated smoking cessation during curative chemoradiotherapy for 63 patients with head and neck squamous cell carcinoma 12 . Forty‐one patients (65%) successfully discontinued smoking throughout chemoradiotherapy (CRT).…”