The effect of second hand smoke in patients with squamous cell carcinoma of the head and neck

Abstract

Background Active tobacco smoking is a well-known risk factor for head and neck malignancy, and strong evidence has associated tobacco as the main carcinogenic factor in squamous cell cancers of this region. Evidence supporting a carcinogenic effect of second-hand smoke (SHS) on head and neck organs in non-smokers was also demonstrated with results consistent with those for active smokers. There is little data on the effects of SHS in patients previously treated for squamous cell carcinomas of the head and neck. Objective The purpose of this study was to prospectively evaluate the role of SHS on recurrence and survival in treated head and neck cancer patients. Methods We conducted a prospective cohort study to examine the association between self-reported SHS exposure and the risk of recurrence and mortality in patients treated for squamous cell cancers of the head and neck in a longitudinal fashion. Patients filled out an exhaustive smoking questionnaire on presentation and abbreviated questionnaires at each follow-up visit, which occurred every 6 months. Primary outcome measures were recurrence, development of a second primary malignancy, and recurrence-free survival. Chi square analysis was used to assess the association between SHS and the primary outcomes. A multivariate binary logistic regression analysis was applied to determine the independent predictors of recurrence. Cox proportional hazards and Kaplan Meier modeling were employed to assess the possible relationships between SHS exposure and time to develop the primary outcomes. Results Untreated new patients with a histologically confirmed diagnosis of first primary SCC of the UADT (defined as cancer of the oral cavity, the oropharynx, the hypopharynx, and the larynx) were recruited. Patients seen at The University of Texas Medical Branch (UTMB) Head and Neck oncology clinic from 1988 to 1996 were considered as cases in this study. One hundred and thirty-five patients were enrolled in the study. The median follow-up time for the sample was 54 months (3.92 years). Complete records were achieved for 92% of patients, thus 124 patients were included in the final analysis. SHS significantly correlated with recurrence and recurrence-free survival. The rate of recurrence was 46% in the group exposed to SHS and 22% in the non-exposed group. Based on multivariate binary logistic regression analysis, SHS exposure was detected as a significant independent predictor for recurrence (HR = 3.00 [95% CI 1.18–7.63]). Kaplan-Meier analysis demonstrated that patients who were not exposed to SHS had a statistically significant longer recurrence-free survival (log-rank P = 0.029). The mean survival for non SHS-exposed patients was 76 [63–89] months versus 54 [45–63] months for those exposed to SHS. Conclusions SHS exposure is an independent predictor of recurrence and survival after head and neck cancer treatment. T...

Semi-quantitative assessment of environmental tobacco smoke exposure and its association with the development of oral squamous cell carcinoma: A pilot study

“…This is very much in line with our results, where the OR is also higher with exposure at both places. In contrast to the results of Idris et al 15 , we could not determine any difference in the occurrence of recurrences in our patients with and without exposure to ETS. However, Zhang et al 14 and Idris et al 15 had evaluated patients with head and neck squamous cell carcinoma and in one study, only about half of the participants were patients with OSCC, and in the other study, no information was given on the percentage of patients with oral cancer.…”

“…With the ETS-score it is possible to record a numerical value for each individual. Other case-control studies report a dose-response relationship for the degree of ETS exposure and describe secondhand smoke as an independent predictor of recurrence and survival in patients with head and neck cancer 14 , 15 . Zhang et al 14 found an increased OR for heavy ETS exposure (exposure at home and at work) in comparison to moderate ETS exposure (exposure only at home or at work) in their study group.…”

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“…Furthermore, none of the trials included in this review reported second-hand smoke exposure, which may negatively impact patient outcomes and quit rates. 124 , 125 With the recent increased prevalence of electronic cigarettes and cannabis use, these additional forms of tobacco, nicotine, and combustibles exposure will also need to be assessed and evaluated in relation to cancer outcomes.…”

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“…Head and neck squamous cell carcinoma (HNSCC) is recorded to be the 8th most commonly occurring form of cancer in the world, with a high mortality and morbidity rate [1,2]. Approximately 600,000 new HNSCC cases and 350,000 HNSCC-related deaths take place every year across the globe [3][4][5]. Though many new techniques have been developed for diagnosing the patients during their early stages, more than half of the HNSSC patients are diagnosed only in their advanced stages [6].…”