The Impact of Smoking Cessation and Continuation on Recurrence and Survival in Patients with Head and Neck Cancer: A Systematic Review of the Literature

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Abstract

Background: The impact of smoking continuation or cessation on the outcome of head and neck cancer (HNC) patients concerning recurrence and survival rates is not well understood. We aimed to analyze the prognostic role of smoking habits in patients with newly diagnosed HNC and the effects on survival, recurrence rates, and second primary tumor (SPT) development. Methods: A systematic literature review of the databases PubMed and Web of Science was performed in October 2019 using the search words “head and neck cancer” and “smoking cessation.” Articles analyzing the effects of ongoing smoking or smoking cessation in HNC patients were included. Results: Twelve studies published from 1993 to 2016 including 6,308 patients with HNC of stages I–IV were eligible for analysis. The median follow-up was 5 years. Six of 8 studies revealed an improved outcome concerning the median overall survival or survival rates favoring smoking cessation. Regarding recurrence rates, 5 of 6 studies indicated a statistically significant benefit associated with smoking cessation, and 2 of 3 studies showed a lower risk for SPT associated with postdiagnosis smoking cessation. Conclusion: Smoking cessation in patients with newly diagnosed HNC is associated with improved outcomes concerning overall survival, recurrence rates, and SPTs. Further research is needed to validate these results and to evaluate the specific effects on different tumor types and treatment approaches.

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Most cited references 30

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Influence of cigarette smoking on the efficacy of radiation therapy in head and neck cancer.

P. Skingley, L. G. McAlpine, J Sathya … (1993)

Smoking is a risk factor for several cancers and may also limit the efficacy of treatment. In this study, we evaluated the influence of cigarette smoking during radiation therapy on the efficacy of treatment in patients with head and neck cancer. Using a questionnaire, we obtained information on smoking behavior at base line and weekly during therapy in 115 patients with head and neck cancer who were treated with radiation therapy with or without fluorouracil. The side effects of therapy were evaluated weekly, and response was assessed 13 weeks after treatment was completed. The main outcomes measured were treatment response and survival. The prognostic variables were similar among the patients who smoked and those who did not smoke during treatment. The 53 patients who continued to smoke during radiation therapy had a lower rate of complete response (45 percent vs. 74 percent, P = 0.008) and poorer two-year survival (39 percent vs. 66 percent, P = 0.005) than the 62 patients who did not smoke or who had quit before treatment. Among the nonsmoking patients, mortality was influenced by the length of time between quitting and treatment, with a risk reduction (relative to that for patients who continued to smoke) of 40 percent for patients who had quit less than 12 weeks before diagnosis and of 70 percent for patients who had quit more than 1 year before diagnosis. After adjustment for other variables with proportional-hazards regression analysis, smoking remained an independent prognostic factor (P = 0.002), with a relative risk of 2.5 (95 percent confidence interval, 1.4 to 4.4) favoring the patients who abstained from smoking. The results could not be explained by the type of chemotherapy received, the presence of coexisting morbid conditions, differences in the side effects of radiation, or the number of interruptions of treatment. Patients with head and neck cancer who continue to smoke during radiation therapy have lower rates of response and survival than patients who do not smoke during radiation therapy.

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Successes and failures of the teachable moment: smoking cessation in cancer patients.

Ellen R Gritz, Michelle Cororve Fingeret, Damon J Vidrine … (2006)

Successful cancer treatment can be significantly compromised by continued tobacco use. Because motivation and interest in smoking cessation increase after cancer diagnosis, a window of opportunity exists during which healthcare providers can intervene and assist in the quitting process. The authors conducted a comprehensive literature review to discuss 1) the benefits of smoking cessation in cancer patients, 2) current knowledge regarding smoking cessation interventions targeted to cancer patients, and 3) treatment models and state-of the-art guidelines for intervention with cancer patients who smoke. The authors present clinical cases to illustrate the challenging nature of smoking cessation treatment for cancer patients. Continued smoking after cancer diagnosis has substantial adverse effects on treatment effectiveness, overall survival, risk of second primary malignancies, and quality of life. Although some encouraging results have been demonstrated with smoking cessation interventions targeted to cancer patients, few empirical studies of such interventions have been conducted. A range of intervention components and state-of-the-art cessation guidelines are available that can be readily applied to cancer patients. Case illustrations highlight the crucial role of healthcare providers in promoting smoking cessation, the harmful impact of nicotine addiction manifested in delayed and failed reconstructive procedures, and unique problems encountered in treating patients who have particular difficulty quitting. Despite the importance of stopping smoking for all cancer patients, the diagnosis of cancer is underused as a teachable moment for smoking cessation. More research is needed to empirically test cessation interventions for cancer patients, and attention must be given to complex and unique issues when tailoring cessation treatment to these individuals. Copyright 2005 American Cancer Society.

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Head and neck cancer: a global perspective on epidemiology and prognosis.

R. Sankaranarayanan, E Masuyer, R. Swaminathan … (1999)

Head and neck cancers (ICD-9 categories 140-149 and 161) are common in several regions of the world where tobacco use and alcohol consumption is high. The age standardized incidence rate of head and neck cancer (around 1990) in males exceeds 30/100, 000 in regions of France, Hong Kong, the Indian sub-continent, Central and Eastern Europe, Spain, Italy, Brazil, and among US blacks. High rates (> 10/100,000) in females are found in the Indian sub-continent, Hong Kong and Philippines. The highest incidence rate reported in males is 63.58 (France, Bas-Rhin) and in females 15.97 (India, Madras). The variation in incidence of cancers by subsite of head and neck is mostly related to the relative distribution of major risk factors such as tobacco or betel quid chewing, cigarette or bidi smoking, and alcohol consumption. Some degree of misclassification by subsites is a clear possibility in view of the close proximity of the anatomical subsites. While mouth and tongue cancers are more common in the Indian sub-continent, nasopharyngeal cancer is more common in Hong Kong; pharyngeal and/or laryngeal cancers are more common in other populations. While the overall incidence rates show a declining trend in both sexes in India, Hong Kong, Brazil and US whites, an increasing trend is observed in most other populations, particularly in Central and Eastern Europe, Scandinavia, Canada, Japan and Australia. The overall trends are a reflection of underlying trends in cancers of major subsites which seem to be related to the changing prevalence of risk factors. The five year relative survival varies from 20-90% depending upon the subsite of origin and the clinical extent of disease. While primary prevention is the potential strategy for long term disease control, early detection and treatment may have limited potential to improve mortality in the short term.

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Author and article information

Journal

Journal ID (publisher-id): ORT

Journal ID (nlm-ta): Oncol Res Treat

Journal ID (doi): 10.1159/issn.2296-5270

Title: Oncology Research and Treatment

Publisher: S. Karger AG

ISSN (Print): 2296-5270

ISSN (Electronic): 2296-5262

Publication date Subscription-year: 2020

Publication date (Print): October 2020

Publication date (Electronic): 18 September 2020

Volume: 43

Issue: 10

Pages: 549-558

Affiliations

[_a] _aDepartment of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

[_b] _bDepartment of Medical Psychology, University Medical Center Hamburg Eppendorf, Hamburg, Germany

Author notes

*Christoph Seidel, Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, DE–20246 Hamburg (Germany), c.seidel@uke.de

Article

Publisher ID: 509427 Other ID: Oncol Res Treat 2020;43:549–557

DOI: 10.1159/000509427

PubMed ID: 32950990

SO-VID: 7738be44-af58-45e1-a149-cf6add7e58d8

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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 27 March 2020

Date accepted : 14 June 2020

Page count

Figures: 2, Tables: 2, Pages: 10

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The Impact of Smoking Cessation and Continuation on Recurrence and Survival in Patients with Head and Neck Cancer: A Systematic Review of the Literature

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Karger: Oncology

Most cited references 30

Influence of cigarette smoking on the efficacy of radiation therapy in head and neck cancer.

Successes and failures of the teachable moment: smoking cessation in cancer patients.

Head and neck cancer: a global perspective on epidemiology and prognosis.

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Cited by 12

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