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      Systematic review evaluating randomized controlled trials of smoking and alcohol cessation interventions in people with head and neck cancer and oral dysplasia

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          Abstract

          Background

          Smoking and alcohol increase the risk of head and neck cancer and affect treatment outcomes. Interventions modifying these behaviors may improve posttreatment outcomes and survival. We systematically reviewed evidence of the effectiveness of smoking/alcohol interventions in head and neck cancer and oral dysplasia.

          Methods

          The AMED, CINAHL, Embase, MEDLINE, and Web of Science databases were searched for randomized controlled trials (RCTs) of smoking/alcohol interventions in people with head and neck cancer. A qualitative synthesis of the studies was conducted.

          Results

          Three RCTs were identified: 2 smoking interventions and 1 smoking and alcohol intervention. One intervention, which was comprised of a smoking intervention based on Cognitive Behavioral Therapy and pharmacologic management compared to usual care, reduced smoking prevalence.

          Conclusion

          Further research is required into the underlying mechanisms that lead to cessation and interventions that include both pharmacological and behavioral therapy. Future RCTs should include suitable control conditions and sufficient power to assess clinical outcomes.

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          Most cited references18

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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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            Formative research in school and community-based health programs and studies: "state of the art" and the TAAG approach.

            Charlotte Pratt, Lisa K. Staten, T Conway … (2006)
            Formative research uses qualitative and quantitative methods to provide information for researchers to plan intervention programs. Gaps in the formative research literature include how to define goals, implementation plans, and research questions; select methods; analyze data; and develop interventions. The National Heart, Lung, and Blood Institute funded the Trial of Activity for Adolescent Girls (TAAG), a randomized, multicenter field trial, to reduce the decline in physical activity in adolescent girls. The goals of the TAAG formative research are to (a) describe study communities and schools, (b) help design the trial's interventions, (c) develop effective recruitment and retention strategies, and (d) design evaluation instruments. To meet these goals, a variety of methods, including telephone interviews, surveys and checklists, semistructured interviews, and focus group discussions, are employed. The purpose, method of development, and analyses are explained for each method.
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              Alcohol and tobacco use prediagnosis and postdiagnosis, and survival in a cohort of patients with early stage cancers of the oral cavity, pharynx, and larynx.

              Cleon Goodwin, Victoria A. Kirsh, Brenda Cartmel … (2009)
              As more people begin to survive first cancers, there is an increased need for science-based recommendations to improve survivorship. For survivors of head and neck cancer, use of tobacco and alcohol before diagnosis predicts poorer survival; however, the role of continuing these behaviors after diagnosis on mortality is less clear, especially for more moderate alcohol consumption. Patients (n = 264) who were recent survivors of early stage head and neck cancer were asked to retrospectively report their tobacco and alcohol histories (before diagnosis), with information prospectively updated annually thereafter. Patients were followed for an average of 4.2 years, with 62 deaths observed. Smoking history before diagnosis dose-dependently increased the risk of dying; risks reached 5.4 [95% confidence interval (95% CI), 0.7-40.1] among those with >60 pack-years of smoking. Likewise, alcohol history before diagnosis dose-dependently increased mortality risk; risks reached 4.9 (95% CI, 1.5-16.3) for persons who drank >5 drinks/d, an effect explained by beer and liquor consumption. After adjusting for prediagnosis exposures, continued drinking (average of 2.3 drinks/d) postdiagnosis significantly increased risk (relative risk for continued drinking versus no drinking, 2.7; 95% CI, 1.2-6.1), whereas continued smoking was associated with nonsignificantly higher risk (relative risk for continued smoking versus no smoking, 1.8; 95% CI, 0.9-3.9). Continued drinking of alcoholic beverages after an initial diagnosis of head and neck cancer adversely affects survival; cessation efforts should be incorporated into survivorship care of these patients.
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                Author and article information

                Contributors
                Ellie Shingler:
                ORCID: http://orcid.org/0000-0002-7332-5362
                ellie.shingler@bristol.ac.uk
                Journal
                Journal ID (nlm-ta): Head Neck
                Journal ID (iso-abbrev): Head Neck
                Journal ID (doi): 10.1002/(ISSN)1097-0347
                Journal ID (publisher-id): HED
                Title: Head & Neck
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 1043-3074
                ISSN (Electronic): 1097-0347
                Publication date (Electronic): 30 March 2018
                Publication date (Print): August 2018
                Volume: 40
                Issue: 8 ( doiID: 10.1002/hed.v40.8 )
                Pages: 1845-1853
                Affiliations
                [ 1 ] National Institute for Health Research (NIHR), Bristol Biomedical Research Centre (BRC) Nutrition Theme University of Bristol Bristol United Kingdom
                [ 2 ] Bristol Medical School: Population Health Sciences University of Bristol Bristol United Kingdom
                [ 3 ] Department of Maxillofacial Surgery University of Bristol Bristol United Kingdom
                [ 4 ] Department of Randomised Trials Collaboration University of Bristol, School of Social and Community Medicine Bristol United Kingdom
                Author notes
                [*] [* ] Correspondence Ellie Shingler, National Institute for Health Research (NIHR) Bristol, Biomedical Research Centre (BRC) Nutrition Theme, Level 3, University Hospitals Bristol, Research and Education Centre, Upper Maudlin Street, Bristol BS2 8AE, United Kingdom., Email: ellie.shingler@ 123456bristol.ac.uk
                Author information
                http://orcid.org/0000-0002-7332-5362
                http://orcid.org/0000-0001-8654-353X
                Article
                Publisher ID: HED25138
                DOI: 10.1002/hed.25138
                PMC ID: 6120449
                PubMed ID: 29603464
                SO-VID: a2cfe69f-053a-49d4-8e05-8ab46a209a8e
                Copyright © © 2018 The Authors Head & Neck Published by Wiley Periodicals, Inc.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 14 July 2017
                Date revision received : 08 September 2017
                Date accepted : 01 February 2018
                Page count
                Figures: 1, Tables: 3, Pages: 9, Words: 5108
                Funding
                Funded by: National Institute for Health Research (NIHR) Bristol Nutritional Biomedical Research Unit based at University Hospitals Bristol NHS Foundation Trust and the University of Bristol
                Funded by: Cancer Research UK Programme Grant – the Integrative Cancer Epidemiology Programme
                Award ID: C18281/A19169
                Categories
                Subject: Clinical Review
                Subject: Clinical Reviews
                Custom metadata
                source-schema-version-number 2.0
                component-id hed25138
                cover-date August 2018
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.4.7.1 mode:remove_FC converted:03.09.2018

                ScienceOpen disciplines: Otolaryngology
                Keywords: alcohol,head and neck cancer,oral dysplasia,systematic review,tobacco cessation
                Data availability:
                ScienceOpen disciplines: Otolaryngology
                Keywords: alcohol, head and neck cancer, oral dysplasia, systematic review, tobacco cessation

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