Association between smoking during radiotherapy and prognosis in head and neck cancer: A follow-up study

• Published in: Head & neck Vol. 24; no. 12; pp. 1031 - 1037
• Main Authors: Browman, George P., Mohide, E. Ann, Willan, Andrew, Hodson, Ian, Wong, Gene, Grimard, Laval, MacKenzie, Robert G., El-Sayed, Samy, Dunn, Edward, Farrell, Sylvia
• Format: Journal Article
• Language: English
• Published: New York Wiley Subscription Services, Inc., A Wiley Company 01-12-2002
• Subjects: Adolescent; Adult; Aged; Carcinoma, Squamous Cell - radiotherapy; Cohort Studies; Cotinine - blood; Female; Follow-Up Studies; head and neck cancer neoplasms/radiotherapy; Head and Neck Neoplasms - radiotherapy; Humans; Indicators and Reagents - analysis; Logistic Models; Male; Middle Aged; Multivariate Analysis; Prognosis; Proportional Hazards Models; Radiotherapy - adverse effects; smoking; Smoking - adverse effects; Smoking - blood; Surveys and Questionnaires; survival; Survival Analysis
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/hed.10168

Background.
The study objective was to confirm a previous finding that patients with stage III/IV squamous head and neck cancer (SHNC) who smoke during radiotherapy (RT) experience reduced survival.
Methods.
An observational cohort study. Patients' smoking status was assessed weekly by questionnaire plus blood cotinine. Patients were assessed every 3 to 4 months for survival. Logistic regression and Cox proportional hazards analyses were used to detect the independent contribution of smoking on survival.
Results.
Of 148 patients, 113 smoked during RT. Blood cotinine and smoking questionnaire responses were highly correlated (Spearman R = .69; p < .0005). Abstainers and very light smokers experienced better survival than light, moderate, and heavy smokers (median, 42 vs 29 months; p = .07). Tumor and nodal status and years smoked were the most important prognostic factors. Smoking during RT was not an independent predictor of survival, but baseline smoking status was (p = .016).
Conclusion.
Smoking status should be documented in all future trials of RT in SHNC to allow for pooled analyses with sufficient power to address this question. © 2002 Wiley Periodicals, Inc. Head Neck 24: 1031–1037, 2002