Cotinine Level in Head and Neck Cancer Patients: An Objective Measure of Tobacco Use

Abstract

Objectives: 1) Compare the prevalence of tobacco use in preoperative head and neck cancer patients as assessed by urinary cotinine and self-report. 2) Consider the importance of accurate measurement of tobacco use in pre-operative head and neck cancer surgical patients and potential implications for clinical interventions. Methods: Patients with squamous cell carcinoma of the upper aerodigestive tract undergoing a major head and neck surgical procedure were recruited from two academic medical centers from May 2011 to November 2012. We assessed preoperative tobacco exposure by self-report and urinary cotinine using a semiquantitative test strip. Results: We recruited 112 patients (mean age 59); 72.3% male, 82.1% white, 76.5% stages III-IV. The prevalence of tobacco use in the 48 hours prior to surgery was higher when assessed by urinary cotinine (41.1%) when compared to self-report (25.9%) (McNemar’s exact test, P < 0.0001). Sensitivity of self-reported tobacco use was 60.9% and specificity was 98.5%. Of those who denied tobacco use prior to surgery (N = 83), 18 (21.7%) had a positive urinary cotinine and 14 (16.9%) reported second-hand smoke exposure. There were no significant associations between second-hand exposure, gender, cancer stage, or prior treatment and positive cotinine. Conclusions: Accurate measurement of tobacco use is critical to care provision and intervention development for head and neck cancer patients. Self-report may fail to identify a significant number of tobacco users. Future analysis in this study will examine relationships among self-reported tobacco use, cotinine level, and postoperative outcomes including length of stay and wound infection.