Longitudinal self-reported and serum-based assessment of tobacco or nicotine use in head and neck cancer patients during definitive radiotherapy or chemoradiotherapy.

Abstract

1594 Background: Tobacco use during cancer treatment is associated with a poor prognosis, but tobacco or nicotine use (TNU) assessment in cancer treatment patients is poorly characterized. Methods: Patients with measurable squamous cell carcinoma of the head and neck (HNSCC) treated with definitive radiotherapy (RT) or chemoradiotherapy (CRT) were eligible for enrollment. Entry and weekly self-reported TNU was measured in combination with objective serum cotinine (SC, an established quantitative measure of TNU). Results: At interim analysis, 50 patients are enrolled and SC assessments are complete for 37 patients. Of 37 patients, 81% are male (median age at diagnosis 53, range 39-75), 68% have oropharyngeal tumors, 84% are node positive, 81% presented at stage III-IVB, and 89% were treated with CRT. Any tobacco use was reported in 78% (median pack-year history of 32.5, range 3-138). Successful tobacco cessation was reported in 54% with 1-3 years median duration (range 2 wks to 40 yrs). At diagnosis, 30% of patients reported TNU; however, 41% of patients were SC positive at some time throughout RT or CRT. Of 30% of patients reporting second-hand smoke (SHS) exposure, 45% denied TNU at study entry. Of 19% of patients reporting social help with cessation, 71% reported that a friend or family helped and only 29% reported that doctors helped. SC values varied widely in individual patients over the course of RT or CRT. Of 41% of SC positive patients, 93% were SC positive at study entry, 73% at mid-treatment (week 4), and 53% during the final week of treatment. Conclusions: Data demonstrate that most HNSCC patients presenting with TNU at the beginning of RT or CRT continue TNU throughout treatment. Multiple TNU and SHS assessments are necessary to accurately characterize TNU during cancer treatment and the effects on clinical outcome. No significant financial relationships to disclose.