Abstract
BackgroundThe survival time of patients with head and neck squamous cell carcinoma (HNSCC) is related to health behavior, such as tobacco smoking and alcohol consumption. Poor oral health (OH), dental care (DC) and the frequent use of mouthwash have been shown to represent independent risk factors for head and neck cancerogenesis, but their impact on the survival of HNSCC patients has not been systematically investigated.MethodsTwo hundred seventy-six incident HNSCC cases recruited for the ARCAGE study were followed through a period of 6–10 years. Interview-based information on wearing of dentures, gum bleeding, teeth brushing, use of floss and dentist visits were grouped into weighted composite scores, i.e. oral health (OH) and dental care (DH). Use of mouthwash was assessed as frequency per day. Also obtained were other types of health behavior, such as smoking, alcohol drinking and diet, appreciated as both confounding and study variables. Endpoints were progression-free survival, overall survival and tumor-specific survival. Prognostic values were estimated using Kaplan-Meier analysis and Cox proportional hazards regression models.ResultsA good dental care score, summarizing annual dental visits, daily teeth cleaning and use of floss was associated with longer overall survival time (p = .001). The results of the Cox regression models similarly suggested a higher risk of tumor progression and shortened overall survival in patients with poor dental care, but the results lost their statistical significance after other types of health behavior had been controlled for. Frequent use of mouthwash (≥ 2 times/day) significantly increased the risk of tumor-specific death (HR = 2.26; CI = 1.19–4.32). Alcohol consumption and tobacco smoking were dose-dependently associated with tumor progression and shorter overall survival.ConclusionFrequent mouthwash use of ≥ 2 times/day seems to elevate the risk of tumor-specific death in HNSCC patients. Good dental care scores are associated with longer overall survival.Electronic supplementary materialThe online version of this article (doi:10.1186/s12903-016-0185-0) contains supplementary material, which is available to authorized users.
Highlights
The survival time of patients with head and neck squamous cell carcinoma (HNSCC) is related to health behavior, such as tobacco smoking and alcohol consumption
A growing body of evidence suggests that a lack of dental care and poor oral health have to be considered as independent risk factors for HNSCC development [14,15,16,17]
The Cox regression model was adjusted for sex, age, tumor stage according to UICC criteria, tumor site (oral cavity (C01-C06), tonsils (C09), pharynx (C10-C13) and larynx (C32), treatment, education, smoking, alcohol consumption, vegetable and fruit consumption and Human papilloma virus (HPV)-16/18-infection status of the tumor, which are established influencing factors for HNSCC patient survival [8, 20, 30]
Summary
The survival time of patients with head and neck squamous cell carcinoma (HNSCC) is related to health behavior, such as tobacco smoking and alcohol consumption. Alcohol consumption, HPV infection and socioeconomic factors are established risk factors for cancer development in the head and neck region [5,6,7,8]. Dietary factors, such as the consumption of vegetables and fruits, have been described as having a protective effect [9,10,11,12,13]. A growing body of evidence suggests that a lack of dental care and poor oral health have to be considered as independent risk factors for HNSCC development [14,15,16,17]
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