Smoking Cessation After Treatment of Squamous Cell Head and Neck Cancer: The Impact of Survivorship Counseling

Abstract

Continued tobacco abuse after diagnosis and treatment of squamous cell head and neck cancer (SCHNC) is associated with an increased risk of treatment failure and second primary malignancies. The purpose of this study is to characterize patients more likely to stop smoking after head and neck cancer treatment and explore the impact of survivorship counseling on tobacco cessation. Patients with locoregionally advanced SCHNC who underwent definitive treatment at a single institution were retrospectively analyzed from an IRB-approved database. All patients analyzed were eligible for survivorship visits, which included smoking cessation counseling beginning at 6 months after completing treatment. Patients with persistent disease, those lost to follow up or deceased at 1 year were excluded. All patients were considered to be active smokers and had smoked cigarettes within 90 days of their cancer diagnosis. Smoking rates 1 year after completion of therapy were analyzed using logistic regression and multivariate analysis. A total of 175 patients treated from 2011-2016 were identified. The sample was comprised largely of Caucasian (78.9%) males (76.6%). The majority of patients had either larynx (38.3%) or oropharynx (37.1%) cancer. All patients were smokers with an average of 39.4 pack-year history of smoking. All patients received radiation therapy (RT), 68% of patients received chemotherapy, and 33.1% underwent surgery; 13.1% were treated with RT alone. Of all patients analyzed, 61.7% had stopped smoking 1 year after completing therapy. In multivariable analysis, patients who quit smoking were more likely to be female (P=.0395), not heavily consume alcohol (P=.0003), have a lower T-stage (P=.0262) and have received multimodality treatment versus RT alone (P=.0018). Survivorship visits were completed for 62 (35.4%) patients 3.9- 43.6 months after completing therapy. Those who received survivorship counseling within the first year after treatment, 73.9% had stopped smoking. In patients who received survivorship counseling after treatment, there was a univariate trend (P=.12) towards smoking cessation when compared to those patients not counseled. Although many patients are able to successfully quit smoking after treatment of SCHNC, heavy alcohol drinkers, patients with more advanced T-stages, and those treated with RT alone are less likely to stop smoking. In this targeted population, survivorship counseling may play a role in smoking cessation.