Unhealthy alcohol use and toxicity of concurrent chemoradiation for head and neck cancer.

Abstract

e17559 Background: Unhealthy alcohol use (UAU) is an important risk factor for development head and neck squamous cell carcinoma (HNSCC), but any effect on treatment outcomes is not well understood. The Veterans Health Administration (VHA) annually screens outpatients for UAU with the validated Alcohol Use Disorders Identification Test Consumption (AUDIT-C). Methods: Using national VHA data we retrospectively identified patients administered upfront radiation with concurrent systemic therapy (chemo- and/or immuno- therapy) for stage III-IVb HNSCC diagnosed 2008 –2017 and included males with a prior-year AUDIT-C. Regression models were fit to assess associations between AUDIT-C risk groups [low-level use (score 1-3), moderate UAU (4-7), severe UAU (≥ 8)] and treatment toxicity. Models were adjusted for a priori defined covariates including smoking and variables related to demographics, comorbidities, and cancer diagnosis and treatment. Results: Among 3,094 patients, 46.7% screened positive for UAU: 23.9% with moderate UAU and 22.9% with severe UAU. Compared to patients with low-level alcohol use, those with severe UAU were younger (mean age 65 vs 67 years) and more frequently active smokers (63.4% vs 36.2%) and underweight (11.2% vs 3.5%) ( p for all comparisons < 0.05). There was no significant difference between alcohol use groups in race/ethnicity, cancer stage, or systemic treatment agent used. In adjusted models, severe UAU was associated with lower risk of nausea [adjusted odds ratio (AOR) 0.63, 95% CI 0.47 – 0.84], ED visits (AOR 0.79, CI 0.63 – 0.99), and hospitalizations during treatment (AOR 0.78, CI 0.62 – 0.98). UAU was not associated with a composite measure of complications of infection or organ damage (AOR 0.94, CI 0.74 – 1.20), severe weight loss (AOR 0.83, CI 0.66 – 1.05), or mortality within 100 days of completing treatment (AOR 1.01, CI 0.62 – 1.66). Conclusions: In this large cohort of male patients in the VHA treated for locoregionally advanced HNSCC with concurrent chemoradiation, moderate and severe UAU is common. UAU is not associated with increased toxicity of treatment, and future research is required to define its place in treatment selection, supportive care, and counseling.