Head and neck cancer survivors who smoke and drink face increased risk of death

Cigarette smoking and alcohol consumption before head and neck cancer diagnosis strongly predicts the patient's future risk of death, according to published studies. Now, results of a new study show a similar effect among those who continued these habits after cancer diagnosis.

"Most cancer survivors are counseled to quit smoking; despite this, many still smoke. In our study, 21 percent continued to smoke even after their cancer diagnosis, increasing their risk of death," said researcher Susan T. Mayne, Ph.D. "Similarly, we found that continued drinking increases the risk of death."

Based on these findings, Mayne advises survivors of head and neck cancer - which includes cancers of the oral cavity, pharynx and larynx - to quit smoking cigarettes and drinking alcoholic beverages in order to increase their odds of longer survival. Mayne is a professor of epidemiology at the Yale Schools of Public Health and Medicine, and the associate director of the Yale Comprehensive Cancer Center.

Results of this study are published in the December issue of Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research. This issue has a special focus on tobacco.

Mayne and colleagues evaluated the habits of 264 recent survivors of early stage head and neck cancer before and after cancer diagnosis. They obtained detailed smoking and drinking histories through in-person and telephone interviews. Patient recruitment was conducted at 49 hospitals in Connecticut and Florida. The purpose of this study was to evaluate if these habits affected the risk of dying in subsequent years.

After more than four years of follow-up, 62 patients died.

Patients who continued to smoke were approximately two times as likely to die during the follow-up, as compared to those who did not smoke after diagnosis. Patients who continued to drink after diagnosis were approximately three times as likely to die during the follow-up, according to Mayne.

"We expected to see an adverse effect of continued smoking; I was really not sure what we would find for continued drinking," she said. "The data from our study indicated that continued drinking should be discouraged in head and neck cancer survivors. Patients need assistance with both tobacco and alcohol cessation."

Yale researchers are conducting studies to determine the most effective ways to help head and neck cancer survivors stop smoking. One preliminary study will compare medications to help survivors quit, and will specifically focus on the effectiveness of varenicline (Chantix) compared with the nicotine patch. Some evidence has shown that varenicline may also help reduce alcohol consumption in patients. Given these findings, the researchers will monitor alcohol use and address potential methods to help patients quit.