Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Program Number: AHNS06
Session Name: Scientific Session 2 - Quality of Life & Health Behaviors
Session Date: Wednesday, May 14, 2025
Session Time: 2:00 PM - 2:45 PM
Post-Diagnosis Smoking Cessation and Its Effect on Survival Outcomes in Head and Neck Cancer Patients: Findings from a Prospective Cohort Study
Elham Mohebbi1; Garret Guthrie1; Siddhi Patil1; Ruzong Fan1; Ming Tan1; Gregory Wolf2; Laura Rozek1; 1Georgetown University Medical Center; 2University of Michigan Medical CenterIntroduction: This study aimed to evaluate the impact of smoking cessation after the diagnosis of head and neck squamous cell carcinoma (HNSCC) on overall survival (OS) and recurrence-free survival (RFS). While the benefits of smoking cessation are well-known, there is still a significant gap in understanding the long-term effects of quitting, particularly in HNSCC patients, emphasizing the need for more focused research.
Methods: We conducted a prospective cohort study involving 835 newly diagnosed HNSCC patients at the University of Michigan between November 2008 and October 2014. Participants were categorized into five smoking status groups: never smokers, former smokers, continued smokers, quit smokers, and intermittent smokers. A structured questionnaire was used annually to assess demographics, health behaviors, and smoking history. We performed Kaplan-Meier survival analysis to plot unadjusted survival curves. Cox proportional hazards models were used to evaluate the effects of smoking status on survival outcomes, adjusting for potential confounders, including age, gender, cancer stage, body mass index (BMI), and alcohol use.
Results: Over an average follow-up of eight years, quitting smoking after diagnosis significantly improved OS in HNSCC patients. The adjusted hazard ratio (HR) for OS was 0.39 (95% CI: 0.22–0.69) at two years and 0.68 (95% CI: 0.45, 1.00) at five years compared to those who continued smoking. Among patients with oral cavity cancer, quitting led to a 72% reduction in death risk at two years (HR = 0.28, 95% CI: 0.12, 0.65). Intermittent smokers also showed improved OS (HR = 0.50, 95% CI: 0.31, 0.79) compared to continued smokers at all follow-up points. However, former smokers showed no significant OS differences. Figure 1-C shows that patients late-stage oral cavity cancer patients who quit smoking post-diagnosis have significantly better survival outcomes compared to those who continued smoking, (P = 0.0154). Similarly, Figure1- F reinforces this finding, revealing a notable RFS advantage for quitters over continuing smokers (P = 0.0413).
Conclusion: This study highlights the critical importance of smoking cessation after HNSCC diagnosis, which is associated with improved OS, especially for oral cavity cancer patients. These findings underscore the need for smoking cessation interventions targeting HNSCC patients to improve survival outcomes and quality of life. Incorporating cessation programs into cancer care can significantly promote long-term health in this vulnerable population.
