Choi Seung Hee, Terrell Jeffrey E, Bradford Carol R, Ghanem Tamer, Spector Matthew E, Wolf Gregory T, Lipkus Isaac M, Duffy Sonia A
College of Nursing, Michigan State University, East Lansing, MI.
University of Michigan Health System, Ann Arbor, MI.
Nicotine Tob Res. 2016 Dec;18(12):2216-2224. doi: 10.1093/ntr/ntw189. Epub 2016 Aug 18.
To determine if smoking after a cancer diagnosis makes a difference in mortality among newly diagnosed head and neck cancer patients.
Longitudinal data were collected from newly diagnosed head and neck cancer patients with a median follow-up time of 1627 days (N = 590). Mortality was censored at 8 years or September 1, 2011, whichever came first. Based on smoking status, all patients were categorized into four groups: continuing smokers, quitters, former smokers, or never-smokers. A broad range of covariates were included in the analyses. Kaplan-Meier curves, bivariate and multivariate Cox proportional hazards models were constructed.
Eight-year overall mortality and cancer-specific mortality were 40.5% (239/590) and 25.4% (150/590), respectively. Smoking status after a cancer diagnosis predicted overall mortality and cancer-specific mortality. Compared to never-smokers, continuing smokers had the highest hazard ratio (HR) of dying from all causes (HR = 2.71, 95% confidence interval [CI] = 1.48-4.98). Those who smoked at diagnosis, but quit and did not relapse-quitters-had an improved hazard ratio of dying (HR = 2.38, 95% CI = 1.29-4.36) and former smokers at diagnosis with no relapse after diagnosis-former smokers-had the lowest hazard ratio of dying from all causes (HR = 1.68, 95% CI = 1.12-2.56). Similarly, quitters had a slightly higher hazard ratio of dying from cancer-specific reasons (HR = 2.38, 95% CI = 1.13-5.01) than never-smokers, which was similar to current smokers (HR = 2.07, 95% CI = 0.96-4.47), followed by former smokers (HR = 1.70, 95% CI = 1.00-2.89).
Compared to never-smokers, continuing smokers have the highest HR of overall mortality followed by quitters and former smokers, which indicates that smoking cessation, even after a cancer diagnosis, may improve overall mortality among newly diagnosed head and neck cancer patients. Health care providers should consider incorporating smoking cessation interventions into standard cancer treatment to improve survival among this population.
Using prospective observational longitudinal data from 590 head and neck cancer patients, this study showed that continuing smokers have the highest overall mortality relative to never-smokers, which indicates that smoking cessation, even after a cancer diagnosis, may have beneficial effects on long-term overall mortality. Health care providers should consider incorporating smoking cessation interventions into standard cancer treatment to improve survival among this population.
确定癌症诊断后吸烟是否会影响新诊断的头颈癌患者的死亡率。
收集新诊断的头颈癌患者的纵向数据，中位随访时间为1627天（N = 590）。死亡率在8年或2011年9月1日（以先到者为准）进行截尾。根据吸烟状况，将所有患者分为四组：持续吸烟者、戒烟者、既往吸烟者或从不吸烟者。分析中纳入了广泛的协变量。构建了Kaplan-Meier曲线、双变量和多变量Cox比例风险模型。
8年总死亡率和癌症特异性死亡率分别为40.5%（239/590）和25.4%（150/590）。癌症诊断后的吸烟状况可预测总死亡率和癌症特异性死亡率。与从不吸烟者相比，持续吸烟者因各种原因死亡的风险比（HR）最高（HR = 2.71，95%置信区间[CI] = 1.48 - 4.98）。那些在诊断时吸烟但已戒烟且未复发的人——戒烟者——死亡风险比有所改善（HR = 2.38，95% CI = 1.29 - 4.36），而诊断时为既往吸烟者且诊断后未复发的人——既往吸烟者——因各种原因死亡的风险比最低（HR = 1.68，95% CI = 1.12 - 2.56）。同样，戒烟者因癌症特异性原因死亡的风险比（HR = 2.38，95% CI = 1.13 - 5.01）比从不吸烟者略高，这与当前吸烟者相似（HR = 2.07，95% CI = 0.96 - 4.47），其次是既往吸烟者（HR = 1.70，95% CI = 1.00 - 2.89）。
与从不吸烟者相比，持续吸烟者的总死亡率风险比最高，其次是戒烟者和既往吸烟者，这表明即使在癌症诊断后戒烟，也可能改善新诊断的头颈癌患者的总死亡率。医疗保健提供者应考虑将戒烟干预措施纳入标准癌症治疗，以提高该人群的生存率。
本研究使用了来自590名头颈癌患者的前瞻性观察纵向数据，结果表明持续吸烟者相对于从不吸烟者的总死亡率最高，这表明即使在癌症诊断后戒烟，也可能对长期总死亡率产生有益影响。医疗保健提供者应考虑将戒烟干预措施纳入标准癌症治疗，以提高该人群的生存率。
