Gritz E R, Carr C R, Rapkin D, Abemayor E, Chang L J, Wong W K, Belin T R, Calcaterra T, Robbins K T, Chonkich G
Division of Cancer Control, Jonsson Comprehensive Cancer Center, UCLA School of Medicine.
Cancer Epidemiol Biomarkers Prev. 1993 May-Jun;2(3):261-70.
Cigarette smoking is a major risk factor for head and neck cancer, and individuals who continue to smoke past diagnosis and treatment are at elevated risk for further disease. In a randomized controlled trial, a state of the art provider-delivered smoking cessation intervention was compared to a usual care advice control condition. The intervention consisted of surgeon- or dentist-delivered advice to stop smoking, a contracted quit date, tailored written materials, and booster advice sessions. Subjects were 186 patients with newly diagnosed first primary squamous cell carcinomas of the upper aerodigestive tract who had smoked cigarettes within the past year. At randomization, 88.2% of subjects were current smokers. At 12-month follow-up, 70.2% of subjects completing the trial (n = 114) were continuous abstainers; among baseline smokers alone the continuous abstinence (CA) rate was 64.6%. The cotinine validation rate at 12 months was 89.6%. Modeling techniques were utilized in order to derive expected CA rates, which included noncompleter subjects (n = 72). The CA rate expected at 1 year for the entire patient population was 64.2%, and for smokers alone the expected CA rate was 59.4%. Logistic regression analysis carried out on baseline smokers identified predictors of 12-month CA status. These included medical treatment, stage of change, age, nicotine dependence, and race. The intervention effect was not significant, although the sign of the effect was positive. Based on these findings, we recommend systematic brief advice to stop smoking for head and neck cancer patients, with a stepped care approach for patients less able to quit.
吸烟是头颈癌的主要危险因素，那些在诊断和治疗后仍继续吸烟的个体面临疾病进一步发展的风险升高。在一项随机对照试验中，将一种先进的由医疗服务提供者提供的戒烟干预措施与常规护理建议对照条件进行了比较。该干预措施包括由外科医生或牙医提供的戒烟建议、约定的戒烟日期、量身定制的书面材料以及强化建议课程。研究对象为186例新诊断为上消化道原发性鳞状细胞癌且在过去一年内吸烟的患者。随机分组时，88.2%的研究对象为当前吸烟者。在12个月的随访中，完成试验的研究对象（n = 114）中有70.2%持续戒烟；仅在基线吸烟者中，持续戒烟率为64.6%。12个月时的可替宁验证率为89.6%。运用建模技术来推导预期的持续戒烟率，其中包括未完成试验的研究对象（n = 72）。整个患者群体预计1年时的持续戒烟率为64.2%，仅吸烟者的预期持续戒烟率为59.4%。对基线吸烟者进行的逻辑回归分析确定了12个月持续戒烟状态的预测因素。这些因素包括医疗治疗、改变阶段、年龄、尼古丁依赖和种族。尽管干预效果的迹象为阳性，但其效果并不显著。基于这些发现，我们建议对头颈癌患者进行系统性简短戒烟建议，并对较难戒烟的患者采用逐步护理方法。
