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Keywords:

  • head and neck cancer;
  • smoking cessation;
  • self-report;
  • passive smoking;
  • social environment

Abstract

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. FUNDING SOURCES
  8. CONFLICT OF INTEREST DISCLOSURES
  9. REFERENCES

BACKGROUND

Smoking during treatment of squamous cell head and neck cancer (HNC) has adverse affects on toxicity, treatment, and survival. The purpose of this report was to evaluate sociodemographic predictors of smoking cessation in HNC patients to support the development of a smoking cessation program.

METHODS

Newly diagnosed HNC patients (2007-2010) at Princess Margaret Cancer Centre treated with curative intent were prospectively recruited. Patients completed self-reported baseline and follow-up questionnaires, assessing changes in social habits. Predictors of smoking cessation and time to quitting were evaluated using logistic regression and Cox proportional hazard models, respectively.

RESULTS

Of 295 HNC patients, 49% were current smokers at diagnosis, and 50% quit after diagnosis. These individuals were more likely to have smoked for fewer years (P = .0003), never used other forms of tobacco (P = .0003), and consumed less alcohol (P = .002). No cigarette exposure at home (OR, 7.44 [3.04-18.2]), no spousal smoking (OR, 4.25 [1.70-10.6]), and having fewer friends who smoke (OR, 2.32 [1.00-5.37]) were consistent predictors of smoking cessation after diagnosis. Having none of these exposures (OR, 13.8 [4.13-46.0]) and seeing a family physician (OR, 3.92 [1.38-11.2]) were independently associated with smoking cessation and time-to-quitting analyses. Most HNC patients (68%) quit within 6 months of diagnosis. Patients who were ex-smokers at diagnosis were older (P < .0001), more likely to be female (P = .0002), more likely to be married (P = .0004), more educated (P = .01), and had fewer pack-years of smoking (P < .0001).

CONCLUSIONS

Spousal smoking, peer smoking, smoke exposure at home, and seeing a family physician were strongly and consistently associated with smoking cessation and time to quitting after a HNC diagnosis. Cancer 2013;119:2701–2709. © 2013 American Cancer Society.


INTRODUCTION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. FUNDING SOURCES
  8. CONFLICT OF INTEREST DISCLOSURES
  9. REFERENCES

Lifetime cigarette use has been associated with higher risks of developing head and neck cancer (HNC).[1] Despite a recent decline in smoking prevalence, the proportion of patients diagnosed with HNC who have a significant smoking history remains high, accounting for the majority of cases in some populations.[2] Continued smoking after diagnosis has been associated with higher risks for the development of second primary malignancies, greater toxicity, and worse overall and disease-specific survival compared with patients who quit smoking years before diagnosis or around the time of diagnosis.[1, 3-11] Thus, smoking is an important adverse yet modifiable behavior associated with clinical outcome.

The broad range of smoking cessation rates reported (33%-70%) among active HNC smokers suggests that there are factors other than the cancer diagnosis itself that may affect smoking cessation in this population.[12-14] This is particularly worrisome in an HNC setting, as these patients tend to be older and more likely have comorbidities in addition to those associated with chronic smoking.[15] Characterizing the subset of HNC patients who continue to smoke after diagnosis may identify those patients for whom smoking cessation interventions may be most crucial. Previous studies have focused on basic demographic factors such as age, education, and sex, as well as clinicopathologic factors such as treatment modality and cancer stage, as predictors of cessation.[13, 16, 17] However, no consistent predictors have been reported. More recently, there has been an interest in understanding the role of a patient's social smoking environment on smoking cessation,[17, 18] but this avenue of research has not been adequately explored in cancer patients.[12, 19] Smoking cessation programs in noncancer patients have incorporated spousal support as a mechanism to boost the success of such interventions, but further exploration in an HNC population is needed.[20]

The goal of this study was to identify the social environmental factors associated with smoking cessation and the time to quitting among newly diagnosed HNC patients.

MATERIALS AND METHODS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. FUNDING SOURCES
  8. CONFLICT OF INTEREST DISCLOSURES
  9. REFERENCES

Population and Questionnaires

Adult patients with newly diagnosed HNC (2007-2010) were asked to complete a baseline questionnaire to assess basic demographics and social habits (Table 1). Clinical data (anatomic subsite, TNM staging) were retrieved from the institutional Head and Neck Anthology.[21] A follow-up questionnaire was mailed out or administered in the clinic to all respondents with a smoking history between January and October 2011 (Fig. 1). The follow-up questionnaire assessed the date last smoked (month and year) and current (ie, at the time of the follow-up questionnaire) smoking habits, number of quit attempts, visitation to his/her general physician, general social support as defined by Pomerleau et al,[22] social smoking environment (ie, sources of secondhand smoke), and intention to quit smoking. The follow-up questionnaire was administered at least 6 months after the baseline questionnaire was completed. Institutional ethics approval was obtained, as neither questionnaire was part of standard clinical practice.

Table 1. Clinical, Demographic, and Smoking/Alcohol Characteristics of the Recruited Head and Neck Cancer Population by Smoking Status
   Predictor of Quitting After 1 Year Prior to Diagnosis (Inactive vs Active)Predictors of Having Already Quit at Baseline (Ex- vs Current Smoker)
 Ex-SmokersCurrent SmokersUnivariateMultivariatecUnivariateMultivariatec
VariableHave not restarted (n = 150)Inactive Smokers (n = 73)Active Smokers (n = 72)Odds RatioPOdds RatioPOdds RatioPOdds RatioP
  1. Ex-smokers quit smoking at least 1 year prior to diagnosis, active smokers continued to smoke at the time of diagnosis, whereas inactive smokers quit at some time between baseline and follow-up.

  2. a

    Mean with 95% confidence limits presented;

  3. b

    each odds ratio (95% confidence limit) was reflective of a 10-unit increment; cadjusted for all variables in table.

Months until follow-upa, b25.2 (23.6-26.7)24.6 (22.4-26.9)21.4 (19.8-23.0)1.58 (1.06-2.35).022.02 (1.24-3.25).004 
Demographic factors64.3 (62.6-65.9)59.6 (57.2-62.0)59.4 (57.2-61.6)1.02 (0.74-1.42) 1.61 (1.27-2.06).00013.71 (2.48-5.55)<.0001
Age (y) at diagnosisa, b32 (21%)11 (15%)9 (12%)1.24 (0.48-3.21) 1.70 (0.92-3.13).093.84 (1.67-8.81).002
Female125 (83%)50 (68%)39 (54%)1.84 (0.93-3.62).08 3.15 (1.83-5.42)<.00014.28 (1.92-9.53).0004
Married or common-law72 (48%)29 (40%)21 (29%)1.60 (0.80-3.20) 1.75 (1.10-2.80).022.12 (1.12-4.01).02
High school or higher138 (92%)68 (93%)63 (87%)1.94 (0.62-6.11) 1.23 (0.55-2.75)<.0001
White131 (87%)56 (77%)63 (88%)2.13 (0.88-5.15).09 1.51 (0.79-2.86).002
Social habits          <.0001
Number of cigarettes per daya, b17.7 (16.0-19.4)17.3 (15.4-19.2)20.4 (18.4-22.3)1.60 (1.04-2.43).03 1.14 (0.89-1.47) 
Number of years smokeda, b25.3 (23.1-27.5)35.9 (32.8-38.9)41.6 (39.0-44.2)1.50 (0.12-2.00).0071.98 (1.37-2.84).00032.20 (1.78-2.74)<.00013.32 (2.46-4.52) 
Age started smokinga, b17.9 (17.1-18.6)17.8 (16.5-19.2)15.4 (14.6-16.2)4.08 (1.54-10.8).005 1.84 (1.07-3.19).03 
Never chewed tobacco/betel nut, or99 (66%)21 (29%)39 (46%)2.93 (1.47-5.82).0024.77 (2.03-11.2).00031.37 (0.85-2.20) 
smoked cigars, pipe, or marijuana6.29 (4.00-8.59)6.63 (3.94-9.31)11.8 (8.57-15.0)1.43 (1.06-1.92).021.76 (1.24-2.54).0021.21 (0.98-1.49).07 
Clinical variables           
COPD (no)135 (92%)66 (90%)56 (78%)2.69 (1.03-7.01).04 2.12 (1.01-4.44).04 
Disease site           
Oropharynx52 (35%)15 (21%)25 (35%)1.0   1.0   
Oral cavity36 (24%)23 (31%)21 (29%)1.83 (0.76-4.36) 0.63 (0.34-1.15)   
Larynx38 (25%)20 (27%)16 (22%)2.08 (0.83-5.22)   0.81 (0.44-1.51) 
Other24 (16%)15 (21%)10 (14%)2.50 (0.90-6.97)   0.74 (0.37-1.48)   
Treatment modality           
Primary surgery24 (19%)19 (29%)5 (8%)1.0.04   
Chemoradiation34 (27%)18 (27%)16 (26%)0.30 (0.09-0.98)       
Primary radiation33 (26%)14 (21%)19 (31%)0.19 (0.06-0.65)       
Surgery + chemoradiation16 (12%)5 (8%)11 (18%)0.12 (0.03-0.51)       
Surgery + radiation21 (16%)10 (15%)11 (18%)0.24 (0.07-0.88)       
Stage           
TNM III vs I/II18 (14%)4 (7%)15 (23%)0.40 (0.11-1.50).04 0.69 (0.31-1.54) 
TNM IV vs I/II66 (53%)37 (70%)31 (48%)1.79 (0.75-4.28)   0.71 (0.40-1.27)   
image

Figure 1. Flow chart depicting the recruitment process and stratagem for administering the baseline and follow-up questionnaires.

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image

Figure 2. Kaplan-Meier plots for factors associated with time to quitting since diagnosis. The shaded areas reflect the 6-month period before and after diagnosis.

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Definition of Smoking

A smoker was defined as an individual who had smoked ≥100 cigarettes in his/her lifetime.[23] Ex-smokers were defined as patients who had quit at >1 year prior to diagnosis (Fig. 1).[5] Current smokers were patients who were smoking within 1 year prior to diagnosis, regardless of their smoking status thereafter. Current smokers were further subdivided as “active smokers” or “inactive smokers” based on their self-reported smoking behavior at the time of follow-up: “Are you currently smoking? Yes/No.”

Categorization of Variables

The number of standard alcoholic drinks (1 bottle/can of beer, one 5-ounce glass of wine, or one 1.5-ounce drink of spirits) consumed weekly was tabulated from the baseline questionnaire. This was the most regular (ie, representative) rate of consumption for each patient. Self-reported performance status was obtained from the baseline questionnaire (Eastern Cooperative Oncology Group).[24] Complete social support was defined as answering affirmative to all psychosocial questions included in Pomerleau et al.[22] Questions specific to active smokers were included on the follow-up questionnaire, which probed current (ie, at the time of follow-up) intention to quit (“no intention,” “intend to quit within the next 6 months,” “intend to quit within the next month” and made a 24-hour quit attempt), and the qualitative state of smoking (“I smoke every once in a while,” “I smoke regularly but have cut down,” “I smoke regularly”).

Statistical Methods

A comparison of demographic, clinical, and social environmental factors between HNC groups by smoking status was performed using stepwise logistic regression using the variables listed in Table 1. The association of social environmental factors with smoking status was performed individually for each factor listed in Table 2, adjusted for the significant variables of the antecedent stepwise regression. Correlation between social environmental variables was assessed using chi-square tests. Kaplan-Meier plots, log-rank tests, and proportional hazard models were used to determine predictors of the months to quitting, using the same methodology as above. Active smokers were censored at the time of follow-up, and quitting was considered an event. The number of months from diagnosis until the quit date was defined as months to quitting. To be consistent with our definition of current smokers, Kaplan-Meier curves started from 1 year prior to the diagnosis date. All statistical procedures were performed using SAS version 9.2. All tests were 2 sided, with significance defined as P < .05.

Table 2. Social Smoking and Environmental Characteristics of the Recruited Head and Neck Cancer Population by Smoking Status
   Predictor of Quitting after 1 Year Prior to Diagnosis (Inactive vs Active)Predictors of Having Already Quit at Baseline (Ex- vs Current Smoker)
 Ex-SmokersCurrent SmokersUnivariateMultivariate[1]UnivariateMultivariate[2]
VariableHave Not Restarted (n = 150)Inactive Smokers (n = 73)Active Smokers (n = 72)Odds RatioPOdds RatioPOdds RatioPOdds RatioP
  1. Ex-smokers quit smoking at least 1 year prior to diagnosis, active smokers continued to smoke at the time of diagnosis, whereas inactive smokers quit at some time between baseline and follow-up. The odds ratios with 95% confidence limits provided were derived from separate analyses.

  2. aAdjusted for the number of years smoked, the number of alcoholic drinks consumed per week, the time between questionnaires, and having ever or never regularly smoked cigars, pipes, marijuana, or chewed tobacco or betel nut; badjusted for age, sex, marital status, education; c2, 4, and 5 patients indicated not having a family physician among ex-, inactive, and active smokers, respectively; dincluded any use of nicotine replacement therapy, bupropion, varenicline, or other pharmacologic agent.

Social support           
Complete123 (82%)59 (81%)54 (75%)1.41 (0.64-3.10).511.52 (0.57-4.05).401.29 (0.73-2.29).380.80 (0.36-1.75).57
Family doctor           
Yes, seen within last 3 months[3]115 (78%)52 (71%)43 (61%)1.61 (0.81-3.23).182.99 (1.21-7.38).021.80 (1.07-3.02).031.42 (0.71-2.84).32
Pharmacologic aids in previous quit attempts         
None[4]108 (77%)41 (63%)28 (43%)2.26 (1.12-4.56).021.82 (0.79-4.23).162.89 (1.72-4.87)<.00011.48 (0.76-2.86).25
Number of previous quit attempts         
≤5137 (91%)61 (84%)56 (78%)1.45 (0.63-3.34).381.16 (0.45-2.99).112.52 (1.25-5.09).012.54 (1.04-6.24).05
Is there work exposure?           
No (0 hours)136 (96%)59 (88%)52 (90%)0.85 (0.28-2.61).781.08 (0.26-4.54).922.86 (1.06-7.68).041.32 (0.38-4.59).66
Does spouse smoke?           
No136 (93%)58 (82%)38 (54%)3.87 (1.81-8.29).00054.25 (1.70-10.6).0026.52 (3.13-13.5)<.00015.16 (2.00-13.3).0007
Is there home exposure?           
No133 (92%)58 (84%)25 (35%)9.70 (4.33-21.8)<.00017.44 (3.04-18.2)<.00018.30 (4.12-16.7)<.00013.98 (1.69-9.40).002
Hours of smoking exposure at home         
1-4 vs 5+ Hours9 (6%)7 (10%)11 (16%)5.57 (1.37-22.6)<.0001;6.00 (1.33-27.1)<.00019.75 (1.91-49.8)<.000110.3 (1.47-71.9).004
0 vs 5+ Hours133 (92%)58 (84%)25 (35%)20.3 (6.52-63.2) 16.1 (4.74-54.8) 31.2 (7.35-133) 17.0 (3.07-93.9) 
Proportion of friends who smoke         
Less than half136 (94%)56 (78%)34 (49%)3.71 (1.79-7.67).00042.32 (1.00-5.37).059.82 (4.46-21.7)<.00014.98 (1.87-13.3).001

RESULTS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. FUNDING SOURCES
  8. CONFLICT OF INTEREST DISCLOSURES
  9. REFERENCES

The baseline questionnaire was completed a mean 2.9 months (95% CI, 2.5-3.4 months) after the date of diagnosis (Fig. 1). Compared with HNC patients not recruited but captured by the institutional Cancer Registry, participants were diagnosed more recently (P < .0001), were younger (P = .004), were more likely to have tumors of the oral cavity (P = .0008), were more likely to have smoked (P = .04), and had accumulated fewer pack-years (P = .001). Four hundred forty-nine HNC patients also completed the follow-up questionnaire a mean 24.5 months (range, 6-43 months) after the baseline questionnaire.

The patient population was composed of 153 ex-smokers and 145 current smokers, of whom 73 (50%) were inactive and 72 (50%) were active smokers at follow-up. Ex-smokers who resumed smoking at follow-up (3 of 153) were excluded from all subsequent analyses (Fig. 1). A description of the clinical, demographic, and primary smoking and alcohol variables of the recruited HNC population is summarized in Table 1, stratified by smoking status.

Clinical and Demographic Factors Associated With Smoking Cessation

After accounting for the time between questionnaires (P = .004), current smokers were more likely to quit smoking (ie, become inactive smokers) if they had smoked for fewer years (P = .0003), had never used other forms of tobacco (P = .0003), and consumed fewer alcoholic drinks per week (P = .002) compared with active smokers (Table 2). These variables formed the adjustment model used for all subsequent multivariate analyses comparing inactive smokers with active smokers. In a subset analysis, HNC patients were more likely to quit smoking within the year prior to diagnosis if they smoked fewer cigarettes per day (OR, 1.17; 95% CI, 1.04-1.31; P = .007).

Compared with current smokers at baseline, ex-smokers were more likely to be older (P < .0001), female (P = .002), married (P = .0004), and more educated (completed high school or higher, P = .02) and to have smoked for fewer years (P < .0001); see Table 1.

Social Smoking Environment and Smoking Cessation

The distribution of the social environmental factors of the recruited HNC population is summarized in Table 2, stratified by smoking status. Among current smokers, patients were more likely to quit by the time of follow-up if they had no cigarette exposure at home (aOR, 7.44 [3.04-18.2]), a spouse who did not smoke (aOR, 4.25 [1.70-10.6]), and fewer peers who smoked (aOR, 2.32 [1.00-5.37]). A dose effect was observed for home exposure, with the odds of smoking cessation highest with the lowest number of hours exposed (P < .0001). Having recently (within 3 months of follow-up) visited a family doctor (surrogate for general primary care) was also associated with quitting [aOR, 2.99 (1.21-7.38)]. Pairwise comparisons revealed significant correlation between the home, spouse, and peer domains (P values ranged from 2.73 × 10−12 to 6.54× 10−27), but seeing a family physician was not significantly correlated (P values ranged from .09 to .64). Consequently, a secondhand smoke risk score was created on the basis of the presence (1 point for each) or absence (0 points for each) of exposure in any domain. At follow-up, 39 (58%), 21 (31%), 4 (6%), and 3 (5%) inactive smokers, and 13 (19%), 20 (29%), 16 (23%), and 20 (29%) active smokers had a risk score of 0, 1, 2, and 3, respectively. Having recently visited a family physician [aOR, 3.92 (1.82-11.2); P = .01] and having a risk score of 0 (aOR, 13.8 [1.07-10.8]) or 1 (aOR, 3.40 [1.07-10.8])—P < .0001—were independent factors associated with smoking cessation. In a subset analysis, there were no social environmental predictors associated with quitting during the year prior to diagnosis.

At baseline, patients who had already quit were more likely to have no exposure to cigarette smoke at home (aOR, 3.98 [1.69-9.40]), a spouse who did not smoke (aOR, 5.16 [2.00-13.3]), and fewer peers who smoked (aOR, 4.98 [1.87-13.3]); see Table 2. A significant dose effect was seen in the home domain, as smoking cessation was strongly and negatively associated with more time exposed (P = .004). Having fewer quit attempts was also associated with being an ex-smoker (P = .05) but was not correlated with exposure in the home domain (P = .23) or spouse domain (P = .18). The previously defined risk score was also used: at baseline, 121 (86%), 12 (9%), 5 (4%), and 2 (1%) ex-smokers had a risk score of 0, 1, 2, and 3, respectively. Fewer previous quit attempts (aOR, 4.61 [1.61-13.2]; P = .004) and having a risk score of 0 (aOR, 7.76 [2.58-23.3]; P < .0001) were independently associated with being an ex-smoker at diagnosis.

Factors Associated With Time to Quitting Among Current Smokers

We evaluated the association of the clinical, demographic, and social or environmental factors with the time to quitting among current smokers. Active smokers were censored, and inactive smokers were considered an event at the reported time of cessation since baseline. Individuals were more likely to quit earlier if they had smoked for fewer years (aHR, 1.55 [1.26-1.88]), had never used other forms of tobacco (aHR, 3.16 [1.73-5.78]), and consumed fewer alcoholic drinks per week (aHR, 1.43 [1.11-1.86]). The association of social and environmental factors with time to quitting was assessed, after adjustment for these variables. Earlier quitting was associated with seeing a family physician (HR, 2.34 [1.23-4.49]) and with having fewer sources of cigarette exposure in the home domain (HR, 4.52 [2.16-9.45]), spousal domain (HR, 2.95 [1.50-5.83]), or peer domain (HR 1.99 [1.05-3.76]); see Figure 2. A significant dose effect was seen with increasing daily exposure in the home domain: HR, 7.61 (2.68-21.6) for no exposure; HR, 3.57 (0.96-13.4) for 1-4 hours of exposure (P = .0003). Both visiting a family physician in the past 3 months (aHR, 2.94 [1.46-5.95], P = .003) and having a risk score of 0 or 1 (aHR, 7.23 [2.94-17.8]; aHR, 3.01 [1.16-7.82], respectively; P < .0001) were independent factors associated with earlier smoking cessation.

Quitting Behavior and Intention to Quit

Sixty-eight percent of patients quit smoking within 6 months of the time of diagnosis (Fig. 1), and 68% quit before treatment started. Among the active smokers, 18 (25%) had no intention to quit smoking, 15 (21%) intended to quit within the next month and made a 24-hour quit attempt, and 39 (54%) indicated the intention to quit within the next 6 months. There were no factors associated with the intention to quit (data not shown). At the time of follow-up, 21 active smokers (29%) smoked regularly after diagnosis, 41 (57%) smoked regularly but had cut down, and 10 (14%) smoked every once in a while. Most active smokers indicated that they believed smoking was associated with the risk of throat cancer (91%) and mouth cancer (90%).

DISCUSSION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. FUNDING SOURCES
  8. CONFLICT OF INTEREST DISCLOSURES
  9. REFERENCES

Social smoking environments were the strongest and most consistent predictors of smoking cessation among patients who quit >1 year prior to diagnosis and who quit close to or following diagnosis, despite the different demographic factors associated with cessation in each group. The most important social factors associated with smoking cessation were whether one's spouse smoked, what proportion of one's friends smoked, and the level of smoke exposure at one's home, with odds ratios in the double digits for the combined risk exposure. Social environments such as being in an environment in which people smoke have been shown to be strongly associated with smoking cessation, but most studies evaluated this in noncancer smoking populations.[25-27] Analysis of patients who quit versus those who did not quit prior to baseline confirms a strong effect of the social smoking environment on one's ability to quit in general.

Few studies to date have evaluated some social smoking or environmental factor as a driver of smoking cessation in an HNC population. Berg et al[19] evaluated the effects of one's family, friends, and significant other on smoking cessation as a single variable in a mixed smoking-associated cancer population. This was measured by the Multidimensional Scale of Perceived Social Support (MSPSS). However, the MSPSS scale was designed to measure the effect of social support and not social smoking environment.[28] Examples of patient comments provided by Berg et al suggested that social smoking environment may have played an important role, but conflation into a single score may have been confounded by other social support measures. Results presented in Table 2 show that our social support variable (similar to the MSPSS scale) was not associated with smoking cessation in our population. Another study found no association of the smoking behavior of one's spouse (quitting or continuing) on the rate of smoking cessation, but this was also performed in a mixed smoking-associated cancer population.[12] A third study found no association of the presence of other smokers in the household with smoking cessation, but data for this variable were available for only a small subset (35%) of the study population.[13] In contrast, the results presented in this study of HNC patients show strong associations of these social smoking environments with smoking cessation and time to quitting.

Other important factors found in this report, such as the number of quit attempts and visitation with a family physician, substantiate previous findings.[13, 29] Although 92% of active smokers in our population indicated having a family physician, only 65% of these individuals had visited this physician within 3 months prior to follow-up. Recently, there has been increased emphasis on family physicians to advocating smoking cessation to their patients.[30, 31] Despite this, physician-guided advice to quit has only been marginally successful for reducing smoking rates among HNC patients, and the role of social environment (ie, advice from family or friends) and patients' motivation to quit should also be considered.[12, 14, 19, 25, 32-36] This report suggests that incorporation of actively smoking family members or friends in smoking cessation interventions may promote higher levels of success for HNC patients.

Social smoking exposures may vary by the socioeconomic makeup of the institutions' catchment areas.[37] This study is therefore limited by its generalizability to other cancers and to other institutions. Smoking-associated cancers that are less well known by the patient population to be associated with cigarette exposure, such as bladder or kidney cancer, may have different factors affecting cessation rates. Furthermore, inactive smokers diagnosed with HNC may relapse 12 or even 36 months after quitting,[38] and so the 50% cessation rate reported in our population may be an overestimate, pending longer follow-up. With respect to this and to compensate for potential recall bias, the time between questionnaires was incorporated into statistical analyses.

In conclusion, social smoking environment, seeing a family physician, and the number of quit attempts of a smoker play a critical role in predicting smoking cessation in the general population and in HNC patients. Targeting patients with higher social risks and inclusion of friends and family in smoking cessation interventions, rather than targeting the patient alone, should be considered.

REFERENCES

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. FUNDING SOURCES
  8. CONFLICT OF INTEREST DISCLOSURES
  9. REFERENCES
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