Quitting smoking after cancer diagnosis may alter prognosis, provide ‘dramatic’ benefits
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Key takeaways:
- Patients with laryngeal cancer who quit smoking after diagnosis have significantly better therapy response, survival rates.
- Those who stop also have much better odds of avoiding a salvage laryngectomy.
Individuals with laryngeal cancer who stop smoking in the 2- to 4-week window between diagnosis and their first treatment can significantly improve their response to therapy, survival rates and quality of life.
The results of the retrospective study, published in Otolaryngology – Head and Neck Surgery, indicated patients who quit smoking had nearly four times the odds of achieving a complete response to cancer treatment compared with those who did not stop, twice the likelihood of keeping their voice box and a 20% higher OS benefit at multiple checkpoints.
“This is dramatic,” Lurdes Queimado, MD, PhD, professor at University of Oklahoma Health Sciences Center, told Healio. “What this does is send a message to our patients with cancer that even though you are smoking at this point, you can make a big difference. You can still change your prognosis.”
Evaluating the recent quitters
Tobacco use significantly increases the odds of an individual developing laryngeal cancer, yet between 30% and 76% of patients who get diagnosed continue to smoke, according to background information researchers provided.
Additionally, previous studies, including those Queimado has worked on, showed tobacco smoke can prevent cisplatin chemotherapy from reaching its potential full efficacy in individuals with head and neck cancer.
Most research, however, has evaluated patients who never smoked or previously smoked vs. those who do smoke.
Queimado and colleagues wanted to know if smokers who stopped before treatment would have a better prognosis.
They used the University of Oklahoma Health Sciences Center cancer registry to build a study cohort of individuals diagnosed with laryngeal squamous cell carcinoma who identified as current smokers. The group included individuals who quit within 3 months of treatment.
The cohort consisted of 140 adults (mean age, 60 years; 72% men; 87% white;), 45% of whom quit smoking before the start of treatment.
Researchers evaluated response to first-line treatment, laryngectomy‐free survival and OS as the study’s primary endpoints.
Study result showed that individuals who stopped smoking had a significantly higher complete response rate compared with active smokers (82% vs. 57%; OR = 3.69; 95% CI, 1.58-8.66).
Patients who ceased smoking also had higher OS rates at multiple checkpoints, including at 3 years (83% vs. 66%), 5 years (79% vs. 60%) and 7 years (75% vs. 56%).
Those who quit had a 54% lower likelihood of needing salvage laryngectomy (HR = 0.456; 95% CI, 0.246-0.848) as well.
“For a person who has a laryngeal cancer, if the chemo doesn’t work, we need to remove the larynx,” Queimado said. “That means your voice, your ability to speak and your ability to breathe will be permanently changed. You are going to breathe through a permanent opening — a stoma — in the base of your neck.”
The results underscore the importance of smoking cessation programs and making sure patients use them, Queimado said.
“Smoking-cessation programs and treatment plans are very prevalent, but the rate at which patients quit [is] really low,” she explained. “I think there is a disconnect there. I think part of it is the lack of integration.”
Patient-tailored, approach
Queimado said her center has worked on bringing cessation programs to the patient to ease their burden.
“Most patients want to quit — it’s just that quitting is very difficult,” she said. “That’s where we come in with the smoking cessation multidisciplinary team, where we offer psychological support and nicotine replacement therapy.”
Medical interventions can be offered as well, including drugs that aid in smoking cessation.
“There are alternatives, and the patients need to know there are alternatives, and they can use all of them or some of them,” Queimado added. “Treatment is usually tailored to what the patient wants to do.”
Individuals may benefit if clinicians check on their cessation progress as well.
“Patients work hard to quit and, when successful, they are proud that they quit,” Queimado said. “They tend to quit more if they are complemented on their effort to quit, so just follow-up.”
Although quitting is critical, Queimado said more research must be done on how cessation methods may impact first-line treatments. More investigations evaluating patients who use nicotine replacement therapy or other medications to stop smoking must be conducted.
Additionally, more work needs to be done to evaluate vaping’s effect on front-line therapy as well as whether switching from smoking to vaping could alter results.
Queimado and colleagues have also developed a protocol for a prospective study evaluating patients who quit smoking prior to treatment.
“We follow every single patient who comes to the clinic and is diagnosed with head and neck cancer,” she said. “What do they use? Do they vape? How much? Do they use tobacco?”
They will also ask whether the study participant stopped smoking before the start of therapy and track their treatment outcomes.
“We need to support these patients,” Queimado said. “Helping patients quit smoking will change so much on their prognosis — not just their survival, but their quality of life.”
For more information:
Lurdes Queimado, MD, PhD, can be reached at lurdes-queimado@ouhsc.edu.
Perspective
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Jessica Geiger, MD
It is common knowledge that tobacco use of any kind is detrimental to one’s health, particularly in the development of cancer. In the oncology world, it also is well known that continuing to smoke after a cancer diagnosis may contribute to poorer outcomes. The data presented by Queimado and colleagues are compelling, highlighting the need to share such results with our patients who are newly diagnosed with head and neck cancer.
Head and neck cancer treatment is complicated, often involving multiple modalities of therapy — including radiation, chemotherapy and surgery — to achieve a cure. Patients frequently ask, “What else can I do to improve my chances?” Counseling a patient to quit smoking is a straightforward task; following through with tobacco cessation, however, is often a nearly impossible task for patients, who are faced with tremendous physical and mental/emotional stress during this time.
These data provide numerical evidence that a patient’s behavior — quitting smoking — can directly have a dramatic effect on her or his own cure rate and OS rate at multiple time points, as well as reduce the risk for needing a salvage laryngectomy.
Although these findings are encouraging, the implementation of tobacco cessation programs presents another challenge. Are we identifying patients at risk from other forms of tobacco use, such as pipe smoking, cigars and chewing tobacco? Are there similar risks with vaping? These questions remain but do not detract from the important work that provides solid numbers and tangible results to encourage each patient to adhere to a tobacco-free lifestyle. As these data show, it is clearly not too late to make a change and have an impactful difference.
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