Many patients with head and neck squamous cell carcinoma (HNSCC) who were daily smokers at the time of diagnosis continued smoking following treatment, according to study results reported in JAMA Otolaryngology-Head & Neck Surgery.

The study was a prospective cohort analysis of patients treated at an academic tertiary care center from January 2009 through December 2017. Eligible patients had received a new diagnosis of HNSCC and were daily smokers at the time of diagnosis, with a habit of 5 cigarettes smoked per day for 5 or more years. The researchers performing the study collected demographic and clinical data for these patients, as well as data from patient reports of smoking-related behaviors. Those included in the study had 24 months of posttreatment follow-up data.

A total of 89 smokers with HNSCC had completed follow-up and were included in the analysis. They had a mean age at enrollment of 60.1 years. Multiple racial and ethnic groups were represented in the study population. Approximately half of the patients had been treated with surgery (50.6%), while others received chemoradiotherapy (49.4%). The oropharynx was the primary tumor site in 39.3% of patients, compared with the larynx in 23.6% and the oral cavity in 22.5%. Patients had a mean smoking habit of 14.7±10.0 cigarettes smoked per day and a mean duration of 23.1±18.6 years of tobacco use.

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At 6 months after treatment, 58.4% of the patients continued smoking. The percentage of patients still smoking at 12 months was 52.8%, at 18 months it was 46.1%, and at 24 months of follow-up it was 44.9%. Smoking cessation probability was greatest during the initial 6 months of follow-up, and at which time it was calculated to be 0.36.

The researchers also evaluated factors associated with continued use of tobacco at 24 months of follow-up, compared with quitting tobacco use. Persistent tobacco use by 24 months was more likely among patients who smoked a higher mean number of cigarettes per day at diagnosis (17.8 vs 12.4 cigarettes; mean difference, 5.1; 95% CI, 0.2-10.6). Patients with a longer duration of tobacco use (28.2 vs 16.4 years; mean difference, 11.8; 95% CI, 1.9-21.7) also were more likely to continue their tobacco use. Additionally, persistent tobacco use was more likely among patients with a lower number of prior attempts at quitting (5.3 vs 10.4 attempts; mean difference, −5.2; 95% CI, −15.7 to 5.4).

“Among patients with 24-month posttreatment follow-up, the majority of patients with HNSCC who smoked at the time of diagnosis continued to smoke after treatment,” the study investigators demonstrated in their study.


Van Heest T, Rubin N, Khariwala S. Persistent tobacco use after treatment for head and neck cancer. JAMA Otolaryngol Head Neck Surg. Published online May 12, 2022. doi:10.1001/jamaoto.2022.0810