Smoking and cancer death rate in head and neck cancer patients

A new large population-based study finds that head and neck cancer patients who smoke at diagnosis have a significantly increased rate of death from cancer.

Chart of cumulative incidence - smoking

The new study, conducted by researchers at the National Cancer Registry Ireland, used registry data to identify patients diagnosed with head and neck cancer during 1994-2009. They were stratified by smoking status at diagnosis. They also grouped patients by cancer site (oral cavity, pharynx, larynx, other) and treatment received (surgery, chemotherapy or radiotherapy within a year of diagnosis).

Over half of the large sample (5,652 patients) smoked at diagnosis, while one-fifth were ex-smokers. A major finding of the study was that smoking increased the rate of cancer death within 5 years of diagnosis. When the researchers compared current smokers to those that had never smoked, current smokers had a significantly increased death rate (36%) from cancer, while ex-smokers had a modest, non-significant, increased death rate in the overall analysis. The rate of death due to cancer was significantly raised in smokers with oral cavity, pharyngeal and laryngeal tumours. The risk of cancer death was higher in current smokers who underwent directed surgery than in those who did not. Neither chemotherapy nor radiotherapy modified the effect of smoking. These results suggest that the relationship may be explained, at least in part, by adverse effects of smoking on surgical outcomes and disease recurrence.

While smoking is a major risk factor in the aetiology of head and neck cancer, greater efforts to encourage smoking cessation in those newly diagnosed with head and neck cancer should bring significant survival benefits. 

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