Alcohol and Tobacco Use Pre- and Post-Diagnosis and Survival In a Cohort of Patients With Early Stage Cancers of the Oral Cavity Pharynx And Larynx

摘要

As more people begin to survive first cancers, there is an increased need for science-based recommendations to improve survivorship. For survivors of head and neck cancer, use of tobacco and alcohol prior to diagnosis predicts poorer survival; however, the role of continuing these behaviors after diagnosis on mortality is less clear, especially for more moderate alcohol consumption. Patients (n=264) who were recent survivors of early stage head and neck cancer were asked to retrospectively report their tobacco and alcohol histories (before diagnosis) with information prospectively updated annually thereafter. Patients were followed for an average of 4.2 years, with 62 deaths observed. Smoking history before diagnosis dose-dependently increased the risk of dying; risks reached 5.4 (95% CI=0.7–40.1) among those with >60 pack-years of smoking. Likewise, alcohol history before diagnosis dose-dependently increased mortality risk; risk reached 4.9 (95% CI=1.5–16.3) for persons who drank >5 drinks/day, an effect explained by beer and liquor consumption. After adjusting for pre-diagnosis exposures, continued drinking (average of 2.3 drinks per day) post-diagnosis significantly increased risk (RR continued drinking vs. no drinking=2.7, 95% CI, 1.2–6.1), while continued smoking was associated with non-significantly higher risk (RR continued smoking vs. no smoking =1.8, 95% CI, 0.9–3.9). Continued drinking of alcoholic beverages after an initial diagnosis of head and neck cancer adversely affects survival; cessation efforts should be incorporated into survivorship care of these patients.