Social environment, secondary smoking exposure, and smoking cessation among head and neck cancer patients

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. (c) 2013 American Cancer Society.