PREDICTORS OF LONG-TERM SMOKING CESSATION IN HEAD AND NECK-CANCER PATIENTS

Cigarette smoking is a major risk factor for head and neck cancer, and individuals who continue to smoke past diagnosis and treatment are at elevated risk for further disease. In a randomized controlled trial, a state of the art provider-delivered smoking cessation intervention w as compared to a usual care advice control condition. The intervention consisted of surgeon- or dentist-delivered advice to stop smoking, a contracted quit date, tailored written materials, and booster advice s essions. Subjects were 186 patients with newly diagnosed first primary squamous cell carcinomas of the upper aerodigestive tract who had smo ked cigarettes within the past year. At randomization, 88.2% of subjec ts were current smokers. At 12-month follow-up, 70.2% of subjects comp leting the trial (n = 114) were continuous abstainers; among baseline smokers alone the continuous abstinence (CA) rate was 64.6%. The cotin ine validation rate at 12 months was 89.6%. Modeling techniques were u tilized in order to derive expected CA rates, which included noncomple ter subjects (n = 72). The CA rate expected at 1 year for the entire p atient population was 64.2%, and for smokers alone the expected CA rat e was 59.4%. Logistic regression analysis carried out on baseline smok ers identified predictors of 12-month CA status. These included medica l treatment, stage of change, age, nicotine dependence, and race. The intervention effect was not significant, although the sign of the effe ct was positive. Based on these findings, we recommend systematic brie f advice to stop smoking for head and neck cancer patients, with a ste pped care approach for patients less able to quit.