Smoking cessation in head & neck cancer patients?

Smoking is a risk factor for head and neck cancer as is alcohol consumption and human papilloma virus. While encouraging smoking cessation and alcohol consumption are key preventive activities continuing smoking after diagnosis of head and neck cancer decreases the efficacy of treatment and increases recurrence risk.

The aim of this review was to describe the efficacy of smoking cessation counseling and the resulting quit rate in patients with head and neck cancer.

Methods

Searches were conducted in the PubMed/Medline, and Embase databases. English language Studies in patients with a head and neck cancer diagnosis or with precancerous lesions involving interventions for smoking cessation were considered. Two reviewers carried out study selection and data abstraction and risk of bias assessment independently.

Results

8 studies involving a total of 1,239 patients were included (3 RCTs, 3 Cohort studies, 2 case-series).
All the studies were considered to be at low risk of bias
Follow up periods for most studies ranged from 1-12 months with one study reporting at 5 years.
Some form of cognitive behavioral therapy (CBT) using a face-to-face approach administered by a physician or nurse was used in all the studies.
Most studies reported no difference in the quit rate between the intervention group and the control group.
Meta-analysis of the 6 studies (946 patients) yielded a pooled RR for smoking cessation of 0.76 (95%CI; 0.59-0.97) with little heterogeneity (I2 = 0%; P = .67).

Conclusions

The authors concluded

The complied data from the studies show that patients receiving counseling had a 26% higher quit rate compared with controls; therefore, it would be reasonable to recommend counseling as a part of smoking cessation programs for patients with head and neck cancer.

Comments

This review is limited to two databases and studies published in English so there is the potential that some potentially relevant studies could have been missed. It is also interesting to note that although the individual studies reported a difference in quit rate with the intervention the meta-analysis suggests a positive impact. Given this findings it would have been interesting if a second meta-analysis had been presented that only included the 3 RCTs to compare the effect size as these studies would be considered to be at less risk of bias.

While it is important for head and neck cancer patient to stop smoking there is greater potential from dentists and the dental team being involved with the identification of at risk patients earlier by identifying patients who smoke and drink above recommended levels and providing advice and or signposting to services to help them quit as discussed in our recent Oral Cancer #elfcampfire.

Links

Primary paper

Klemp I, Steffenssen M, Bakholdt V, Thygesen T, Sørensen JA. Counseling Is Effective for Smoking Cessation in Head and Neck Cancer Patients-A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg. 2016 Feb 18. pii: S0278-2391(16)00166-X. doi: 10.1016/j.joms.2016.02.003. [Epub ahead of print] Review. PubMed PMID: 26973223.

Other references

Dental Elf – 14^th Mar 2016 – Tobacco use and alcohol intake key risk factors for head and neck cancer – See more at: https://www.nationalelfservice.net/dentistry/page/2/#sthash.5XmNi4wo.dpuf