P003: HOW DOES SMOKING AFFECT SURVIVAL IN HEAD AND NECK CANCER? A POPULATION-BASED STUDY ANALYZING SURVIVAL OUTCOMES BY CIGARETTE USE, DEMOGRAPHICS, AND TUMOR CHARACTERISTICS.
Connor B Christensen, BS1; Julien Tremblay, BS1; Amrit Baral, MD, MPH2; Paulo S Pinheiro, MD, MSc, PhD3; 1University of Miami Miller School of Medicine; 2Department of Public Health Sciences, University of Miami Miller School of Medicine; 3Sylvester Comprehensive Cancer Center, Department of Public Health Sciences, University of Miami Miller School of Medicine
Background: Head and neck cancer (HNC) is the eighth most common and fifth most deadly malignant neoplasm in the world, with males affected significantly more than females. The American Cancer Society estimates that there are more than 550,000 new cases and 380,000 deaths annually from HNC in the U.S. While cases associated with smoking have reduced over recent decades given the decline of tobacco use in general, long-term mortality is far worse in patients with concomitant history of smoking. Despite the strong association with HNC and smoking status, the role of smoking as an independent predictor of of 5-year mortality in cases of oropharyngeal cancer (OPC) is unclearhas conflicting evidence. Disparities between black and white in the morbidity and mortality of HNC survival are widely reported, however, very little is known about the Hispanic population. In this study, wWe make use of unique, individual-level, population-based data on cigarette smoking status from the Florida Cancer Data System (FCDS), the Florida statewide cancer registry. This is the first study to our knowledge that to assesses the prognostic role of cigarette use in the ethnically diverse population of Florida, while taking into consideration cancer sublocation, tumor characteristics, socio-economic factors, and treatment status.
Methods: All primary HNC cases (N=38,990) from the Florida Cancer Registry Data diagnosed during 2005–2018 were analyzed (N=38,990). A Cox univariable and multivariable regression was conducted using SPSS to assess the determinants of HNC survival, including age, sex, race/ethnicity, socioeconomic status, cancer location (oropharynx, tongue etc.), cancer stage, and treatment received with a particular focus on smoking status (current, former, and never smoker).
Results: Of all HNC cases less than a third (29.6%) occurred among never smokers. Non-Hispanic whites had the highest proportionsrates of ever smokerssmoking (72.2%) followed by American Indian (70.2%), Non-Hispanic blacks (68.4%), Hispanics (62.2%), mixed/other (59.1%), and lastly Asian/pacific islanders (47.6%). Ever smokers accounted for 70.4% of total cases but 77.7% of all HNC deaths. In multivariable analysis comparing against never smokers, there was a 26% and 79% increased risk of death for former and current smokers respectively while adjusting for potential confounders (HR: 1.26, 95%CI: 1.21-1.31; HR: 1.79 95%CI: 1.72-1.86). In the same analysis comparing against non-Hispanic whites, non-Hispanic blacks were found to have an 24% increased risk of death while Hispanics were found to have a 15% decreased risk of death (HR: 1.24, 95%CI: 1.18-1.3; HR: 0.85 95%CI: 0.82-0.89) compared to non-Hispanic Whites.
Conclusion: While controlling for sex, SES, race/ethnicity, stage, insurance status, age, and different treatment regiments smoking status is associated with increased risk for death among patients with HNC. Additionally, survival disparities by race, SES, insurance status and a number of other factors still exist among HNC patients in south Florida. Clinicians should encourage and implement cigarette smoking cessation interventions targeted at current smokers diagnosed with HNC. Future studies are warranted to assess the role of different types of tobacco use and cessation programs on HNC survival.