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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention
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Alcohol and Tobacco Use Prediagnosis and Postdiagnosis, and Survival in a Cohort of Patients with Early Stage Cancers of the Oral Cavity, Pharynx, and Larynx

Susan T. Mayne, Brenda Cartmel, Victoria Kirsh and W. Jarrard Goodwin Jr.
Susan T. Mayne
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Brenda Cartmel
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Victoria Kirsh
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W. Jarrard Goodwin Jr.
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DOI: 10.1158/1055-9965.EPI-09-0944 Published December 2009
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Abstract

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 before 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% confidence interval (95% CI), 0.7-40.1] among those with >60 pack-years of smoking. Likewise, alcohol history before diagnosis dose-dependently increased mortality risk; risks reached 4.9 (95% CI, 1.5-16.3) for persons who drank >5 drinks/d, an effect explained by beer and liquor consumption. After adjusting for prediagnosis exposures, continued drinking (average of 2.3 drinks/d) postdiagnosis significantly increased risk (relative risk for continued drinking versus no drinking, 2.7; 95% CI, 1.2-6.1), whereas continued smoking was associated with nonsignificantly higher risk (relative risk for continued smoking versus 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. (Cancer Epidemiol Biomarkers Prev 2009;18(12):3368–74)

Keywords
  • head and neck
  • alcohol
  • tobacco
  • survival
  • prognostic factors
  • prospective study

Footnotes

  • Grant support: NIH P01-CA42101 and NIH R01-CA64567.

    • Received September 14, 2009.
    • Revision received October 20, 2009.
    • Accepted October 20, 2009.
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Cancer Epidemiology Biomarkers & Prevention: 18 (12)
December 2009
Volume 18, Issue 12
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Alcohol and Tobacco Use Prediagnosis and Postdiagnosis, and Survival in a Cohort of Patients with Early Stage Cancers of the Oral Cavity, Pharynx, and Larynx
Susan T. Mayne, Brenda Cartmel, Victoria Kirsh and W. Jarrard Goodwin Jr.
Cancer Epidemiol Biomarkers Prev December 1 2009 (18) (12) 3368-3374; DOI: 10.1158/1055-9965.EPI-09-0944

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Alcohol and Tobacco Use Prediagnosis and Postdiagnosis, and Survival in a Cohort of Patients with Early Stage Cancers of the Oral Cavity, Pharynx, and Larynx
Susan T. Mayne, Brenda Cartmel, Victoria Kirsh and W. Jarrard Goodwin Jr.
Cancer Epidemiol Biomarkers Prev December 1 2009 (18) (12) 3368-3374; DOI: 10.1158/1055-9965.EPI-09-0944
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