Abstract B78: The interplay between smoking at diagnosis, marital status, and head and neck cancer survivorship
Authors: Osazuwa-Peters Nosayaba , Boakye Eric Adjei , Tobo Betelihem B. , Christopher Kara M. , Chen Betty Y. , Freter Carl E. , Varvares Mark A. 
Published: March 2017

Abstract
BACKGROUND
There are currently almost 300,000 head and neck cancer survivors in the United States, and that number is increasing due to a nationwide decrease in smoking incidence. Reports on whether smoking at time of diagnosis is associated with adverse head and neck cancer outcomes are inconsistent. There is also a paucity of information on whether marital status of head and neck cancer patients affects tobacco use. In the era of personalized cancer care, it is important to examine whether smoking status at diagnosis negatively affects survival of head and neck cancer patients to develop interventions that improve survivorship. It is also important to examine how marital status is associated with smoking, since spousal support is known to improve survival outcomes among head and neck cancer patients.
PURPOSE
Examine the association between smoking status at diagnosis and survival among head and neck cancer patients, as well as the association between marital status and smoking in these patients.
METHODS
This retrospective cohort study included 463 patients aged 20 to 87 (59.31 ± 11.42) with a diagnosis of head and neck squamous cell carcinoma (HNSCC) who attended an academic medical center between 1997 and 2012. For the first aim, the outcome was overall mortality. Main predictor variable was smoking at diagnosis (dichotomized as yes/no) and covariates included age, gender, race, marital status, insurance, alcohol use, stage of cancer, and treatment type received. Descriptive statistics and Cox proportional hazards regression analysis were used to evaluate predictors of survival based on smoking status at diagnosis and covariates. For the second aim, the outcome was smoking status at diagnosis, and the main predictor variable was marital status using the same covariates in the first aim. Multivariate logistic regression models were used to assess whether marital status was a predictor of smoking at diagnosis.
RESULTS
Approximately 56% of patients were smokers at diagnosis, and 50% were married. We found a statistically significant difference in median survival time between smokers vs. nonsmokers (50 months vs. 80 months, p &lt; .05). In the adjusted Cox proportional hazards model, smoking status at diagnosis was an independent predictor of survival. Patients who were smokers at diagnosis were almost twice as likely to die earlier compared to nonsmokers (HR = 1.98; 95% CI: 1.42, 2.77). Other predictors of survival included stage of presentation (early stage HR=0.61; 95% CI: 0.42, 0.88), marital status (married HR=0.54; 95% CI: 0.40, 0.73), and age (20-49 years HR=0.42; 95% CI: 0.26, 0.67). In the multivariate logistic regression analysis, marital status was a significant predictor of tobacco use. Patients who were unmarried were 76% more likely to use tobacco compared to married patients (aOR=1.76; 95% CI: 1.08, 2.84). Patients who used tobacco were almost 3 times more likely to use alcohol vs. non-users (aOR=2.90; 95% CI: 1.82, 4.60). Other significant predictors of tobacco use included age and insurance status.
CONCLUSIONS
Smoking status at diagnosis independently predicts survival of head and neck cancer patients, and those who were smokers were almost twice as likely to die earlier than those who did not smoke. We also found that those who were married were less likely to be smokers at diagnosis. Our study suggests that individualized cancer care should incorporate social support in managing cancer risk behaviors. Both smoking and marital status predicted survival outcomes; thus, our findings highlight the need for providers to discuss and encourage spousal involvement in tobacco cessation efforts to mitigate risky behaviors that negatively affect head and neck cancer survival.
Citation Format: Nosayaba Osazuwa-Peters, Eric Adjei Boakye, Betelihem B. Tobo, Kara M. Christopher, Betty Y. Chen, Carl E. Freter, Mark A. Varvares. The interplay between smoking at diagnosis, marital status, and head and neck cancer survivorship. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B78.