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Epidemiology

Post-diagnosis smoking cessation and survival of patients with head and neck cancer: a systematic review and meta-analysis

Abstract

Cigarette smoking is the main risk factor for head and neck cancer (HNC) and many HNC patients are active smokers at diagnosis. We conducted a systematic literature review and meta-analysis to quantify the survival impact of smoking cessation at or around the time of HNC diagnosis. We searched studies published until December 31, 2021, and used random-effects meta-analysis to pool study-specific estimates into summary hazard ratio (SHR) and corresponding 95% confidence intervals (CI). Sixteen studies were published between 1983 and 2021, and over 2300 HNC patients were included. Studies were diverse in terms of design, patients, tumours and treatment characteristics, and criteria used to discriminate quitters from continued smokers. HNC patients who quit smoking at or around diagnosis had significantly better overall survival than continued smokers (SHR 0.80, 95% CI 0.70–0.91, n studies = 10). A beneficial effect of post-diagnosis smoking cessation was suggested for other survival endpoints as well, but the results were based on fewer studies (n = 5) and affected by publication bias. Cessation counselling should be offered to all smokers who start a diagnostic workup for HNC and should be considered standard multidisciplinary oncological care for HNC patients. PROSPERO registration number CRD42021245560.

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Fig. 1: PRISMA 2020 flow diagram for new systematic reviews which included searches of databases and registers only.
Fig. 2: Forest plot for the association between quitting smoking at or around the diagnosis and overall survival of patients with head and neck cancer.
Fig. 3: Forest plot for the association between quitting smoking at or around diagnosis and event-free survival of patients with head and neck cancer.
Fig. 4: Forest plot for the association between quitting smoking at or around the diagnosis and locoregional control among patients with head and neck cancer.

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Funding

This work was supported by the Italian Ministry of Health (Ricerca Corrente and 5 ×1000 funds), no grant number applicable. The Funder had no role in designing and conducting the study, in the writing of the manuscript, and in the decision to submit it in its present form.

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SC: conceptualisation, data curation, investigation, methodology, project administration, resources, supervision, validation and writing—original draft. MDR: conceptualisation, data curation, investigation, methodology, project administration and writing—original draft. VV: conceptualisation, data curation, investigation, project administration, validation and writing—original draft. OD’E: data curation, formal analysis, investigation, methodology, software, visualisation, writing—review and editing. PB: conceptualisation, investigation, methodology, resources, supervision, writing—original draft. LGL: investigation, methodology and writing—original draft. VS: data curation, investigation, validation and writing—original draft. OG: conceptualisation, investigation, resources, supervision and writing—review & editing. MT: data curation, formal analysis, software, visualisation and writing—review and editing. SR: formal analysis, funding acquisition, methodology, software, visualisation and writing—review and editing. CS: investigation, resources, supervision and writing—review and editing. FC: data curation, investigation, validation and writing—original draft. BB: investigation, methodology, supervision and writing—review and editing. SG: conceptualisation, formal analysis, funding acquisition, methodology, project administration, resources, software, supervision, visualisation and writing—review & editing.

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Correspondence to Saverio Caini.

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Caini, S., Del Riccio, M., Vettori, V. et al. Post-diagnosis smoking cessation and survival of patients with head and neck cancer: a systematic review and meta-analysis. Br J Cancer 127, 1907–1915 (2022). https://doi.org/10.1038/s41416-022-01945-w

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