Association between smoking during radiotherapy and prognosis in head and neck cancer: a follow-up study

Head Neck. 2002 Dec;24(12):1031-7. doi: 10.1002/hed.10168.


Background: The study objective was to confirm a previous finding that patients with stage III/IV squamous head and neck cancer (SHNC) who smoke during radiotherapy (RT) experience reduced survival.

Methods: An observational cohort study. Patients' smoking status was assessed weekly by questionnaire plus blood cotinine. Patients were assessed every 3 to 4 months for survival. Logistic regression and Cox proportional hazards analyses were used to detect the independent contribution of smoking on survival.

Results: Of 148 patients, 113 smoked during RT. Blood cotinine and smoking questionnaire responses were highly correlated (Spearman R = .69; p < .0005). Abstainers and very light smokers experienced better survival than light, moderate, and heavy smokers (median, 42 vs 29 months; p = .07). Tumor and nodal status and years smoked were the most important prognostic factors. Smoking during RT was not an independent predictor of survival, but baseline smoking status was (p = .016).

Conclusion: Smoking status should be documented in all future trials of RT in SHNC to allow for pooled analyses with sufficient power to address this question.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Carcinoma, Squamous Cell / radiotherapy*
  • Cohort Studies
  • Cotinine / blood
  • Female
  • Follow-Up Studies
  • Head and Neck Neoplasms / radiotherapy*
  • Humans
  • Indicators and Reagents / analysis
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Proportional Hazards Models
  • Radiotherapy / adverse effects*
  • Smoking / adverse effects*
  • Smoking / blood
  • Surveys and Questionnaires
  • Survival Analysis


  • Indicators and Reagents
  • Cotinine