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Patterns of tobacco cessation attempts and symptoms experienced among smokers with head and neck squamous cell carcinoma

JAMA Otolaryngology—Head & Neck Surgery Apr 21, 2018

Khariwala SS, et al. - Authors ascertained the frequency and character of tobacco cessation attempts and symptoms experienced prior to the development of head and neck squamous cell carcinoma (HNSCC). They also determined the correlation of these symptoms with the number of cessation attempts and maximum quit days. Experts noted clustering of the symptoms during cessation and that most patients made 1 or more cessation attempts. Successful cessation before restarting was noted in many patients. More quit attempts were seen in the patients who experienced C2 symptoms. Because of the association of the C1 symptoms with fewer quit attempts, these symptoms could be more difficult to overcome.

Methods

  • Experts conducted a cross-sectional study including 123 active smokers with HNSCC recruited from a tertiary medical center at an academic institution from February 2014 to May 2017.
  • Prior to developing HNSCC, all included patients were active cigarette smokers.
  • Data indicating intensity of smoking, duration, number of cessation attempts, maximum number of days during which they successfully ceased smoking, and symptoms during cessation attempts was provided by the patients.
  • Researchers used principal component analysis to identify clustering of symptoms.

Results

  • As per data, in total, 123 patients were identified (97 men, 23 women, and 3 unspecified) from February 2014 to May 2017 as active smokers (mean [SD] age, 59.4 [9.0] years; median [interquartile range] age, 58.5 [54.8-66.0] years); patients had oral (n = 39 [32%]), oropharyngeal (n = 44 [36%]), laryngeal (n = 32 [26%]) or hypopharyngeal (n = 7 [6%]) tumors.
  • Findings suggested that overall, 108 patients (88%) had made at least 1 prior attempt at cessation, and the mean number of lifetime cessation attempts was 6.6.
  • Most frequently, the symptoms of cravings, restlessness, irritability, and anxiety were reported.
  • Authors clustered the symptoms into 2 component groups: Component group 1 (C1; increased appetite, cravings, depression) and component group 2 (C2; restlessness, irritability, insomnia, anxiety, and difficulty concentrating).
  • Correlation of component group 2 with quit attempts (Spearman correlation, 0.268 [95% CI, 0.07 to 0.45]) was seen, and C1 and C2 were not associated with maximum quit days.
  • A positive association of cessation attempts with maximum quit days was seen.

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