You may well ask what is the novel value of a paper looking at smoking habits in patients with confirmed head and neck squamous cell carcinoma (HNSCC), but this paper highlights some pertinent points for clinical practice in the current era of individualised patient care. The robust methodology employed by this group from Ann Arbor in the USA used prospectively collected self-reported annual questionnaires on an unselected cohort of previously untreated HNSCC patients. In particular, they emphasised the need to move away from the over-simplified ‘current/ex/never smoked’ smoking history, and focused in addition on what age patients started/stopped smoking and details of smoking intensity. A large cohort of 687 patients was followed and survival outcomes recorded.
The study revealed some new and interesting findings as well as supporting associations already reported. Survival was significantly worse with every 10-year increase in pack-years, as was being a current smoker. However, they found that smoking from an earlier age may be more clinically relevant for survival than those who are recent/current smokers.
They also underlined the strong correlation between smoking and smoking-associated comorbidities such as cardiovascular and pulmonary disease (again, having a temporal association) which can significantly impact HNSCC treatment outcomes. The current era of HPV-related HNSCC, and more tailored patient-specific paradigms in modern HNSCC treatment, emphasises the need for prognostic information for each patient. A history of smoking in HPV-positive patients in this cohort was not found to have a significant association with survival outcomes. However, HPV-negative non-smokers did not have improved survival outcomes when compared with their smoking counterparts. Management of smoking-associated comorbidities and detailed temporal smoking history was a key take-home message from this paper.
