Change in tobacco and alcohol consumption following a diagnosis of head and neck cancer: results from Head and Neck 5000


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Chris Penfold1,Andrea Waylen1,Steve Thomas2,Andy Ness1
1Bristol Nutrition BRU,2University Hospitals Bristol NHS Foundation Trust

Abstract

Background

Tobacco and alcohol consumption in people with head and neck cancer (HNC) are associated with higher mortality. Smoking cessation and reduced alcohol consumption following diagnosis may therefore improve outcomes. A diagnosis of HNC may represent a ‘teachable moment’ when individuals are better able to reduce risky health behaviours. We explored whether people recently diagnosed with HNC modified their health behaviour over the 12-months following diagnosis in Head and Neck 5000, a large prospective clinical cohort of people with HNC.

Method

We included participants diagnosed with oral cavity, oropharyngeal or laryngeal cancer who were alive 12-months after diagnosis, and completed health and lifestyle questionnaires prior to treatment and 4 months and 12 months later. We described the prevalence of self-reported smoking and alcohol consumption above recommended limits (>14 units/week) at diagnosis, 4-months and 12-months, and change in these behaviours.

Results

Complete data were available on 1,027 people (26%). At diagnosis 21% (95%CI 19%-24%) of people were current smokers and 54% (51%-57%) were high alcohol consumers. At 4 and 12-months these reduced to 11% (9%-13%) and 12% (10%-14%) for smoking, and 35% (32%-38%) and 41% (38%-44%) for alcohol respectively. Only 55% of 12-month smokers were smokers at both diagnosis and 4-months, 27% were former smokers at diagnosis, and 17% quit and restart after diagnosis. 65% of high alcohol consumers at 12-months were high consumers at diagnosis and 4-months. 26% were initially high consumers who reduced consumption at 4-months, and 9% were initially low consumers.

Conclusion

A diagnosis of HNC is associated with reductions in alcohol consumption and smoking. However, falls in the prevalence of risky behaviours disguise the dynamic nature of these behaviours. Diagnosis and treatment of HNC may represent a series of ‘teachable moments’ for behaviour change and people may need tailored interventions to support and maintain behaviour change.