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Original Investigation
June 2018

Patterns of Tobacco Cessation Attempts and Symptoms Experienced Among Smokers With Head and Neck Squamous Cell Carcinoma

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis
  • 2Masonic Cancer Center, University of Minnesota, Minneapolis
  • 3Department of Psychiatry, University of Minnesota, Minneapolis
  • 4Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis
  • 5Department of Epidemiology and Community Health, University of Minnesota, Minneapolis
  • 6Department of Biostatistics, University of Minnesota, Minneapolis
JAMA Otolaryngol Head Neck Surg. 2018;144(6):477-482. doi:10.1001/jamaoto.2018.0249
Key Points

Question  At what rate is smoking cessation attempted by those who develop head and neck squamous cell carcinoma (HNSCC) and what symptoms are experienced?

Findings  In this cross-sectional study of 123 smokers who developed HNSCC, most patients (108) had attempted to quit smoking before developing the disease. During their quit attempts, patients developed symptoms that clustered into 2 groups; C1 (increased appetite, cravings, and depression) was associated with fewer smoking cessation attempts than C2 (restlessness, irritability, insomnia, anxiety, and difficulty concentrating).

Meaning  Our findings suggest that symptoms in C1 (increased appetite, cravings, and depression) might be more difficult for smokers to overcome in their smoking cessation attempts.


Importance  Among smokers with head and neck squamous cell carcinoma (HNSCC), there is ample evidence regarding the benefits of smoking cessation prior to treatment. Prior data indicates that increased attempts at cessation result in higher likelihood of cessation after diagnosis but the prediagnostic patterns of smoking cessation attempts among those smokers developing HNSCC has not been characterized. Data of this kind may direct cessation efforts toward increased efficacy.

Objective  To determine the frequency and character of tobacco cessation attempts and symptoms experienced prior to development of HNSCC, as well as to determine the correlation of these symptoms with number of cessation attempts and maximum quit days.

Design, Setting, and Participants  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.

Exposures  All included patients were active cigarette smokers prior to developing HNSCC.

Main Outcomes and Measures  Patients provided 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. Principal component analysis was used to identify clustering of symptoms.

Results  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. Overall, 108 patients (88%) had made at least 1 prior attempt at cessation, and the mean number of lifetime cessation attempts was 6.6. Symptoms of cravings, restlessness, irritability, and anxiety were reported most frequently. Symptoms were clustered into 2 component groups: component group 1 (C1; increased appetite, cravings, depression) and component group 2 (C2; restlessness, irritability, insomnia, anxiety, and difficulty concentrating). Component group 2 correlated with quit attempts (Spearman correlation, 0.268 [95% CI, 0.07 to 0.45]), and C1 and C2 were not correlated with maximum quit days. Cessation attempts and maximum quit days positively correlated with each other.

Conclusions and Relevance  Our analysis shows that symptoms during cessation attempts tend to cluster and that most patients made 1 or more cessation attempts. Many patients successfully ceased before restarting. Our data suggest that patients experiencing C2 symptoms make more quit attempts; C1 symptoms may be more difficult to overcome because they are associated with fewer quit attempts. Future work will address whether amelioration of these symptoms may help smoking cessation among smokers with HNSCC.