Originally published as JCO Early Release 10.1200/JCO.2008.18.2188 on March 16 2009

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Pretreatment Health Behaviors Predict Survival Among Patients With Head and Neck Squamous Cell Carcinoma

From the Departments of Otolaryngology, Psychiatry, Internal Medicine, Epidemiology, and Human Genetics, University of Michigan Medical School; School of Nursing, University of Michigan; Ann Arbor Veterans Affairs (VA) Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor; and Department of Otolaryngology, Henry Ford Health System, Detroit, MI.

Corresponding author: Sonia A. Duffy, PhD, RN, VA Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare System (11H), PO Box 130170, Ann Arbor, MI 48113-0170; e-mail: bump{at}med.umich.edu.

Purpose Our prior work has shown that the health behaviors of head and neck cancer patients are interrelated and are associated with quality of life; however, other than smoking, the relationship between health behaviors and survival is unclear.

Patients and Methods A prospective cohort study was conducted to determine the relationship between five pretreatment health behaviors (smoking, alcohol, diet, physical activity, and sleep) and all-cause survival among 504 head and neck cancer patients.

Results Smoking status was the strongest predictor of survival, with both current smokers (hazard ratio [HR] = 2.4; 95% CI, 1.3 to 4.4) and former smokers (HR = 2.0; 95% CI, 1.2 to 3.5) showing significant associations with poor survival. Problem drinking was associated with survival in the univariate analysis (HR = 1.4; 95% CI, 1.0 to 2.0) but lost significance when controlling for other factors. Low fruit intake was negatively associated with survival in the univariate analysis only (HR = 1.6; 95% CI, 1.1 to 2.1), whereas vegetable intake was not significant in either univariate or multivariate analyses. Although physical activity was associated with survival in the univariate analysis (HR = 0.95; 95% CI, 0.93 to 0.97), it was not significant in the multivariate model. Sleep was not significantly associated with survival in either univariate or multivariate analysis. Control variables that were also independently associated with survival in the multivariate analysis were age, education, tumor site, cancer stage, and surgical treatment.

Conclusion Variation in selected pretreatment health behaviors (eg, smoking, fruit intake, and physical activity) in this population is associated with variation in survival.

Supported by Grant No. P50 CA97248 from the National Institutes of Health through the University of Michigan's Head and Neck Specialized Program of Research Excellence.

Presented in part at the 7th International Conference on Head and Neck Cancer, American Head and Neck Society, July 19-23, 2008, San Francisco, CA.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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