Apr. 10, 2009 Head and neck cancer patients who smoked, drank, didn't exercise or didn't eat enough fruit when they were diagnosed had worse survival outcomes than those with better health habits, according to a new study from the University of Michigan Comprehensive Cancer Center.
"While there has been a recent emphasis on biomarkers and genes that might be linked to cancer survival, the health habits a person has at diagnosis play a major role in his or her survival," says study author Sonia Duffy, Ph.D., R.N., associate professor of nursing at the U-M School of Nursing, research assistant professor of otolaryngology at the U-M Medical School, and research scientist at the VA Ann Arbor Healthcare System.
Each of the factors was independently associated with survival. Results of the study appear online in the Journal of Clinical Oncology.
The researchers surveyed 504 head and neck cancer patients about five health behaviors: smoking, alcohol use, diet, exercise and sleep. Patients were surveyed every three months for two years then yearly after that.
Smoking was the biggest predictor of survival, with current smokers having the shortest survival. Problem drinking and low fruit intake were also associated with worse survival, although vegetable intake was not. Lack of exercise also appears to decrease survival.
"Health behaviors are only sporadically addressed in busy oncology clinics where the major focus is on surgery, chemotherapy or radiation. Addressing health behaviors may enhance the survival advantage offered by these treatments," says Duffy, a U-M Cancer Center investigator.
Complicating matters is that many of these health behaviors are inter-related. For example, smokers might also be heavy drinkers, making it more difficult to quit. It's not enough, Duffy points out, to refer someone to a smoking cessation program if alcohol is a major underlying problem.
In addition, previous research has associated many of these health behaviors with preventing cancer. In the current study, a third of the patients reported eating fewer than four servings of fruit per month. Nutrition experts recommend two servings of fruit per day.
"Eating fruits and vegetables, not smoking and drinking in moderation can have a big impact on a person's risk of getting cancer in the first place. Now it appears that these factors also impact survival after diagnosis," Duffy says.
The next step for the researchers is to look at behavior changes over time to determine if changing health habits when a person is diagnosed can impact survival. That will help determine what types of interventions or services should be offered to patients in the clinic.
Head and neck cancer statistics: 35,310 Americans will be diagnosed with head and neck cancers this year and 7,590 will die from the disease, according to the American Cancer Society
Additional authors include David L. Ronis, Ph.D., associate research scientist, U-M School of Nursing; Scott McLean, M.D., Ph.D., Henry Ford Health System; Karen E. Fowler, U-M research associate; Stephen B. Gruber, M.D., Ph.D., M.P.H., associate professor of internal medicine, human genetics and epidemiology, U-M Medical School and U-M School of Public Health; Gregory T. Wolf, M.D., professor of otolaryngology, U-M Medical School; and Jeffrey E. Terrell, M.D., associate professor of otolaryngology, U-M Medical School.
Funding was provided through the National Institutes of Health, Head and Neck Cancer Specialized Program of Research Excellence (SPORE) grant.
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- Duffy et al. Pretreatment Health Behaviors Predict Survival Among Patients With Head and Neck Squamous Cell Carcinoma. Journal of Clinical Oncology, March 16, 2009; DOI: 10.1200/JCO.2008.18.2188
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