Smoking During Head & Neck Cancer Therapy Tied to Poor Outcome

Patients with head and neck cancer who continue to smoke while undergoing radiation treatments have a much lower long-term survival rate than those who kick the addiction, researchers have found. In the study of patients with squamous cell carcinoma of the head and neck, 23 percent of 101 patients who continued to smoke were still alive five years after treatment, compared with 55 percent of matched patients in a control group who quit smoking before they began radiation therapy.

In addition, 53 of the patients who continued to smoke suffered cancer recurrence, compared with 40 patients in the control group. The patients who kept smoking also had more treatment-related complications such as the development of scar tissue, hoarseness and difficulty eating. The poorer outcomes for persistent smokers were found both in patients who had radiation alone and in those who had surgery prior to radiation, the study authors noted in the report published in the February issue of the International Journal of Radiation Oncology/Biology/Physics.

"I've always told patients, 'You should really stop smoking,' but I had no tangible evidence to use to convince them that they would be worse off if they continued to smoke," lead author Dr. Allen Chen, residency training program director at the University of California, Davis, School of Medicine, said in a news release from the American Society for Radiation Oncology. "I wanted concrete data to see if smoking was detrimental in terms of curability, overall survival and tolerability of treatment. We showed continued smoking contributed to negative outcomes with regard to all of those," he added.

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Odds of Quitting Smoking May Be Clear on Scans

Brain scans can predict a smoker's chances of being able to quit, according to a new study. It included 28 heavy smokers recruited from a smoking cessation program. Functional MRI was used to monitor the participants' brain activity as they watched television ads meant to help people quit smoking. The researchers contacted the participants one month later and found that they were smoking an average of five cigarettes a day, compared with an average of 21 a day at the start of the study.

But there was considerable variation in how successful individual participants were in reducing their smoking. The researchers found that a reaction in an area of the brain, called the medial prefrontal cortex, while watching the quit-smoking ads was linked to reductions in smoking during the month after the brain scan. Previous research by the same team suggested that activity in the prefrontal cortex is predictive of behavior change.

In the new study, published in the current issue of Health Psychology, "we targeted smokers who were already taking action to quit, and we found that neural activity can predict behavior change, above and beyond people's own assessment of how likely they are to succeed," study author Emily Falk, director of the Communication Neuroscience Laboratory at the University of Michigan Institute for Social Research and Department of Communication Studies, said in a university news release.

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'Stop Smoking' Ads That Target Emotions Seem to Work Best

Television ads that encourage people to quit smoking are most effective when they use a "why to quit" strategy that includes either graphic images or personal testimonials, a new study suggests. The three most common broad themes used in smoking cessation campaigns are why to quit, how to quit and anti-tobacco industry, according to scientists at RTI International, a research institute. The study authors examined how smokers responded to and reacted to TV ads with different themes. They also looked at the impact that certain characteristics such as cigarette consumption, desire to quit, and past quit attempts had on smokers' responses to the different types of ads.

"While there is considerable variation in the specific execution of these broad themes, ads using the 'why to quit' strategy with graphic images or personal testimonials that evoke specific emotional responses were perceived as more effective than the other ad categories," lead author Kevin Davis, a senior research health economist in RTI's Public Health Policy Research Program, said in an institute news release. Davis and his colleagues also found that those who had less desire to quit and those who had not tried quitting in the past year had significantly less favorable responses to all types of smoking cessation ads. The same was true, to a lesser extent, for smokers with high levels of cigarette consumption.

"These findings suggest that smokers clearly differ in their reactions to cessation-focused advertising based on their individual desire to quit, prior experience with quit attempts and, to a lesser degree, cigarette consumption. These are important considerations for campaign creators, designers and media planners," Davis said. The study, published online in the journal Tobacco Control, used data from 7,060 adult smokers in New York State who took part in an online survey. On Wednesday, the U.S. Food and Drug Administration announced a new "comprehensive tobacco control strategy" that would include not only graphic photos on packs of cigarettes, but bold statements such as "Smoking Will Kill You."

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Better Screening Urged for Self-Injury in Teens

Doctors often fail to screen their adolescent eating-disorder patients for evidence of self-inflicted physical harm in the form of cutting or burning, new research reveals. The observation stems from work conducted by researchers at the Stanford University School of Medicine and Lucile Packard Children's Hospital in Palo Alto, Calif. Led by Dr. Rebecka Peebles, the research team published its findings in the Sept. 28 online edition of the Journal of Adolescent Health. Peebles and her colleagues noted that eating disorders typically found among adolescents, such as bulimia and anorexia, are often associated with a higher risk for self-inflicted injury. This, Peebles noted in a Stanford news release, often stems from a troubled patient's need to try "to feel pain."

"Patients describe a feeling of release that comes when they cut or burn themselves," she said. "They'll cut with a razor or a scissor blade. Sometimes we've even had kids who will take the tip of a paper clip and gouge holes. To burn themselves, they'll heat up a metal object and press it to their skin, or they'll use cigarettes." Prior research has indicated that between 13 percent and 40 percent of all American adolescents engage in some form of self-injury. The practice is also linked to a higher risk for suicide, the study authors noted. To see how often this happens and how often doctors proactively screen for the association, the investigators focused on the medical records of 1,432 patients between the ages of 10 and 21 years, who had sought treatment for an eating disorder at the Comprehensive Eating Disorders Program at Packard Children's Hospital between 1997 and 2008.

More than 90 percent of the patients were female, three-quarters were white, and the average age was 15, the researchers noted. Nearly 41 percent were found to have engaged in intentional self-inflicted injury. More than 85 percent of the time this took the form of cutting themselves. Yet despite the high prevalence, only about half of the patients had been asked by hospital staff if they had hurt themselves on purpose. Those who were asked tended to fit a classic profile: they were female, older, white and had a diagnosis of bulimia and/or substance abuse of some kind. "The question is," said Peebles, "are we missing other kids who are not meeting this profile? This is part of why we wanted to look at this. If you see an innocent-looking 12-year-old boy, you don't even think of asking about self-injurious behavior. We need to get much better about universal screening."

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Study Finds Even a Little Cigarette Smoke Harms Airway

A drag from a cigarette now and then can't hurt, right? Wrong, according to a new study that finds even low levels of smoke exposure can cause irreparable damage to cells essential to breathing. The damage occurred among "casual" smokers and even after exposure to secondhand smoke. The initial damage, while not usually severe, can be cumulative and prolonged exposure to tobacco smoke could lead to chronic obstructive pulmonary disease (COPD) and even lung cancer, the researchers reported. "It has been known for a long time that secondhand smoke or smoking occasionally can be risky for your health," said study author Dr. Ronald Crystal.

Just how much a little exposure might damage airway cells hasn't been clear, however. "We found that if we could detect nicotine in the urine we could also detect changes in the genes in the cells lining the airways," said Crystal, who is also chair of the department of genetic medicine at Weill Cornell Medical College. The bottom line: "There is no level of cigarette smoking or exposure to cigarette smoke that does not make the cells in your lungs sick," he said. "If you are an occasional smoker you are still at risk. Don't think that smoking one or two cigarettes a week means you are home free."

As for secondhand smoke, "if you are working in a place where people smoke, either get them to stop or go get another job," Crystal advised. "If you have somebody at home who smokes, send them outside to smoke. Don't be exposed to secondhand smoke." The report is published in the Aug. 20 issue of American Journal of Respiratory and Critical Care Medicine. For the study, Crystal's team recruited 121 people who were nonsmokers, active smokers or low-exposure smokers. To determine who belonged in which group, all participants had their urine tested for levels of nicotine.

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