Addictions, Social Deprivation and Cessation Failure in Head and Neck Squamous Cell Carcinoma Survivors

SIMPLE SUMMARY: Tobacco and alcohol are well-known risk factors of head and neck squamous cell carcinoma (HNSCC). A low socio-economic status also represents an independent risk factor of HNSCC. However, tobacco, alcohol, and social precariousness are rarely assessed by oncologists. The aim of this prospective study was to evaluate the evolution of tobacco/alcohol consumption and dependence, as well as social deprivation, in survivors of a first HNSCC to whom systematic screening and management were proposed from the time of diagnosis. We show that addictions and social deprivation tend to improve when taken care of from the diagnosis. The most dependent and frail patients are at highest risk of cessation failure. Intervention targeting smoking and drinking at the same time might be more effective. Smoking and drinking cessation might improve survival for HNSCC patients. ABSTRACT: Aim: To evaluate the evolution of addictions (tobacco and alcohol) and social precarity in head and neck squamous cell carcinoma survivors when these factors are addressed from the time of diagnosis. Methods: Addictions and social precarity in patients with a new diagnosis of HNSCC were assessed through the EPICES score, the Fagerström score, and the CAGE questionnaire. When identified as precarious/dependent, patients were referred to relevant addiction/social services. Results: One hundred and eighty-two patients were included. At the time of diagnosis, an active tobacco consumption was associated with alcohol drinking (Fisher’s exact test, p < 0.001). Active smokers were more socially deprived (mean EPICES score = mES = 36.2 [±22.1]) than former smokers (mES = 22.8 [±17.8]) and never smokers (mES = 18.9 [±14.5]; Kruskal-Wallis, p < 0.001). The EPICES score was correlated to the Fagerström score (Kruskal-Wallis, p < 0.001). Active drinkers (mES = 34.1 [±21.9]) and former drinkers (mES = 32.7 [±21]) were more likely to be socially deprived than those who never drank (mES = 20.8 [±17.1]; Krukal-Wallis, p < 0.001). A Fagerström score improvement at one year was associated to a CAGE score improvement (Fisher’s exact test, p < 0.001). Tobacco and alcohol consumption were more than halved one year after treatment. Patients who continued to smoke one year after diagnosis were significantly more likely to continue to drink (Fisher’s exact test, p < 0.001) and had a significantly higher initial EPICES score (Kruskal-Wallis, p < 0.001). Conclusions: At one year, addictions and social deprivation tend to improve when taken care of from the diagnosis. The most dependent patients and those with multiple frailties are at highest risk of cessation failure.