Cotinine Level in Head and Neck Cancer Patients: An Objective Measure of Tobacco Use. (23rd August 2013)

• Record Type: Journal Article
• Authors: Hatcher, Jeanne L.; Weaver, Kathryn; Tooze, Janet; Sterba, Katherine; Day, Terry A.; Sullivan, Christopher A.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 149(2013)Supplement 2
• Page Start: P167
• Page End: P167
• Publication Date: 2013-08-23
• Subjects: Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599813496044a77
• Languages: English
• ISSNs: 0194-5998

Abstract

Abstract : Objectives: 1) Compare the prevalence of tobacco use in preoperative head and neck cancer patients as assessed by urinary cotinine and self‐report. 2) Consider the importance of accurate measurement of tobacco use in pre‐operative head and neck cancer surgical patients and potential implications for clinical interventions. Methods: Patients with squamous cell carcinoma of the upper aerodigestive tract undergoing a major head and neck surgical procedure were recruited from two academic medical centers from May 2011 to November 2012. We assessed preoperative tobacco exposure by self‐report and urinary cotinine using a semiquantitative test strip. Results: We recruited 112 patients (mean age 59); 72.3% male, 82.1% white, 76.5% stages III‐IV. The prevalence of tobacco use in the 48 hours prior to surgery was higher when assessed by urinary cotinine (41.1%) when compared to self‐report (25.9%) (McNemar's exact test, P < 0.0001). Sensitivity of self‐reported tobacco use was 60.9% and specificity was 98.5%. Of those who denied tobacco use prior to surgery (N = 83), 18 (21.7%) had a positive urinary cotinine and 14 (16.9%) reported second‐hand smoke exposure. There were no significant associations between second‐hand exposure, gender, cancer stage, or prior treatment and positive cotinine. Conclusions: Accurate measurement of tobacco use is critical to care provision and intervention development for head and neck cancer patients. Self‐report may fail to identify a significant number of tobacco users. Future analysis in this study will examine relationships among self‐reported tobacco use, cotinine level, and postoperative outcomes including length of stay and wound infection.