European Society for Therapeutic Radiology and Oncology (ESTRO): International Oncology Forum

LONDON – Nonglottic cancer and the presence of dysphagia before treatment are highly predictive for severe acute and late swallowing difficulties after radiotherapy for head and neck cancer, according to new data from the DAHANCA 6&7 randomized trial.

Patients with nonglottic cancer were more likely than those with other cancer types to experience severe dysphagia at both 6 and 12 months. Dysphagia before treatment was also associated with both acute and late severe swallowing difficulties.

"The peak incidence of dysphagia is seen during the first 6 months after radiotherapy," Hanna Rahbek Mortensen, Ph.D., reported in an analysis of the DAHANCA (Danish Head and Neck Cancer Group) 6&7 trial findings at the European Society for Therapeutic Radiation Oncology Anniversary Congress.

"After 1 year, however, there is no further increase in severity or prevalence," said Dr. Mortensen of the department of experimental clinical oncology at Åarhus (Denmark) University Hospital.

The trial involved 1,478 patients with squamous cell carcinomas of the glottic larynx, supraglottic larynx, pharynx, or oral cavity who were who were treated with five or six weekly fractions of radiotherapy in 1992-1999. The total dose of radiotherapy delivered was 66-68 Gy in 33-34 fractions.

Efficacy data from the trial have already been published; they showed improved disease-specific but not overall survival of five vs. six fractions of radiotherapy (Lancet 2003;362:933-40).

The aim of the present analysis was to use prospectively collected data from the trial to determine whether any factors could be used to establish which patients may be more likely than others to experience dysphagia following treatment.

"Dysphagia is a common and debilitating side effect of radiotherapy, leading to malnutrition, aspiration, and reduced quality of life," Dr. Mortensen explained. The side effect can be graded using a 5-point scale, with a score of 0 signifying no dysphagia and a score of 3 or 4 indicating considerable or severe dysphagia despite the ingestion of a liquid-only diet.

In all, 1,422 (96%) patients experienced acute dysphagia, including severe grade 3/4 dysphagia in 47% and 38% of those receiving accelerated or conventional radiotherapy, respectively. The two factors most predictive for severe dysphagia at 6 months were nonglottic cancer (odds ratio, 6.73 vs. other sites; P less than .0001) and a baseline dysphagia score of 2-4 vs. 0-1 (OR, 2.11; P =.004).

Odd ratios for other factors predictive for acute – but not late – dysphagia were 1.92 for any (N1-N3) vs. no (N0) nodal involvement (P less than .001), 1.82 for the use of accelerated (six weekly fractions) vs. conventional (five weekly fractions) radiotherapy (P less than .001), and 1.58 for stage T3-T4 vs. stage T1-T2 cancer (P = .02).

After 5-years of regular follow-up, late dysphagia had occurred in 1,205 patients (81%), with grade 3 severity in 24% and grade 4 in 23%. Factors that were predictive for late severe dysphagia that occurred 12 months after radiotherapy were, again, nonglottic cancer (OR, 8.25; P less than .0001) and a baseline dysphagia score greater than 1 (OR, 2.57; P less than .002). Late (T3-T4) tumor stage was also predictive (OR, 1.86; P = .03).

"Predictive factors have been identified to characterize patients at risk of developing acute and late dysphagia," Dr. Mortensen said. These factors may be useful to identify patients who could perhaps benefit from prophylactic measures against swallowing dysfunction.

The DAHANCA 6&7 trial was supported by the Danish Cancer Society, Åarhus University Hospital, Copenhagen University Hospital, Herlev (Denmark) Hospital, Odense (Denmark) University Hospital, and Aalborg (Denmark) Hospital on behalf of DAHANCA. Dr. Mortensen had no personal financial disclosures to declare.

LONDON – Nonglottic cancer and the presence of dysphagia before treatment are highly predictive for severe acute and late swallowing difficulties after radiotherapy for head and neck cancer, according to new data from the DAHANCA 6&7 randomized trial.

Patients with nonglottic cancer were more likely than those with other cancer types to experience severe dysphagia at both 6 and 12 months. Dysphagia before treatment was also associated with both acute and late severe swallowing difficulties.

"The peak incidence of dysphagia is seen during the first 6 months after radiotherapy," Hanna Rahbek Mortensen, Ph.D., reported in an analysis of the DAHANCA (Danish Head and Neck Cancer Group) 6&7 trial findings at the European Society for Therapeutic Radiation Oncology Anniversary Congress.

"After 1 year, however, there is no further increase in severity or prevalence," said Dr. Mortensen of the department of experimental clinical oncology at Åarhus (Denmark) University Hospital.

The trial involved 1,478 patients with squamous cell carcinomas of the glottic larynx, supraglottic larynx, pharynx, or oral cavity who were who were treated with five or six weekly fractions of radiotherapy in 1992-1999. The total dose of radiotherapy delivered was 66-68 Gy in 33-34 fractions.

Efficacy data from the trial have already been published; they showed improved disease-specific but not overall survival of five vs. six fractions of radiotherapy (Lancet 2003;362:933-40).

The aim of the present analysis was to use prospectively collected data from the trial to determine whether any factors could be used to establish which patients may be more likely than others to experience dysphagia following treatment.

"Dysphagia is a common and debilitating side effect of radiotherapy, leading to malnutrition, aspiration, and reduced quality of life," Dr. Mortensen explained. The side effect can be graded using a 5-point scale, with a score of 0 signifying no dysphagia and a score of 3 or 4 indicating considerable or severe dysphagia despite the ingestion of a liquid-only diet.

In all, 1,422 (96%) patients experienced acute dysphagia, including severe grade 3/4 dysphagia in 47% and 38% of those receiving accelerated or conventional radiotherapy, respectively. The two factors most predictive for severe dysphagia at 6 months were nonglottic cancer (odds ratio, 6.73 vs. other sites; P less than .0001) and a baseline dysphagia score of 2-4 vs. 0-1 (OR, 2.11; P =.004).

Odd ratios for other factors predictive for acute – but not late – dysphagia were 1.92 for any (N1-N3) vs. no (N0) nodal involvement (P less than .001), 1.82 for the use of accelerated (six weekly fractions) vs. conventional (five weekly fractions) radiotherapy (P less than .001), and 1.58 for stage T3-T4 vs. stage T1-T2 cancer (P = .02).

After 5-years of regular follow-up, late dysphagia had occurred in 1,205 patients (81%), with grade 3 severity in 24% and grade 4 in 23%. Factors that were predictive for late severe dysphagia that occurred 12 months after radiotherapy were, again, nonglottic cancer (OR, 8.25; P less than .0001) and a baseline dysphagia score greater than 1 (OR, 2.57; P less than .002). Late (T3-T4) tumor stage was also predictive (OR, 1.86; P = .03).

"Predictive factors have been identified to characterize patients at risk of developing acute and late dysphagia," Dr. Mortensen said. These factors may be useful to identify patients who could perhaps benefit from prophylactic measures against swallowing dysfunction.

The DAHANCA 6&7 trial was supported by the Danish Cancer Society, Åarhus University Hospital, Copenhagen University Hospital, Herlev (Denmark) Hospital, Odense (Denmark) University Hospital, and Aalborg (Denmark) Hospital on behalf of DAHANCA. Dr. Mortensen had no personal financial disclosures to declare.

LONDON – Nonglottic cancer and the presence of dysphagia before treatment are highly predictive for severe acute and late swallowing difficulties after radiotherapy for head and neck cancer, according to new data from the DAHANCA 6&7 randomized trial.

Patients with nonglottic cancer were more likely than those with other cancer types to experience severe dysphagia at both 6 and 12 months. Dysphagia before treatment was also associated with both acute and late severe swallowing difficulties.

"The peak incidence of dysphagia is seen during the first 6 months after radiotherapy," Hanna Rahbek Mortensen, Ph.D., reported in an analysis of the DAHANCA (Danish Head and Neck Cancer Group) 6&7 trial findings at the European Society for Therapeutic Radiation Oncology Anniversary Congress.

"After 1 year, however, there is no further increase in severity or prevalence," said Dr. Mortensen of the department of experimental clinical oncology at Åarhus (Denmark) University Hospital.

The trial involved 1,478 patients with squamous cell carcinomas of the glottic larynx, supraglottic larynx, pharynx, or oral cavity who were who were treated with five or six weekly fractions of radiotherapy in 1992-1999. The total dose of radiotherapy delivered was 66-68 Gy in 33-34 fractions.

Efficacy data from the trial have already been published; they showed improved disease-specific but not overall survival of five vs. six fractions of radiotherapy (Lancet 2003;362:933-40).

The aim of the present analysis was to use prospectively collected data from the trial to determine whether any factors could be used to establish which patients may be more likely than others to experience dysphagia following treatment.

"Dysphagia is a common and debilitating side effect of radiotherapy, leading to malnutrition, aspiration, and reduced quality of life," Dr. Mortensen explained. The side effect can be graded using a 5-point scale, with a score of 0 signifying no dysphagia and a score of 3 or 4 indicating considerable or severe dysphagia despite the ingestion of a liquid-only diet.

In all, 1,422 (96%) patients experienced acute dysphagia, including severe grade 3/4 dysphagia in 47% and 38% of those receiving accelerated or conventional radiotherapy, respectively. The two factors most predictive for severe dysphagia at 6 months were nonglottic cancer (odds ratio, 6.73 vs. other sites; P less than .0001) and a baseline dysphagia score of 2-4 vs. 0-1 (OR, 2.11; P =.004).

Odd ratios for other factors predictive for acute – but not late – dysphagia were 1.92 for any (N1-N3) vs. no (N0) nodal involvement (P less than .001), 1.82 for the use of accelerated (six weekly fractions) vs. conventional (five weekly fractions) radiotherapy (P less than .001), and 1.58 for stage T3-T4 vs. stage T1-T2 cancer (P = .02).

After 5-years of regular follow-up, late dysphagia had occurred in 1,205 patients (81%), with grade 3 severity in 24% and grade 4 in 23%. Factors that were predictive for late severe dysphagia that occurred 12 months after radiotherapy were, again, nonglottic cancer (OR, 8.25; P less than .0001) and a baseline dysphagia score greater than 1 (OR, 2.57; P less than .002). Late (T3-T4) tumor stage was also predictive (OR, 1.86; P = .03).

"Predictive factors have been identified to characterize patients at risk of developing acute and late dysphagia," Dr. Mortensen said. These factors may be useful to identify patients who could perhaps benefit from prophylactic measures against swallowing dysfunction.

The DAHANCA 6&7 trial was supported by the Danish Cancer Society, Åarhus University Hospital, Copenhagen University Hospital, Herlev (Denmark) Hospital, Odense (Denmark) University Hospital, and Aalborg (Denmark) Hospital on behalf of DAHANCA. Dr. Mortensen had no personal financial disclosures to declare.

LONDON – Nonglottic cancer and the presence of dysphagia before treatment are highly predictive for severe acute and late swallowing difficulties after radiotherapy for head and neck cancer, according to new data from the DAHANCA 6&7 randomized trial.

Patients with nonglottic cancer were more likely than those with other cancer types to experience severe dysphagia at both 6 and 12 months. Dysphagia before treatment was also associated with both acute and late severe swallowing difficulties.

"The peak incidence of dysphagia is seen during the first 6 months after radiotherapy," Hanna Rahbek Mortensen, Ph.D., reported in an analysis of the DAHANCA (Danish Head and Neck Cancer Group) 6&7 trial findings at the European Society for Therapeutic Radiation Oncology Anniversary Congress.

"After 1 year, however, there is no further increase in severity or prevalence," said Dr. Mortensen of the department of experimental clinical oncology at Åarhus (Denmark) University Hospital.

The trial involved 1,478 patients with squamous cell carcinomas of the glottic larynx, supraglottic larynx, pharynx, or oral cavity who were who were treated with five or six weekly fractions of radiotherapy in 1992-1999. The total dose of radiotherapy delivered was 66-68 Gy in 33-34 fractions.

Efficacy data from the trial have already been published; they showed improved disease-specific but not overall survival of five vs. six fractions of radiotherapy (Lancet 2003;362:933-40).

The aim of the present analysis was to use prospectively collected data from the trial to determine whether any factors could be used to establish which patients may be more likely than others to experience dysphagia following treatment.

"Dysphagia is a common and debilitating side effect of radiotherapy, leading to malnutrition, aspiration, and reduced quality of life," Dr. Mortensen explained. The side effect can be graded using a 5-point scale, with a score of 0 signifying no dysphagia and a score of 3 or 4 indicating considerable or severe dysphagia despite the ingestion of a liquid-only diet.

In all, 1,422 (96%) patients experienced acute dysphagia, including severe grade 3/4 dysphagia in 47% and 38% of those receiving accelerated or conventional radiotherapy, respectively. The two factors most predictive for severe dysphagia at 6 months were nonglottic cancer (odds ratio, 6.73 vs. other sites; P less than .0001) and a baseline dysphagia score of 2-4 vs. 0-1 (OR, 2.11; P =.004).

Odd ratios for other factors predictive for acute – but not late – dysphagia were 1.92 for any (N1-N3) vs. no (N0) nodal involvement (P less than .001), 1.82 for the use of accelerated (six weekly fractions) vs. conventional (five weekly fractions) radiotherapy (P less than .001), and 1.58 for stage T3-T4 vs. stage T1-T2 cancer (P = .02).

After 5-years of regular follow-up, late dysphagia had occurred in 1,205 patients (81%), with grade 3 severity in 24% and grade 4 in 23%. Factors that were predictive for late severe dysphagia that occurred 12 months after radiotherapy were, again, nonglottic cancer (OR, 8.25; P less than .0001) and a baseline dysphagia score greater than 1 (OR, 2.57; P less than .002). Late (T3-T4) tumor stage was also predictive (OR, 1.86; P = .03).

"Predictive factors have been identified to characterize patients at risk of developing acute and late dysphagia," Dr. Mortensen said. These factors may be useful to identify patients who could perhaps benefit from prophylactic measures against swallowing dysfunction.

The DAHANCA 6&7 trial was supported by the Danish Cancer Society, Åarhus University Hospital, Copenhagen University Hospital, Herlev (Denmark) Hospital, Odense (Denmark) University Hospital, and Aalborg (Denmark) Hospital on behalf of DAHANCA. Dr. Mortensen had no personal financial disclosures to declare.

LONDON – Nonglottic cancer and the presence of dysphagia before treatment are highly predictive for severe acute and late swallowing difficulties after radiotherapy for head and neck cancer, according to new data from the DAHANCA 6&7 randomized trial.

Patients with nonglottic cancer were more likely than those with other cancer types to experience severe dysphagia at both 6 and 12 months. Dysphagia before treatment was also associated with both acute and late severe swallowing difficulties.

"The peak incidence of dysphagia is seen during the first 6 months after radiotherapy," Hanna Rahbek Mortensen, Ph.D., reported in an analysis of the DAHANCA (Danish Head and Neck Cancer Group) 6&7 trial findings at the European Society for Therapeutic Radiation Oncology Anniversary Congress.

"After 1 year, however, there is no further increase in severity or prevalence," said Dr. Mortensen of the department of experimental clinical oncology at Åarhus (Denmark) University Hospital.

The trial involved 1,478 patients with squamous cell carcinomas of the glottic larynx, supraglottic larynx, pharynx, or oral cavity who were who were treated with five or six weekly fractions of radiotherapy in 1992-1999. The total dose of radiotherapy delivered was 66-68 Gy in 33-34 fractions.

Efficacy data from the trial have already been published; they showed improved disease-specific but not overall survival of five vs. six fractions of radiotherapy (Lancet 2003;362:933-40).

The aim of the present analysis was to use prospectively collected data from the trial to determine whether any factors could be used to establish which patients may be more likely than others to experience dysphagia following treatment.

"Dysphagia is a common and debilitating side effect of radiotherapy, leading to malnutrition, aspiration, and reduced quality of life," Dr. Mortensen explained. The side effect can be graded using a 5-point scale, with a score of 0 signifying no dysphagia and a score of 3 or 4 indicating considerable or severe dysphagia despite the ingestion of a liquid-only diet.

In all, 1,422 (96%) patients experienced acute dysphagia, including severe grade 3/4 dysphagia in 47% and 38% of those receiving accelerated or conventional radiotherapy, respectively. The two factors most predictive for severe dysphagia at 6 months were nonglottic cancer (odds ratio, 6.73 vs. other sites; P less than .0001) and a baseline dysphagia score of 2-4 vs. 0-1 (OR, 2.11; P =.004).

Odd ratios for other factors predictive for acute – but not late – dysphagia were 1.92 for any (N1-N3) vs. no (N0) nodal involvement (P less than .001), 1.82 for the use of accelerated (six weekly fractions) vs. conventional (five weekly fractions) radiotherapy (P less than .001), and 1.58 for stage T3-T4 vs. stage T1-T2 cancer (P = .02).

After 5-years of regular follow-up, late dysphagia had occurred in 1,205 patients (81%), with grade 3 severity in 24% and grade 4 in 23%. Factors that were predictive for late severe dysphagia that occurred 12 months after radiotherapy were, again, nonglottic cancer (OR, 8.25; P less than .0001) and a baseline dysphagia score greater than 1 (OR, 2.57; P less than .002). Late (T3-T4) tumor stage was also predictive (OR, 1.86; P = .03).

"Predictive factors have been identified to characterize patients at risk of developing acute and late dysphagia," Dr. Mortensen said. These factors may be useful to identify patients who could perhaps benefit from prophylactic measures against swallowing dysfunction.

The DAHANCA 6&7 trial was supported by the Danish Cancer Society, Åarhus University Hospital, Copenhagen University Hospital, Herlev (Denmark) Hospital, Odense (Denmark) University Hospital, and Aalborg (Denmark) Hospital on behalf of DAHANCA. Dr. Mortensen had no personal financial disclosures to declare.

LONDON – Nonglottic cancer and the presence of dysphagia before treatment are highly predictive for severe acute and late swallowing difficulties after radiotherapy for head and neck cancer, according to new data from the DAHANCA 6&7 randomized trial.

Patients with nonglottic cancer were more likely than those with other cancer types to experience severe dysphagia at both 6 and 12 months. Dysphagia before treatment was also associated with both acute and late severe swallowing difficulties.

"The peak incidence of dysphagia is seen during the first 6 months after radiotherapy," Hanna Rahbek Mortensen, Ph.D., reported in an analysis of the DAHANCA (Danish Head and Neck Cancer Group) 6&7 trial findings at the European Society for Therapeutic Radiation Oncology Anniversary Congress.

"After 1 year, however, there is no further increase in severity or prevalence," said Dr. Mortensen of the department of experimental clinical oncology at Åarhus (Denmark) University Hospital.

The trial involved 1,478 patients with squamous cell carcinomas of the glottic larynx, supraglottic larynx, pharynx, or oral cavity who were who were treated with five or six weekly fractions of radiotherapy in 1992-1999. The total dose of radiotherapy delivered was 66-68 Gy in 33-34 fractions.

Efficacy data from the trial have already been published; they showed improved disease-specific but not overall survival of five vs. six fractions of radiotherapy (Lancet 2003;362:933-40).

The aim of the present analysis was to use prospectively collected data from the trial to determine whether any factors could be used to establish which patients may be more likely than others to experience dysphagia following treatment.

"Dysphagia is a common and debilitating side effect of radiotherapy, leading to malnutrition, aspiration, and reduced quality of life," Dr. Mortensen explained. The side effect can be graded using a 5-point scale, with a score of 0 signifying no dysphagia and a score of 3 or 4 indicating considerable or severe dysphagia despite the ingestion of a liquid-only diet.

In all, 1,422 (96%) patients experienced acute dysphagia, including severe grade 3/4 dysphagia in 47% and 38% of those receiving accelerated or conventional radiotherapy, respectively. The two factors most predictive for severe dysphagia at 6 months were nonglottic cancer (odds ratio, 6.73 vs. other sites; P less than .0001) and a baseline dysphagia score of 2-4 vs. 0-1 (OR, 2.11; P =.004).

Odd ratios for other factors predictive for acute – but not late – dysphagia were 1.92 for any (N1-N3) vs. no (N0) nodal involvement (P less than .001), 1.82 for the use of accelerated (six weekly fractions) vs. conventional (five weekly fractions) radiotherapy (P less than .001), and 1.58 for stage T3-T4 vs. stage T1-T2 cancer (P = .02).

After 5-years of regular follow-up, late dysphagia had occurred in 1,205 patients (81%), with grade 3 severity in 24% and grade 4 in 23%. Factors that were predictive for late severe dysphagia that occurred 12 months after radiotherapy were, again, nonglottic cancer (OR, 8.25; P less than .0001) and a baseline dysphagia score greater than 1 (OR, 2.57; P less than .002). Late (T3-T4) tumor stage was also predictive (OR, 1.86; P = .03).

"Predictive factors have been identified to characterize patients at risk of developing acute and late dysphagia," Dr. Mortensen said. These factors may be useful to identify patients who could perhaps benefit from prophylactic measures against swallowing dysfunction.

The DAHANCA 6&7 trial was supported by the Danish Cancer Society, Åarhus University Hospital, Copenhagen University Hospital, Herlev (Denmark) Hospital, Odense (Denmark) University Hospital, and Aalborg (Denmark) Hospital on behalf of DAHANCA. Dr. Mortensen had no personal financial disclosures to declare.

LONDON – One-third of current smokers with head and neck cancer experienced substantial difficulties in swallowing 1 year after radiotherapy, according to the results of a Danish study.

In comparison, 20% of ex-smokers and just 10% of never-smokers experienced dysphagia as a late-occurring side effect. Current smoking also was linked to higher rates of mucosal edema, atrophy, fibrosis, dry mouth, and hoarseness or loss of voice compared with outcomes in ex- and never-smokers.

These findings highlight the importance of smoking cessation before and even during treatment, said Dorthe Wiinholdt, M.P.H., a radiotherapy technician nurse from Copenhagen University Hospital.

"As nurses, we see patients every day with side effects during treatment," she said May 9 at the European Society for Therapeutic Radiation Oncology Anniversary Conference. "We talk to them about quitting smoking before treatment, because we know that smoking has an influence on efficacy and quality of life, and [in this study] we wanted to know if there was anything that patients could do for themselves to decrease the severity of these side effects."

To examine the influence of smoking on late side effects commonly associated with radiotherapy, Ms. Wiinholdt and her colleagues used prospectively collected data from the Danish Head and Neck Cancer Study Group (DAHANCA)’s database.

Between January 2000 and March 2009, they identified 578 men and 217 women with head and neck cancer who had been treated with radiotherapy at Copenhagen University Hospital. The mean age of patients was 60 years.

Treatment consisted of 66-68 Gy for carcinoma of the larynx, pharynx, and oral cavity, with less than 10% receiving concomitant chemotherapy. In the majority (84%) of cases, treatment was intended to cure the cancer.

Before starting treatment, 60 (7.5%) patients were identified as never-smokers, with 290 (36.5%) defined as ex-smokers and the remaining 445 (56%) as current smokers. "Sixty percent of patients quit smoking during treatment, but one-third resumed smoking after treatment," Ms. Wiinholdt reported.

Of the six side effects associated with head and neck radiotherapy included in the analysis, dysphagia and mucosal edema were the most significant in relation to smoking.

Dysphagia occurred in 34% of current smokers, 21% of ex-smokers, and 15% of never-smokers 6 months after stopping radiotherapy, and in 31%, 20%, and 10%, respectively, 1 year after treatment cessation. Corresponding figures for mucosal edema were 25%, 19%, and 10% at 6 months, and 22%, 14%, and 5% at 1 year.

With never-smokers as the reference group, the odds ratios (OR) were 4.3 (P = .02) for the association between smoking and dysphagia and 4.2 (P = .01) for smoking and mucosal edema after 12 months.

"We also saw a significant correlation between daily tobacco use and the number of moderate to severe side effects," Ms. Wiinholdt noted, with respective odds ratios at 6 and 12 months of 2.71 (P = .006) and 2.54 (P = .009).

Importantly, quitting smoking during treatment was found to significantly reduce the severity of voice changes (OR, 1.78; P =.04) and mucosal edema (OR, 1.89; P = .03) after 6 months.

"These findings back up our advice that patients should stop smoking," Ms. Wiinholdt suggested. They not only emphasize the importance of quitting smoking before starting treatment, she added, but also highlight the continued need to support patients with smoking cessation initiatives during treatment.

Ms. Wiinholdt had no financial conflicts of interest.

LONDON – One-third of current smokers with head and neck cancer experienced substantial difficulties in swallowing 1 year after radiotherapy, according to the results of a Danish study.

In comparison, 20% of ex-smokers and just 10% of never-smokers experienced dysphagia as a late-occurring side effect. Current smoking also was linked to higher rates of mucosal edema, atrophy, fibrosis, dry mouth, and hoarseness or loss of voice compared with outcomes in ex- and never-smokers.

These findings highlight the importance of smoking cessation before and even during treatment, said Dorthe Wiinholdt, M.P.H., a radiotherapy technician nurse from Copenhagen University Hospital.

"As nurses, we see patients every day with side effects during treatment," she said May 9 at the European Society for Therapeutic Radiation Oncology Anniversary Conference. "We talk to them about quitting smoking before treatment, because we know that smoking has an influence on efficacy and quality of life, and [in this study] we wanted to know if there was anything that patients could do for themselves to decrease the severity of these side effects."

To examine the influence of smoking on late side effects commonly associated with radiotherapy, Ms. Wiinholdt and her colleagues used prospectively collected data from the Danish Head and Neck Cancer Study Group (DAHANCA)’s database.

Between January 2000 and March 2009, they identified 578 men and 217 women with head and neck cancer who had been treated with radiotherapy at Copenhagen University Hospital. The mean age of patients was 60 years.

Treatment consisted of 66-68 Gy for carcinoma of the larynx, pharynx, and oral cavity, with less than 10% receiving concomitant chemotherapy. In the majority (84%) of cases, treatment was intended to cure the cancer.

Before starting treatment, 60 (7.5%) patients were identified as never-smokers, with 290 (36.5%) defined as ex-smokers and the remaining 445 (56%) as current smokers. "Sixty percent of patients quit smoking during treatment, but one-third resumed smoking after treatment," Ms. Wiinholdt reported.

Of the six side effects associated with head and neck radiotherapy included in the analysis, dysphagia and mucosal edema were the most significant in relation to smoking.

Dysphagia occurred in 34% of current smokers, 21% of ex-smokers, and 15% of never-smokers 6 months after stopping radiotherapy, and in 31%, 20%, and 10%, respectively, 1 year after treatment cessation. Corresponding figures for mucosal edema were 25%, 19%, and 10% at 6 months, and 22%, 14%, and 5% at 1 year.

With never-smokers as the reference group, the odds ratios (OR) were 4.3 (P = .02) for the association between smoking and dysphagia and 4.2 (P = .01) for smoking and mucosal edema after 12 months.

"We also saw a significant correlation between daily tobacco use and the number of moderate to severe side effects," Ms. Wiinholdt noted, with respective odds ratios at 6 and 12 months of 2.71 (P = .006) and 2.54 (P = .009).

Importantly, quitting smoking during treatment was found to significantly reduce the severity of voice changes (OR, 1.78; P =.04) and mucosal edema (OR, 1.89; P = .03) after 6 months.

"These findings back up our advice that patients should stop smoking," Ms. Wiinholdt suggested. They not only emphasize the importance of quitting smoking before starting treatment, she added, but also highlight the continued need to support patients with smoking cessation initiatives during treatment.

Ms. Wiinholdt had no financial conflicts of interest.

LONDON – One-third of current smokers with head and neck cancer experienced substantial difficulties in swallowing 1 year after radiotherapy, according to the results of a Danish study.

In comparison, 20% of ex-smokers and just 10% of never-smokers experienced dysphagia as a late-occurring side effect. Current smoking also was linked to higher rates of mucosal edema, atrophy, fibrosis, dry mouth, and hoarseness or loss of voice compared with outcomes in ex- and never-smokers.

These findings highlight the importance of smoking cessation before and even during treatment, said Dorthe Wiinholdt, M.P.H., a radiotherapy technician nurse from Copenhagen University Hospital.

"As nurses, we see patients every day with side effects during treatment," she said May 9 at the European Society for Therapeutic Radiation Oncology Anniversary Conference. "We talk to them about quitting smoking before treatment, because we know that smoking has an influence on efficacy and quality of life, and [in this study] we wanted to know if there was anything that patients could do for themselves to decrease the severity of these side effects."

To examine the influence of smoking on late side effects commonly associated with radiotherapy, Ms. Wiinholdt and her colleagues used prospectively collected data from the Danish Head and Neck Cancer Study Group (DAHANCA)’s database.

Between January 2000 and March 2009, they identified 578 men and 217 women with head and neck cancer who had been treated with radiotherapy at Copenhagen University Hospital. The mean age of patients was 60 years.

Treatment consisted of 66-68 Gy for carcinoma of the larynx, pharynx, and oral cavity, with less than 10% receiving concomitant chemotherapy. In the majority (84%) of cases, treatment was intended to cure the cancer.

Before starting treatment, 60 (7.5%) patients were identified as never-smokers, with 290 (36.5%) defined as ex-smokers and the remaining 445 (56%) as current smokers. "Sixty percent of patients quit smoking during treatment, but one-third resumed smoking after treatment," Ms. Wiinholdt reported.

Of the six side effects associated with head and neck radiotherapy included in the analysis, dysphagia and mucosal edema were the most significant in relation to smoking.

Dysphagia occurred in 34% of current smokers, 21% of ex-smokers, and 15% of never-smokers 6 months after stopping radiotherapy, and in 31%, 20%, and 10%, respectively, 1 year after treatment cessation. Corresponding figures for mucosal edema were 25%, 19%, and 10% at 6 months, and 22%, 14%, and 5% at 1 year.

With never-smokers as the reference group, the odds ratios (OR) were 4.3 (P = .02) for the association between smoking and dysphagia and 4.2 (P = .01) for smoking and mucosal edema after 12 months.

"We also saw a significant correlation between daily tobacco use and the number of moderate to severe side effects," Ms. Wiinholdt noted, with respective odds ratios at 6 and 12 months of 2.71 (P = .006) and 2.54 (P = .009).

Importantly, quitting smoking during treatment was found to significantly reduce the severity of voice changes (OR, 1.78; P =.04) and mucosal edema (OR, 1.89; P = .03) after 6 months.

"These findings back up our advice that patients should stop smoking," Ms. Wiinholdt suggested. They not only emphasize the importance of quitting smoking before starting treatment, she added, but also highlight the continued need to support patients with smoking cessation initiatives during treatment.

Ms. Wiinholdt had no financial conflicts of interest.

LONDON – One-third of current smokers with head and neck cancer experienced substantial difficulties in swallowing 1 year after radiotherapy, according to the results of a Danish study.

In comparison, 20% of ex-smokers and just 10% of never-smokers experienced dysphagia as a late-occurring side effect. Current smoking also was linked to higher rates of mucosal edema, atrophy, fibrosis, dry mouth, and hoarseness or loss of voice compared with outcomes in ex- and never-smokers.

These findings highlight the importance of smoking cessation before and even during treatment, said Dorthe Wiinholdt, M.P.H., a radiotherapy technician nurse from Copenhagen University Hospital.

"As nurses, we see patients every day with side effects during treatment," she said May 9 at the European Society for Therapeutic Radiation Oncology Anniversary Conference. "We talk to them about quitting smoking before treatment, because we know that smoking has an influence on efficacy and quality of life, and [in this study] we wanted to know if there was anything that patients could do for themselves to decrease the severity of these side effects."

To examine the influence of smoking on late side effects commonly associated with radiotherapy, Ms. Wiinholdt and her colleagues used prospectively collected data from the Danish Head and Neck Cancer Study Group (DAHANCA)’s database.

Between January 2000 and March 2009, they identified 578 men and 217 women with head and neck cancer who had been treated with radiotherapy at Copenhagen University Hospital. The mean age of patients was 60 years.

Treatment consisted of 66-68 Gy for carcinoma of the larynx, pharynx, and oral cavity, with less than 10% receiving concomitant chemotherapy. In the majority (84%) of cases, treatment was intended to cure the cancer.

Before starting treatment, 60 (7.5%) patients were identified as never-smokers, with 290 (36.5%) defined as ex-smokers and the remaining 445 (56%) as current smokers. "Sixty percent of patients quit smoking during treatment, but one-third resumed smoking after treatment," Ms. Wiinholdt reported.

Of the six side effects associated with head and neck radiotherapy included in the analysis, dysphagia and mucosal edema were the most significant in relation to smoking.

Dysphagia occurred in 34% of current smokers, 21% of ex-smokers, and 15% of never-smokers 6 months after stopping radiotherapy, and in 31%, 20%, and 10%, respectively, 1 year after treatment cessation. Corresponding figures for mucosal edema were 25%, 19%, and 10% at 6 months, and 22%, 14%, and 5% at 1 year.

With never-smokers as the reference group, the odds ratios (OR) were 4.3 (P = .02) for the association between smoking and dysphagia and 4.2 (P = .01) for smoking and mucosal edema after 12 months.

"We also saw a significant correlation between daily tobacco use and the number of moderate to severe side effects," Ms. Wiinholdt noted, with respective odds ratios at 6 and 12 months of 2.71 (P = .006) and 2.54 (P = .009).

Importantly, quitting smoking during treatment was found to significantly reduce the severity of voice changes (OR, 1.78; P =.04) and mucosal edema (OR, 1.89; P = .03) after 6 months.

"These findings back up our advice that patients should stop smoking," Ms. Wiinholdt suggested. They not only emphasize the importance of quitting smoking before starting treatment, she added, but also highlight the continued need to support patients with smoking cessation initiatives during treatment.

Ms. Wiinholdt had no financial conflicts of interest.

LONDON – One-third of current smokers with head and neck cancer experienced substantial difficulties in swallowing 1 year after radiotherapy, according to the results of a Danish study.

In comparison, 20% of ex-smokers and just 10% of never-smokers experienced dysphagia as a late-occurring side effect. Current smoking also was linked to higher rates of mucosal edema, atrophy, fibrosis, dry mouth, and hoarseness or loss of voice compared with outcomes in ex- and never-smokers.

These findings highlight the importance of smoking cessation before and even during treatment, said Dorthe Wiinholdt, M.P.H., a radiotherapy technician nurse from Copenhagen University Hospital.

"As nurses, we see patients every day with side effects during treatment," she said May 9 at the European Society for Therapeutic Radiation Oncology Anniversary Conference. "We talk to them about quitting smoking before treatment, because we know that smoking has an influence on efficacy and quality of life, and [in this study] we wanted to know if there was anything that patients could do for themselves to decrease the severity of these side effects."

To examine the influence of smoking on late side effects commonly associated with radiotherapy, Ms. Wiinholdt and her colleagues used prospectively collected data from the Danish Head and Neck Cancer Study Group (DAHANCA)’s database.

Between January 2000 and March 2009, they identified 578 men and 217 women with head and neck cancer who had been treated with radiotherapy at Copenhagen University Hospital. The mean age of patients was 60 years.

Treatment consisted of 66-68 Gy for carcinoma of the larynx, pharynx, and oral cavity, with less than 10% receiving concomitant chemotherapy. In the majority (84%) of cases, treatment was intended to cure the cancer.

Before starting treatment, 60 (7.5%) patients were identified as never-smokers, with 290 (36.5%) defined as ex-smokers and the remaining 445 (56%) as current smokers. "Sixty percent of patients quit smoking during treatment, but one-third resumed smoking after treatment," Ms. Wiinholdt reported.

Of the six side effects associated with head and neck radiotherapy included in the analysis, dysphagia and mucosal edema were the most significant in relation to smoking.

Dysphagia occurred in 34% of current smokers, 21% of ex-smokers, and 15% of never-smokers 6 months after stopping radiotherapy, and in 31%, 20%, and 10%, respectively, 1 year after treatment cessation. Corresponding figures for mucosal edema were 25%, 19%, and 10% at 6 months, and 22%, 14%, and 5% at 1 year.

With never-smokers as the reference group, the odds ratios (OR) were 4.3 (P = .02) for the association between smoking and dysphagia and 4.2 (P = .01) for smoking and mucosal edema after 12 months.

"We also saw a significant correlation between daily tobacco use and the number of moderate to severe side effects," Ms. Wiinholdt noted, with respective odds ratios at 6 and 12 months of 2.71 (P = .006) and 2.54 (P = .009).

Importantly, quitting smoking during treatment was found to significantly reduce the severity of voice changes (OR, 1.78; P =.04) and mucosal edema (OR, 1.89; P = .03) after 6 months.

"These findings back up our advice that patients should stop smoking," Ms. Wiinholdt suggested. They not only emphasize the importance of quitting smoking before starting treatment, she added, but also highlight the continued need to support patients with smoking cessation initiatives during treatment.

Ms. Wiinholdt had no financial conflicts of interest.

LONDON – One-third of current smokers with head and neck cancer experienced substantial difficulties in swallowing 1 year after radiotherapy, according to the results of a Danish study.

In comparison, 20% of ex-smokers and just 10% of never-smokers experienced dysphagia as a late-occurring side effect. Current smoking also was linked to higher rates of mucosal edema, atrophy, fibrosis, dry mouth, and hoarseness or loss of voice compared with outcomes in ex- and never-smokers.

These findings highlight the importance of smoking cessation before and even during treatment, said Dorthe Wiinholdt, M.P.H., a radiotherapy technician nurse from Copenhagen University Hospital.

"As nurses, we see patients every day with side effects during treatment," she said May 9 at the European Society for Therapeutic Radiation Oncology Anniversary Conference. "We talk to them about quitting smoking before treatment, because we know that smoking has an influence on efficacy and quality of life, and [in this study] we wanted to know if there was anything that patients could do for themselves to decrease the severity of these side effects."

To examine the influence of smoking on late side effects commonly associated with radiotherapy, Ms. Wiinholdt and her colleagues used prospectively collected data from the Danish Head and Neck Cancer Study Group (DAHANCA)’s database.

Between January 2000 and March 2009, they identified 578 men and 217 women with head and neck cancer who had been treated with radiotherapy at Copenhagen University Hospital. The mean age of patients was 60 years.

Treatment consisted of 66-68 Gy for carcinoma of the larynx, pharynx, and oral cavity, with less than 10% receiving concomitant chemotherapy. In the majority (84%) of cases, treatment was intended to cure the cancer.

Before starting treatment, 60 (7.5%) patients were identified as never-smokers, with 290 (36.5%) defined as ex-smokers and the remaining 445 (56%) as current smokers. "Sixty percent of patients quit smoking during treatment, but one-third resumed smoking after treatment," Ms. Wiinholdt reported.

Of the six side effects associated with head and neck radiotherapy included in the analysis, dysphagia and mucosal edema were the most significant in relation to smoking.

Dysphagia occurred in 34% of current smokers, 21% of ex-smokers, and 15% of never-smokers 6 months after stopping radiotherapy, and in 31%, 20%, and 10%, respectively, 1 year after treatment cessation. Corresponding figures for mucosal edema were 25%, 19%, and 10% at 6 months, and 22%, 14%, and 5% at 1 year.

With never-smokers as the reference group, the odds ratios (OR) were 4.3 (P = .02) for the association between smoking and dysphagia and 4.2 (P = .01) for smoking and mucosal edema after 12 months.

"We also saw a significant correlation between daily tobacco use and the number of moderate to severe side effects," Ms. Wiinholdt noted, with respective odds ratios at 6 and 12 months of 2.71 (P = .006) and 2.54 (P = .009).

Importantly, quitting smoking during treatment was found to significantly reduce the severity of voice changes (OR, 1.78; P =.04) and mucosal edema (OR, 1.89; P = .03) after 6 months.

"These findings back up our advice that patients should stop smoking," Ms. Wiinholdt suggested. They not only emphasize the importance of quitting smoking before starting treatment, she added, but also highlight the continued need to support patients with smoking cessation initiatives during treatment.

Ms. Wiinholdt had no financial conflicts of interest.