Improving Head and Neck Cancer Outcomes With Smoking Cessation Education

By Elaine S. DeMeyer, RN, MSN, AOCN®, BMTCN® - Last Updated: April 20, 2023

Most oncology nurses know that October is breast cancer awareness month and perhaps some other months are for major cancers, like lung or prostate cancer. However, head and neck cancer (HNC) awareness month in April may go unrecognized. Yet, cancer care teams agree that managing HNCs poses several challenges. Since post-diagnosis smoking cessation can be beneficial, oncology nurses should offer smoking cessation counseling to all smokers as soon as possible after an HNC diagnosis.

What Are HNCs?

The American Cancer Society estimates that approximately 88,480 new HNC cases will be diagnosed in 2023. The majority will be in the oral cavity and pharynx (45,540), followed by the esophagus (21,560) and larynx (12,380). In addition, some organizations or researchers include thyroid cancers (43,720) or superficial skin cancer in the head and neck region. Since HNCs are a group of cancers that most often are in the mucosal surfaces’ squamous lining, the term used is head and neck squamous cell carcinoma (HNSCC). Overall, HNSCCs comprise approximately 90% of all HNCs. Alcohol use, tobacco use, and human papillomavirus (HPV) are the 3 major risk factors for developing HNCs.

What Is the Impact of Smoking Cessation on Outcomes?

A critical factor in improving patient outcomes is tobacco cessation. Smoking and chewing tobacco not only cause HNCs, but they can also limit the effectiveness of cancer treatment. For example, several studies show that patients who continue to smoke during HNC treatment with radiation therapy have poorer locoregional control, lower overall survival, and a higher incidence of acute and late toxicities.

In a 2023 article, researchers found that smoking cessation at diagnosis can reduce overall mortality and cancer-specific mortality in patients with HNSCC. In their study of 2482 patients with HNSCC, former smokers had a reduced risk of overall mortality compared with current smokers (841 vs 931, respectively). In addition, death rates for HNSCC-specific and noncancer deaths were almost one-half less in nonsmokers than in smokers (9.4% vs 16.8%, respectively). Again, quitting smoking before a diagnosis produced the best results. In a CURE® interview, the lead author noted that >40% of patients were still smoking after their diagnosis, and approximately 50% reported that they were unaware of the negative impact of smoking on treatment outcomes. He emphasized that patients must receive formal education about the importance of quitting smoking at the time of diagnosis.

What Is an Informed Best Practice Example?

Oncology nurses can provide simple explanations focusing on 3 key points:

  1. People who quit smoking after a cancer diagnosis live longer.
  2. They have more successful treatment and fewer side effects.
  3. Often, they recover faster with a better quality of life than those who smoke.

The critical point is ensuring that patients receive information about the dangers of continuing to smoke after an HNC diagnosis and documenting that teaching. For example, one radiologist at a large cancer center in Dallas provides written information with statistics and carefully reviews the data and percentages with patients using plain language during the consent process. In addition, he emphasizes and formalizes his teaching by having patients sign the summary indicating that they understand the risk of continuing to smoke.

3 Key Strategies for Smoking Cessation

Patients often say smoking is a form of stress relief, so quitting after a cancer diagnosis is hard. Some may rationalize it by saying, “I already have cancer, so why does it matter now?”

Oncology nurse Laurie Robbins, BSN, RN, OCN®, discusses some strategies in her Cancer Nursing Today article, “Difficult Conversations: Smoking Cessation.” Try these 3 essential tips to support smoking cessation:

  1. Counseling. Refer patients to the National Cancer Institute website,, for support, tips, tools, and expert advice to help quit smoking. Experts are available through the site or toll-free quit line to talk live. In addition, they can receive support through texts, the app, or social media to help them quit and stay smoke-free.
  2. Pharmacologic agents. Verify a prescription, if necessary, and financial resources for nicotine replacement therapy. Inform patients that withdrawal symptoms can last several days to a few weeks.
  3. Solicit support. Provide caregivers with tips to support the person trying to quit. Help them identify and eliminate triggers and create distractions and a place when cravings are at their worse.

Oncology nurses are in a vital position to help improve prognosis by encouraging smoking cessation. They can help patients understand that if they continue to smoke after their HNC diagnosis, they may have a blunted response to treatment and may be more likely to develop toxicity. Therefore, oncology nurses must address tobacco before, during, and after treatment. They can ensure that patients understand the risks of continuing to smoke during treatment and make an informed decision if they decline to quit. In addition, oncology nurses can locate counseling resources and verify they have a prescription for nicotine replacement, as the use of both counseling and pharmacotherapy shows the most outstanding smoking cessation success rates.


American Cancer Society Cancer Facts & Figures 2023

Cigarette Smoking Cessation, Duration of Smoking Abstinence, and Head and Neck Squamous Cell Carcinoma Prognosis

Patients With Head and Neck Cancer Require Double-Testing for Accurate Prognosis

Difficult Conversations: Smoking Cessation

National Cancer Institute: