The role of vegetable and fruit consumption and other habits on survival following the diagnosis of oral cancer: a prospective study in Spain

doi:10.1016/j.ijom.2008.09.004

International Journal of Oral and Maxillofacial Surgery

Volume 38, Issue 1, January 2009, Pages 31-39

https://doi.org/10.1016/j.ijom.2008.09.004 Get rights and content

Abstract

The authors carried out a hospital-based prospective study to evaluate the role of behavioral and clinical risk factors, occurring before and after diagnosis, on the prognosis of 146 patients with newly diagnosed oral cancer using Cox models.

High weekly intake of vegetables before and after diagnosis were both associated with lower recurrence rates, longer overall survival and longer oral cancer survival. Diagnostic delay was associated with an increased risk of recurrence and oral cancer mortality. Patients presenting with pharyngeal pain or a mucosal lesion had a longer oral cancer survival than patients presenting with other symptoms. Quitting tobacco and alcohol consumption before and after diagnosis were both associated with a lower recurrence and/or better survival, but the effects were not statistically significant.

This study suggests that high consumption of vegetables before and after diagnosis of oral cancer may reduce the risk of recurrence, overall mortality and cancer mortality in oral cancer patients.

Section snippets

Material and methods

A hospital-based prospective study was carried out to assess the potential prognostic value of behavioral factors occurring before and after the diagnosis of oral cancer. The study was performed in the departments of Otorhinolaryngology, Facial Plastic Surgery, and Maxillo-Facial Surgery of the Hospital Universitari de Bellvitge located in L’Hospitalet de Llobregat, Barcelona, Spain.

The present research is an extension of an international case–control study on oral cancer coordinated by the

Demographic and clinical data

Table 1 shows the baseline distribution of selected demographic and clinical characteristics with their associated adjusted relative risks for recurrence, overall mortality and oral cancer mortality.

73% of the patients were 50 years and older and most (87%) were men. Most tumors (79%) were located in the oral cavity and 21% in the oropharynx. 69% of patients were diagnosed with advanced disease and most (63%) were treated with surgery with or without radiation therapy (Table 1). Overall mean

Discussion

This study was designed to assess prospectively the role of behavioral factors occurring before and after diagnosis on the prognosis of oral cancer patients. In addition, to established clinical and tumor-related prognostic variables, such as clinical stage, tumor site and treatment modality, the authors were interested in assessing the prognostic value of new candidate factors such as alcohol and tobacco consumption before and after diagnosis, fruit and vegetable consumption before and after

Grants

Supported by Fondo de Investigaciones Sanitarias (FIS), Madrid, Spain, grants FIS 97/0662, FIS 01/1236, and BAE 01/5013 (to the Institut Català d’Oncologia, Barcelona, Spain [X. Castellsagué and F. Xavier Bosch]). Funding was also provided by the International Union Against Cancer (UICC) Yamagiwa–Yoshida Memorial International Cancer Study (to X. Castellsagué), the Assaig Foundation and IDIBELL Foundation for residents physicians in the Ciutat Sanitaria i Universitaria de Bellvitge, Barcelona,

Novelty and impact statement of the paper

This is, to the authors’ knowledge, the first study assessing the prognostic value of fruit and vegetable intake, quitting cigarette smoking and alcohol consumption after diagnosis, in the survival of oral cancer patients. The study adds evidence to the conclusion that high vegetable consumption before and after diagnosis of oral cancer reduces the risk of recurrence, overall mortality and cancer mortality in oral cancer patients.

Acknowledgements

The authors want to express their gratitude to the Departments of Otorhinolaryngology, Plastic Surgery and Maxillo-Facial Surgery of the Ciutat Sanitaria i Universitaria de Bellvitge for contributing patients to the study and to the Cancer Epidemiology and Registration Unit of the Institut Català d’Oncologia for their unconditional support.

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Head and neck squamous cell carcinoma (HNSCC) is a class of heterogenous cancers involving the upper aerodigestive tract. We previously demonstrated the utility of a priori diet quality indices for predicting survival after an HNSCC diagnosis. The aim of this analysis was to evaluate the role of those a priori diet quality indices and proinflammatory cytokines in newly diagnosed HNSCC survivors.
We analyzed cross-sectional data from a sample (n = 146; mean age 59.6 y; 79.3% male) from the University of Michigan Head and Neck Specialized Program of Research Excellence prospective longitudinal cohort study. Dietary intake was measured at pretreatment using a food frequency questionnaire. Serum samples were also collected at pretreatment. Covariate-adjusted proportional odds and logistic regression models were used to assess the relationship between 6 diet quality indices (Alternative Healthy Eating Index [AHEI]-2010, Alternate Mediterranean Diet, Dietary Approaches to Stop Hypertension [DASH], and 3 low-carbohydrate indices) and serum measures of a panel of 10 inflammatory cytokines and a cytokine summary composite score.
Higher scores on the AHEI-2010 and DASH diet quality indices were associated with higher odds of lower cytokine value scores for several cytokines and for the cytokine summary composite score (AHEI-2010—odds ratio [OR]: 1.55; 95% confidence interval [CI]: 1.10, 2.20; DASH—OR: 1.65; 95% CI 1.15, 2.36).
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This unique finding suggests that oncologists perceive tobacco cessation as less important in the palliative setting, particularly due to the reported hesitations from not feeling comfortable taking something away patients might enjoy doing, and less belief in an effect on outcomes. To date, the evidence on survival benefits in patients with stage IV disease is indeed sparse [17–21]; however, the body of evidence is expected to grow in the near future given the current focus on this topic. Nevertheless, still 64% of oncologists disagreed that cessation is a waste of time because of no impact on outcomes.
Smoking cessation after a cancer diagnosis is associated with improved overall survival. Few studies have reported oncologists' cessation practice patterns, but differences between the curative and palliative settings have not been described. We aimed to study the oncologist's perceptions on patients' tobacco use, current practices and barriers to providing smoking cessation support, while distinguishing between treatment with curative (C) and palliative (P) intent.
In 2019, an online 34-item survey was sent to approximately 6235 oncologists from 16 European countries. Responses were descriptively reported and compared by treatment setting.
Responses from 544 oncologists were included. Oncologists appeared to favour addressing tobacco in the curative setting more than in the palliative setting. Oncologists believe that continued smoking impacts treatment outcomes (C: 94%, P: 74%) and that cessation support should be standard cancer care (C: 95%, P: 63%). Most routinely assess tobacco use (C: 93%, P: 78%) and advise patients to stop using tobacco (C: 88%, P: 54%), but only 24% (P)–39% (C) routinely discuss medication options, and only 18% (P)–31% (C) provide cessation support. Hesitation to remove a pleasurable habit (C: 13%, P: 43%) and disbelieve on smoking affecting outcomes (C: 3%, P: 14%) were disparate barriers between the curative and palliative settings (p < 0.001), but dominant barriers of time, resources, education and patient resistance were similar between settings.
Oncologists appear to favour addressing tobacco use more in the curative setting; however, they discuss medication options and/or provide cessation support in a minority of cases. All patients who report current smoking should have access to evidence-based smoking cessation support, also patients treated with palliative intent given their increasing survival.
Overall time interval (“Total diagnostic delay”) and mortality in symptomatic oral cancer: A U-shaped association
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Despite survival is a recommended outcome for research about early diagnosis in symptomatic cancer, reports considering survival as a dependent variable are scarce [10–12,27–29]. Moreover, this kind of studies have considered no conceptual framework and have assessed intermediate intervals with a high heterogeneity: patient delay [10,27], professional delay [10,27], total delay [10], total diagnostic delay [10–29], referral delay [14–28], and, more recently, the interval between diagnosis and treatment (DTI) [30–34]. Time increments until diagnosis and treatment of different cancers (breast, colorectal, testicular and melanoma) seem to be associated to poorer outcomes [15].
To assess the impact on survival of the total time interval since the first bodily change (sign/symptom) until the start of treatment in symptomatic oral cancer patients.
Retrospective, hospital-based study designed within the “Aarhus Statement” conceptual framework, using the overall interval to treatment of 183 oral cancer patients to analyse their survival rates.
Overall time interval (T5): 107.1 ± 85.2 days. Overall survival rate: 58.4 (CI: 51.3–66.4%). Recurrence time (median): 724 days (IQR, 223–2963.5). Median survival time: 1744 days (IQR, 479.5–3438). Overall delay (T5) and mortality showed a U-shaped association, where patients with short (24.0–55.5 days) and long T5 intervals (127.5–420 days) had higher mortality than those with medium T5 intervals (55.5–127.5 days).
There is a non-monotonic association between time interval and mortality. Higher mortality rates are linked to shorter and longer time intervals. This may induce underestimation of the association when time intervals are considered dichotomously.
Criteria for eligibility to cisplatin in the curative treatment of head and neck cancer: Consensus opinion from a panel of experts
2018, Critical Reviews in Oncology/Hematology
Squamous-cell carcinoma of the head and neck (SCCHN) is an important problem in Brazil, where epidemiological and socioeconomic features often create barriers to the implementation of combined modalities with curative potential. Cisplatin improves the efficacy of radiotherapy in the adjuvant treatment of localized SCCHN and in the definitive therapy of locally advanced disease. However, the addition of high-dose cisplatin to radiotherapy increases treatment toxicity and is not always warranted. A panel of experts convened in Sao Paulo, Brazil, for discussions and recommendations regarding the use of high-dose cisplatin in combination with radiotherapy in SCCHN. In addition to discussing their professional experience, panel members used the current literature to provide evidence-based, practical recommendations regarding sociodemographic or medical criteria that may preclude safe administration of cisplatin. It is hoped that the application of these recommendations in clinical practice may improve therapeutic results in Brazil and other countries with similar health-care environments.
Blood-brain barrier–adapted precision medicine therapy for pediatric brain tumors
2017, Translational Research
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A common theme in the evaluation of targeted agents in neuro-oncology is the impediment of BBB penetration due to the presence of efflux pumps. These energy-dependent transporters are expressed on the apical surface of the cells that line the vasculature and actively efflux compounds that are able to cross the membrane via passive diffusion or other methods, thus limiting CNS accumulation of promising targeted therapies.58 The most commonly found ATP-binding cassette efflux transporters, P-gp (also known as ABCB1 or MDR1), and BCRP (also known as ABCG2), are responsible for the efflux of a wide variety of traditional chemotherapy agents (eg, anthracyclinces, taxanes, methotrexate).59
Targeted chemotherapeutics provide a promising new treatment option in neuro-oncology. The ability of these compounds to penetrate the blood-brain barrier is crucial for their successful incorporation into patient care. “CNS Targeted Agent Prediction” (CNS-TAP) is a multi-institutional and multidisciplinary translational program established at the University of Michigan for evaluating the central nervous system (CNS) activity of targeted therapies in neuro-oncology. In this report, we present the methodology of CNS-TAP in a series of pediatric and adolescent patients with high-risk brain tumors, for which molecular profiling (academic and commercial) was sought and targeted agents were incorporated. Four of five of the patients had potential clinical benefit (partial response or stable disease greater than 6 months on therapy). We further describe the specific drug properties of each agent chosen and discuss characteristics relevant in their evaluation for therapeutic suitability. Finally, we summarize both tumor and drug characteristics that impact the ability to successfully incorporate targeted therapies into CNS malignancy management.
Key points and time intervals for early diagnosis in symptomatic oral cancer: a systematic review
2017, International Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
These intervals are summarized in Fig. 2. The outcome of diagnostic delay has been presented as a continuous variable28,30,31,34,35,40,42,43,53,57,64,66 and as a categorical variable.27,29,33,36,41,44,45,49,51,54–56,65 When expressed as a dichotomous variable, the criterion for delay was either arbitrarily established or based upon central trend statistics37,39 of the distribution (>2 days,32 >1 week,46 >3 weeks,59,61 >30 days,51,58,62 >45 days,47,48 >6 weeks,63 >2 months,52 >3 months7,45,50,60).
The aim of this study was to identify key points and time intervals in the patient pathway to the diagnosis of oral cancer, from the detection of a bodily change to the start of treatment. A systematic search of three databases was performed by two researchers independently. Articles reporting original data on patients with symptomatic primary oral or oropharyngeal squamous cell carcinoma that was pathologically confirmed were included. These articles had to include an outcome variable of ‘diagnostic delay’, ‘time interval’, or ‘waiting time to diagnosis’, or report time intervals from first symptom to treatment. Furthermore, the outcome variable had to have a clearly defined start point and end point, with the time measurement presented as a continuous or categorical variable. A total of 1175 reports were identified; 28 articles on oral cancer studies and 13 on oral and oropharyngeal cancer studies were finally included. These papers showed poor quality in terms of questionnaire validation, acknowledgement of biases influencing time-point measurements, and strategies for verification of patient self-reported data. They also showed great heterogeneity. The review findings allowed the definition of key points and time intervals within the Aarhus framework that may better suit the features of the diagnostic process of this neoplasm, particularly when assessing the impact of waiting time to diagnosis.

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Clinical PaperHead and Neck OncologyThe role of vegetable and fruit consumption and other habits on survival following the diagnosis of oral cancer: a prospective study in Spain

Abstract

Section snippets

Material and methods

Demographic and clinical data

Discussion

Grants

Novelty and impact statement of the paper

Acknowledgements

Eur J Cancer B Oral Oncol

Oral Oncol

J Craniomaxillofac Surg

Epidemiologia i prevenció del càncer a Catalunya (1975–1992)

The role of type of tobacco and type of alcoholic beverage in oral carcinogenesis

Int J Cancer

Long-term quality of life of patients with head and neck cancer

Laryngoscope

Treatment outcome of squamous cell carcinoma of the oral tongue

J Otolaryngol

Human papillomavirus and oral cancer: the International Agency for Research on Cancer multicenter study

J Natl Cancer Inst

Lifetime body mass index and risk of oral cavity and oropharyngeal cancer by smoking and drinking habits

Br J Cancer

Clinical Paper
Head and Neck Oncology
The role of vegetable and fruit consumption and other habits on survival following the diagnosis of oral cancer: a prospective study in Spain