Effects of Smoking on Quality of Life in Patients with Malignancies of the Anterior Cranial Base

Background: Malignancies of the anterior cranial base have substantial and highly variable effect on the quality of life (QoL) for patients. This is, in part, related to the critical anatomic location and highly diverse set of malignancies. In the general head and neck cancer literature, a history of smoking has been associated with diminished quality of life. We sought to determine if smoking history, either current or past, impacts quality of life over time for patients with newly diagnosed anterior skull base malignancies.

Methods: We followed 36 patients with cranial base malignancies prospectively with the Anterior Skull Base Questionnaire (ASBQ) from May 2011 through July 2015. Questionnaires were offered to patients pretreatment, early post-treatment, and annually thereafter. Patients were then divided by smoking history as either never smokers (less than 1 pack year total), or smokers (past or current).

Results: The average age for smokers was 50.6 years, while the average age for nonsmokers was 55.1 years (not significant). Furthermore, there was a wide array of malignancies represented, including adenocarcinoma, adenoid cystic carcinoma, chondrosarcoma, chordoma, esthesioneuroblastoma, sarcoma, sinonasal undifferentiated carcinoma, and squamous cell carcinoma as well as metastatic disease from other sites. Analysis showed a significantly poorer quality of life in patients with a history of smoking at 1 year after treatment. Not only did smokers score significantly poorer in overall QoL (p = 0.012), but also in the domains of performance, physical function, vitality, and symptoms. This trend continued at 2 years, though did not reach statistical significance at this point (p = 0.062) as only 9 of the 36 patients had completed 2-year questionnaires. Additionally, there was a significantly higher rate of recurrence in patients with a smoking history (p = 0.01).

Conclusion: Smoking history has long been associated with recurrence and diminished QoL in patients with head and neck cancer. Our small, prospective cohort study demonstrates that for patients with anterior cranial base malignancies, a history of smoking, current or prior, is associated with diminished long-term quality of life. While larger cohort studies may be needed to elaborate on this finding in more detail, this information may be valuable to patients with smoking history and newly diagnosed anterior cranial base malignancies.