title: Pretreatment health behaviors predict survival among patients with head and neck squamous cell carcinoma.
abstract: OBJECTIVE
  Our prior work has shown that the health behaviors of head and neck cancer patients are interrelated and are associated with quality of life; however, other than smoking, the relationship between health behaviors and survival is unclear.
  
  
  METHODS
  A prospective cohort study was conducted to determine the relationship between five pretreatment health behaviors (smoking, alcohol, diet, physical activity, and sleep) and all-cause survival among 504 head and neck cancer patients.
  
  
  RESULTS
  Smoking status was the strongest predictor of survival, with both current smokers (hazard ratio [HR] = 2.4; 95% CI, 1.3 to 4.4) and former smokers (HR = 2.0; 95% CI, 1.2 to 3.5) showing significant associations with poor survival. Problem drinking was associated with survival in the univariate analysis (HR = 1.4; 95% CI, 1.0 to 2.0) but lost significance when controlling for other factors. Low fruit intake was negatively associated with survival in the univariate analysis only (HR = 1.6; 95% CI, 1.1 to 2.1), whereas vegetable intake was not significant in either univariate or multivariate analyses. Although physical activity was associated with survival in the univariate analysis (HR = 0.95; 95% CI, 0.93 to 0.97), it was not significant in the multivariate model. Sleep was not significantly associated with survival in either univariate or multivariate analysis. Control variables that were also independently associated with survival in the multivariate analysis were age, education, tumor site, cancer stage, and surgical treatment.
  
  
  CONCLUSIONS
  Variation in selected pretreatment health behaviors (eg, smoking, fruit intake, and physical activity) in this population is associated with variation in survival.
authors.affiliation: VA Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare System (11H), PO Box 130170, Ann Arbor, MI 48113-0170, USA. bump@med.umich.edu
authors.forename: Sonia A
authors.initials: SA
authors.lastname: Duffy
authors.forename: David L
authors.initials: DL
authors.lastname: Ronis
authors.forename: Scott
authors.initials: S
authors.lastname: McLean
authors.forename: Karen E
authors.initials: KE
authors.lastname: Fowler
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Gruber
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Wolf
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Terrell
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000523:psychology* / Q000556:secondary; D015331:Cohort Studies; D015444:Exercise; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology / Q000523:psychology*; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D012890:Sleep; D012907:Smoking; D015996:Survival Rate