title: The Validity of Self-reported Recent Smoking in Head and Neck Cancer Surgical Patients.
abstract: OBJECTIVE
  In cancer patients, cigarette smoking causes poorer response to treatment, treatment toxicity, increased risk of recurrence, higher surgical complication rates, and poorer overall survival. As such a significant determinant of patient prognosis, accurate classification of current smoking status is important. Self-reported smoking status may lead to misclassification if patients conceal their true status. The purpose of this study was to assess the validity of self-reported tobacco use during the previous 48 hours in head and neck cancer patients on the day of surgery.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Two academic medical centers in the southeastern United States.
  
  
  METHODS
  On the day of surgery, 108 head and neck cancer patients completed a survey asking about tobacco use during the past 48 hours and had semi-quantitative levels of urinary cotinine measured to biochemically validate self-reported recent smoking.
  
  
  RESULTS
  Self-reported smoking yielded a sensitivity of 60.9% (95% CI, 45.4%-74.9%) and a specificity of 98.4% (95% CI, 91.3%-100.0%). The sensitivity increased to 76.1% (95% CI, 61.2%-87.4%) when allowing for the possibility that exposure to secondhand smoke or use of nicotine-containing products could have caused a positive cotinine test.
  
  
  CONCLUSIONS
  In this patient population, self-reported recent smoking yielded a high (39%) proportion of false-negatives, and even 24% remained false-negatives after allowing for other sources of nicotine exposure. This magnitude of underreporting combined with the importance of tobacco use to patient prognosis supports the need for routinely biochemically verifying recent tobacco use in self-reported nonsmokers within the clinical setting.
authors.affiliation: Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.|Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Alberg
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA.|Wake Forest Comprehensive Cancer Center, Wake Forest University, Winston Salem, North Carolina, USA.
authors.forename: Mitchell L
authors.initials: ML
authors.lastname: Worley
authors.affiliation: Wake Forest Comprehensive Cancer Center, Wake Forest University, Winston Salem, North Carolina, USA.|Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA.
authors.forename: Janet A
authors.initials: JA
authors.lastname: Tooze
authors.affiliation: Department of Otolaryngology, Emory University, Atlanta, Georgia, USA.
authors.forename: Jeanne L
authors.initials: JL
authors.lastname: Hatcher
authors.affiliation: Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA.|Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Carpenter
authors.affiliation: Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA.|Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Terry A
authors.initials: TA
authors.lastname: Day
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA.|Wake Forest Comprehensive Cancer Center, Wake Forest University, Winston Salem, North Carolina, USA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Sullivan
authors.affiliation: Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA.|Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina, USA.|Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Graham W
authors.initials: GW
authors.lastname: Warren
authors.affiliation: Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.|Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Katherine R
authors.initials: KR
authors.lastname: Sterba
authors.affiliation: Wake Forest Comprehensive Cancer Center, Wake Forest University, Winston Salem, North Carolina, USA.|Department of Social Sciences and Public Policy, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Weaver
mesh_terms: D003367:Cotinine / Q000652:urine; D003430:Cross-Sectional Studies; D005188:False Negative Reactions; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012650:Self Disclosure; D012907:Smoking
chemical_list: D003367:Cotinine
keywords: cancer patients; cigarette smoking; cotinine; measurement of smoking status; research methods; validity