Validating Tobacco Use with Cotinine in Cancer Patients

Objective Tobacco use may be a risk factor for poor outcomes following surgery for head and neck cancer patients. We sought to determine the prevalence of tobacco exposure prior to head and neck surgery using both patient report and urinary cotinine. Method Patients with squamous cell carcinoma of the upper aerodigestive tract undergoing a major head and neck procedure were recruited from 2 academic medical centers from 2011 to date. We assessed preoperative tobacco use by self‐report and by cotinine level, a nicotine metabolite, in urine using a semiquantitative test strip. Results We have recruited 49 patients to date (mean age, 60 years), 71.4% male, 85.7% non‐Hispanic white, 60.0% stages III‐IV. In the 48 hours before surgery, 11 patients (22.5%) reported tobacco use; 18 (36.7%) were identified by intraoperative urine cotinine. In sum, 57.1% of women and 28.6% of men tested positive for cotinine ( P =. 06). Of those who denied tobacco use, 7 out of 38 (18.4%) were positive for cotinine (>2); sensitivity for self‐report was 61.1%. Secondhand exposure was reported by 6 of 38 (15.8%) nonusers, 2 being cotinine positive. There was no association between secondhand exposure and positive cotinine (Fisher’s Exact, P =. 30). Conclusion Tobacco is a major risk factor for head and neck cancer. The use of a urine cotinine screening test demonstrated that self‐report may fail to identify a significant number of tobacco users. Implementation of cotinine screening could facilitate precise understanding of tobacco use patterns and opportunities for intervention.