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179 Background: Smoking cessation is becoming an integral part of cancer survivorship. To help improve survivorship education, clinicians need an understanding of patient knowledge of the harms of continued smoking. Methods: Patients with various cancer subtypes were surveyed with respect to self-awareness of the harms of continued smoking on cancer outcomes. Multivariable logistic regression models assessed factors associated with the level of awareness. Results: Among 985 patients, 23% smoked at diagnosis; 34% quit > 1 year prior to diagnosis; 25% had lung, 30% had head and neck cancers; 77% received curative therapy. Many patients reported being unaware that smoking can negatively impact cancer surgery (65%), radiation (74%), chemo outcomes (64%), treatment efficacy (70%), cancer prognosis (54%) and second primary development (52%). Among all patients, those smoking at diagnosis were significantly more likely to be unaware of radiation (aOR = 1.73, 95% CI [1.16-2.57]) and chemo (aOR = 2.10 [1.17-3.79]) toxicities, cancer prognosis (aOR = 1.63 [1.16-2.29]) and second primary risk (aOR = 1.61 [1.14-2.26]). Those with poorer health status were more likely unaware of effects on prognosis (aOR = 1.56 [1.18-2.08]) and second primaries (aOR = 1.54 [1.14-2.08]). Patients with non-tobacco related cancers (non-TRCs) were more likely unaware smoking impacts cancer surgery (aOR = 1.45 [1.04-2.04]) and radiation (aOR = 1.37 [1.01-1.85]). Among smokers at diagnosis, those with non-TRCs (aOR = 4.00 [1.45-11.11]) were more likely unaware smoking can impact chemo outcomes. Awareness was not associated with stage, second-hand smoke exposure, cessation or interest in a smoking cessation program (SCP), but was associated with patients believing that a SCP would be beneficial to their health (aORs = 2.33-4.35, P < 0.03). Among smokers at diagnosis, believing that a SCP is beneficial (51%) was associated with both interest in an in-patient (aOR = 4.65 [2.15-10.03]) and ambulatory (aOR = 4.08 [2.14-7.79]) SCP. Conclusions: Many cancer patients were unaware of the harms of continued smoking; mainly smokers at diagnosis and those with non-TRCs. Patient education should focus on emphasizing awareness, which may help improve patient interest in smoking cessation.

251 Background: With improvements in cancer therapies, palliative patients with cancer now enjoy improved and sometimes prolonged survival. Continued smoking after a cancer diagnosis negatively impacts treatment response/toxicities, survival and quality of life and is influenced by SHS exposure. Little is known about the perceptions of palliative patients with cancer in comparison to patients who are considered potentially curative, on smoking after a cancer diagnosis and of SHS exposure. We assessed such potential differences in perception. Methods: Patients with cancer across all sites were surveyed with respect to their smoking habits and perceptions on how smoking and SHS influences cancer-related QofL, fatigue and overall survival (OS). Review of patient charts confirmed which patients were considered palliative versus potentially curative. Multivariable logistic regression models assessed for associations between treatment intent and patient perceptions, adjusted for significant co-variables. Results: Among 985 patients with cancer, 22% were considered palliative; 23% of surveyed patients smoked at diagnosis; 10% continued smoking at follow-up. Most patients perceived that continued smoking and SHS exposure negatively impacted QofL (continued smoking: 83%, SHS: 82%), fatigue (83%, 79%) and OS (86%, 81%). Palliative patients were more likely to believe that SHS worsened their cancer-related fatigue (adjusted odds ratio (aOR) = 1.65, 95% CI [1.05-2.56], P = 0.03) and worsened OS (unadjusted OR = 1.92, [1.12-3.33], P= 0.02; aOR = 1.56 [0.98-2.50], P = 0.06). Yet palliative/non-palliative status was not found to be associated with perceived benefits of smoking cessation on QofL, fatigue, or OS (P > 0.10, all comparisons). Conclusions: When compared with non-palliative patients, palliative patients with cancer perceived a greater negative impact of SHS on fatigue and survival, but had similar views of continued smoking after a cancer diagnosis. We are encouraged that palliative status did not lead to patients having diluted perceptions on the negative impact of smoking on cancer outcomes. Health care providers should continue to focus on the positive impacts of smoking cessation and SHS in this setting.

10086Background: Smoking cessation is becoming an integral part of cancer survivorship. To help improve survivorship education, clinicians need an understanding of patient knowledge of the harms of...

10090Background: Smoking cessation is becoming an integral part of cancer survivorship care. We assessed cancer patients’ interest and preferences in the design of a SCP. Methods: Cancer patients f...

6019Background: Lymph node ratio (LNR, number of positive lymph nodes/total number of excised lymph nodes) has been shown to be associated with outcomes in multiple malignancies. In this study, the impact of LNR on distant metastasis (DM) and overall survival (OS) in oral cavity squamous cell carcinoma (OSCC) was investigated. Methods: Retrospective review of pN0-2 OSCC patients (pts) treated between 1994-2012 with curative surgery with neck dissection (ND) +/- postoperative radiotherapy (PORT) with or without concurrent chemotherapy (CCT). LNR was subjected to multivariable analysis (MVA) of DM and OS, adjusted for pT3-4, extracapsular extension (ECE), high grade (G3), lymphovascular invasion (LVI), perineural invasion (PNI), and tumor subsite. Results: Overall 914 pts were identified; median age: 61 yr (18-92); median follow-up: 51 months (1–189); pT3-4: 283 (31%); pN-classification: N0: 482 (53%), N1: 128 (14%), N2a: 6 (0.5%); N2b: 225 (24.5%); N2c: 73 (8%); median number of dissected nodes: 36 (6-125)...

183 Background: Exposure to SHS after a cancer diagnosis is associated with continued smoking in lung and HN cancer patients (PMID: 24419133, 23765604). However, smoking is a social activity. We evaluated whether elimination of SHS exposure around and after a diagnosis of lung or HN cancer is associated with smoking cessation in the cancer patient. Methods: Lung and HN cancer patients from Princess Margaret Cancer Centre (2006-12) completed questionnaires at diagnosis and follow-up (median 2 years apart) that assessed smoking history and SHS exposures (cohort study). Multivariate logistic regression analysis evaluated the association of elimination of SHS exposure after a diagnosis of cancer with subsequent smoking cessation, adjusted for significant covariates. A cross-sectional study (2014-15) of 183 lung and HN smoking patients assessed consistency in associations and interest in SHS cessation programs. Results: For the cohort study, 261/731 lung and 145/450 HN cancer patients smoked at diagnosis; subsequent quit rates were 69% and 50% respectively. 91% of lung and 94% of HN cancer patients were exposed to SHS at diagnosis while only 40% (lung) and 62% (HN) were exposed at follow-up. Elimination of SHS exposure was associated with smoking cessation in lung (aOR = 4.76, 95% CI [2.56-9.09], P< 0.001), HN (aOR = 5.00 [1.61-14.29], P< 0.001), and combined cancers (aOR = 5.00 [3.03-8.33], P< 0.001). The cross-sectional study has similar cessation and SHS exposure rates and a similar association for elimination of SHS with smoking cessation (aOR = 3.42 [1.16-10.10], P= 0.03). However when asked directly, only 26% of patients quit smoking with another individual and 13% of patients exposed to SHS had at least 1 interested party in joining a SHS cessation program. Conclusions: Elimination of SHS exposure around patients is significantly associated with smoking cessation in lung and HN cancer patients, but few patients quit smoking together with others around them, despite the ‘teachable moment’ with a cancer diagnosis. Clinicians should encourage patients and their household/friends to quit smoking together to improve cessation rates in cancer patients and those around them.

9591 Background: Some cancer survivorship programs incorporate components of healthy lifestyle behavior modification. We evaluated the role that various clinical variables and smoking habits play i...

9556 Background: Exposure to second-hand smoke (SHS) after a cancer diagnosis is associated with continued smoking in lung and head and neck (HN) cancer patients (PMID: 24419133, 23765604). We eval...