Supportive Care Needs Among Pretreatment Head and Neck Cancer Patients According to Smoking Status: A Cross‐Sectional Study With Nested Analyses

ABSTRACT Objective New head and neck cancer (HNC) patients may prioritize “competing” supportive care needs (SCNs) over smoking cessation, yet the burden of these SCNs according to smoking status is poorly characterized. We aimed to address this gap in knowledge. Methods The study applied a cross‐sectional design and was guided by the Supportive Care Framework. Newly diagnosed HNC patients seen at the UTSW head and neck surgical oncology clinic between January 2021 and August 2024 and who completed the Patient Health Questionnaire (PHQ)‐4 were eligible. Clinically significant SCNs were derived from validated measures. The primary outcome was smoking status and the primary exposure was moderate–severe psychological distress (PHQ‐4 ≥ 6). Results Among 250 new HNC patients, 16.4% were current smokers. Relative to never or former smokers, current smokers exhibited significantly more SCNs (median 4 [3–5] vs. 2 [1–4], p < 0.001) and higher prevalence rates of pain (72.2%, 41.0%, p = 0.001), malnutrition (54.8%, 24.9%, p = 0.001), and anxiety (46.3%, 24.0%, p = 0.004). On univariate analysis, moderate–severe distress was not associated with smoking status. On adjusted analyses of a subsample of 136 patients with ≥ 98% complete SCN questionnaires, malnutrition was significantly associated with smoking (adjusted odds ratio: 3.49, 95% confidence interval: 1.34–9.03, p = 0.010) after adjusting for pain and anxiety. Conclusion Pretreatment HNC patients who smoke exhibit a high burden of SCNs. Further research is needed to determine whether targeting common needs such as malnutrition, pain, and anxiety may improve patients' ability to prioritize smoking cessation. Level of Evidence Level 3.