Do smoking and alcohol behaviours influence GI cancer survival?

Abstract

Little is known about the role of alcohol and smoking in GI cancer survival compared to GI cancer development. We systematically reviewed the evidence for a role of smoking and alcohol in prognosis among GI cancer patients and inform whether smoking or alcohol cessation interventions or guidelines for GI cancer patients are likely to improve prognosis. A total of 84 relevant studies were identified. Continued smokers, particularly heavy smokers, had worse prognosis than never smokers in most GI cancers. However, more evidence is needed to establish the likely impact of smoking cessation interventions amongst GI cancer patients. Heavy alcohol drinkers had worse prognosis in oesophageal squamous cell carcinoma and hepatocellular carcinoma patients. Light alcohol consumption was not associated with worse prognosis from any GI cancer, though further studies are needed. UK guidelines for the general population recommending under 14 units (∼7 drinks) per week may be sufficient for GI cancer patients, until further evidence is available.

Alcohol intake, tobacco smoking, and esophageal adenocarcinoma survival: a molecular pathology epidemiology cohort study

“…This meta-analysis also investigated the association between these lifestyle factors and survival in other cancers of the digestive tract. Results demonstrated that cigarette smoking was associated with poorer survival in patients with colorectal, gastric, or pancreatic cancer, hepatocellular carcinoma, or esophageal squamous cell carcinoma [14]. Alcohol consumption was associated with a poorer survival in patients with esophageal squamous cell carcinoma or hepatocellular carcinoma [14].…”

“…However, only four published studies, including relatively small numbers of patients, have investigated the association between tobacco smoking, alcohol consumption, and esophageal adenocarcinoma survival [10][11][12][13]. Our working group has published a recent meta-analysis combining two of these studies, which demonstrated no significant difference in esophageal adenocarcinoma survival in neveralcohol drinkers compared to moderate alcohol drinkers (HR 1.34 95% CI 0.95-1.89) [14]. Similarly, there were no associations with survival in esophageal adenocarcinoma patients who were current (HR 0.99 95% CI 0.73-1.36) or former (HR 0.88 95% CI 0.68-1.14) smokers, compared to never smokers [14].…”

“…Our working group has published a recent meta-analysis combining two of these studies, which demonstrated no significant difference in esophageal adenocarcinoma survival in neveralcohol drinkers compared to moderate alcohol drinkers (HR 1.34 95% CI 0.95-1.89) [14]. Similarly, there were no associations with survival in esophageal adenocarcinoma patients who were current (HR 0.99 95% CI 0.73-1.36) or former (HR 0.88 95% CI 0.68-1.14) smokers, compared to never smokers [14]. This meta-analysis also investigated the association between these lifestyle factors and survival in other cancers of the digestive tract.…”

Smoking and gastrointestinal cancer patients—is smoking cessation an attainable goal?

“…A recent study of the VA Surgical Quality Improvement Program database demonstrated, over a 6 year period, that current smokers with GI malignancies were significantly more likely to experience surgical site infections (SSIs), combined pulmonary complications, pneumonia, failure to wean from ventilator, reintubation, and return to the operating room . A separate systematic review of 84 studies has also demonstrated that current smokers, particularly those who smoke heavily, have worse survival outcomes than never smokers in most GI cancers . In addition, continued tobacco use during chemotherapy has been shown to exacerbate drug toxicity/side effects, impair immune function, and increase the incidence of infection .…”

“…heavily, have worse survival outcomes than never smokers in most GI cancers. 2 In addition, continued tobacco use during chemotherapy has been shown to exacerbate drug toxicity/side effects, impair immune function, and increase the incidence of infection. [3][4][5][6][7][8] Furthermore, cancer survivors who continue to smoke also demonstrate a higher risk than non-smokers for developing a second cancer.…”