Predictors of smoking relapse in patients with thoracic cancer or head and neck cancer

Abstract

BACKGROUND:Cancer patients who continue smoking are at increased risk for adverse outcomes including reduced treatment efficacy and poorer survival rates. Many patients spontaneously quit smoking after diagnosis; however, relapse is understudied. The goal of this study was to evaluate smoking-related, affective, cognitive, and physical variables as predictors of smoking after surgical treatment among patients with lung cancer and head and neck cancer. METHODS: A longitudinal study was conducted with 154 patients (57% male) who recently quit smoking. Predictor variables were measured at baseline (ie, time of surgery); smoking behavior was assessed at 2, 4, 6, and 12 months after surgery. Analyses of 7-day point prevalence were performed using a Generalized Estimating Equations approach. RESULTS: Relapse rates varied significantly depending on presurgery smoking status. At 12 months after surgery, 60% of patients who smoked during the week prior to surgery had resumed smoking versus only 13% who were abstinent prior to surgery. Smoking rates among both groups were relatively stable across the 4 follow-ups. For patients smoking before surgery (N ¼ 101), predictors of smoking relapse included lower quitting self-efficacy, higher depression proneness, and greater fears about cancer recurrence. For patients abstinent before surgery (N ¼ 53), higher perceived difficulty quitting and lower cancer-related risk perceptions predicted smoking relapse. CONCLUSIONS: Efforts to encourage early cessation at diagnosis, and increased smoking relapse-prevention efforts in the acute period following surgery, may promote long-term abstinence. Several modifiable variables are identified to target in future smoking relapse-prevention interventions for cancer patients. Cancer 2013;119:1420-7. V C 2012 American Cancer Society.KEYWORDS: tobacco use, smoking relapse, head and neck cancer, lung cancer. INTRODUCTIONCigarette smoking is responsible for 30% of all cancer-related mortalities. 1 Lung cancers and head and neck cancers are among the malignancies most strongly linked to tobacco use, 1 and a significant proportion of patients with lung cancer and/or head and neck cancer are current smokers at the time of diagnosis. 2,3 Smoking cessation reduces morbidity and mortality in these patients, 4,5 whereas continued smoking after diagnosis increases patients' risk for other smoking-related illnesses (eg, coronary heart disease), second primary tumors, 6,7 and disease recurrence. 5,6 Continued smoking also has more immediate adverse impact, including reduced cancer treatment efficacy, 8,9 higher rates of treatment complications and side effects, 10-13 greater treatment-related weight loss, 14 and poorer quality of life. [15][16][17] The majority of patients smoking at the time of their diagnosis spontaneously quit smoking (eg, 86% among patients with lung cancer 18 ; 84% among patients with head and neck cancer 19 ), with the greatest proportion of quit attempts occurring at diagnosis. 20 Furthermore, smoking cessation interventions for can...

Relapse Rate and Factors Related to Relapse in a 1-Year Follow-Up of Subjects Participating in a Smoking Cessation Program

“…OR ϭ odds ratio ciated with depression. 29 In contrast, a study involving 677 subjects showed that, although a history of depression was found to be a determining factor for relapse in the short term, it was not significant in the long term. 30 In our center, the Beck depression scale is used on each subject attending the smoking cessation program, and those with a high score and those who have a history of depression are referred to a psychiatric specialist, and the follow-up and treatment of these subjects are planned together.…”

“…Several studies report that prolonged treatment with varenicline may prevent relapse. 5,29 Prolonged nicotine replacement treatment has shown promising but controversial results, 5 as there are more relapses with short-term nicotine replacement treatment compared with treatment regimens including bupropion and varenicline. 33 Interestingly, we found no difference in relapse rates between subjects who received pharmacologic treatment and those who did not.…”

Socioeconomic Status and Lifestyle Behaviours in Cancer Survivors: Smoking and Physical Activity

“…A thorough understanding of the factors influencing changes in those behaviours after diagnosis is needed to best inform survivorship program development for a number of cancer groups. Thus far, studies examining smoking cessation have focused primarily on survivors of lung and head-and-neck cancers; those studies have pointed to the level of nicotine dependence 17 and psychosocial factors such as social environment 18,19 and mental health 13,20 as predictors of continued smoking in cancer patients. In contrast, most studies evaluating post-diagnosis pa in cancer patients have involved survivors of breast and colorectal cancers.…”

Smoking Cessation Treatment and Outcomes in Medium to Heavy Cigarette Smokers being Treated for Cancer in Jordan

“…Other studies that have examined predictors of smoking relapse have varied in their conclusions regarding predictors of smoking relapse: for example, variables such as smoking frequency at baseline, extent of nicotine dependence, greater fear of disease recurrence, lower perceived risk of disease, lower self-efficacy, higher anxiety and craving during withdrawal, shorter quit duration prior to treatment for cancer, lower income, and younger age of initiation, have been shown to be associated with lower likelihood of quitting (Simmons et al, 2013;Gritz et al, 1999;Walker et al, 2006). These studies have varied in their methods of measurements of potential factors that can influence smoking cessation, thus making comparisons between studies difficult.…”