Smoking Behaviors in Survivors of Smoking-Related and Non–Smoking-Related Cancers

Abstract

IMPORTANCE The population of cancer survivors is rapidly growing in the US. Tobacco smoking is associated with many cancers; however, whether cigarette smoking behaviors among cancer survivors vary according to cancer type-that is, smoking-related cancers (SRCs) vs non-smokingrelated cancers (NSRCs)-remains unclear. OBJECTIVES To examine cigarette smoking prevalence and behaviors (ie, continuing or quitting smoking) among cancer survivors and to compare them between survivors of SRCs and NSRCs. DESIGN, SETTING, AND PARTICIPANTS This study was a cross-sectional analysis of the 2017 National Health Interview Survey, a household survey of civilian US residents who were aged 18 years or older. The National Health Interview Survey is population based and is representative of the US population. Data analysis was performed from June to October 2019. MAIN OUTCOMES AND MEASURES The primary outcomes were prevalence of current cigarette smoking among cancer survivors and prevalence of continuing smoking and quitting smoking after a cancer diagnosis. Secondary outcomes included factors associated with continued smoking vs quitting smoking after a cancer diagnosis. RESULTS A total of 26 742 respondents (mean [SD] age, 50.97 [18.61] years; 14 646 women [51.76%]) to the 2017 National Health Interview Survey were included in this study. Of the 3068 individuals (9.42%) in the study population who had cancer, 589 (19.96%) were SRC survivors, 2297 (74.50%) were NSRC survivors, 168 (4.96%) were survivors of both SRC and NSRC, and the remaining 14 (0.58%) had missing information about the type of cancer. Four hundred forty-nine SRC survivors (54.08%) were women, compared with 1412 NSRC survivors (54.30%). Ninety-six SRC survivors (15.69%) and 151 NSRC survivors (7.99%) were younger than 45 years. Overall, 372 cancer survivors (13.16%) were current smokers. Current smoking prevalence was higher among survivors of SRCs (145 survivors [19.78%]) compared with NSRC survivors (251 survivors [10.63%]). Among cancer survivors, 309 current smokers at cancer diagnosis (43.96%) reported having successfully quit smoking and 372 (56.04%) reported continuing smoking. Among the continuing smokers, 176 (56.49%) reported an unsuccessful quit attempt in the last 12 months. After cancer diagnosis, SRC survivors had higher odds of continued smoking compared with NSRC survivors (odds ratio [OR],

Assessment of Trends in Cigarette Smoking Cessation After Cancer Diagnosis Among US Adults, 2000 to 2017

“…In a recent analysis of the 2017 NHIS data, 1 in 7 cancer survivors in the United States reported being a current cigarette smoker. 7 Therefore, coordinated action at cancer diagnosis and treatment centers and hospitals, at survivorship clinics, and at the level of primary health care professionals is needed to continue progress toward reducing tobacco-related disease and death among cancer survivors in the United States. Considering that a high proportion of US adult cancer survivors continue to smoke, integration of behavioral and pharmacological cigarette smoking cessation interventions into oncology care is imperative to improve quit rates in this high-risk population.…”

“… 5 However, the prevalence of cigarette smoking among cancer survivors remains high. 2 , 6 , 7 A recent cross-sectional analysis of the 2017 National Health Interview Survey (NHIS) data reported that 13.2% of US adult cancer survivors were current smokers, 7 but trends in cigarette smoking cessation among cancer survivors have not yet been fully investigated. Because the pattern of cigarette smoking varies substantially according to certain sociodemographic factors, such as sex, race/ethnicity, age, educational level, income, and US Census region, comprehensive temporal trend analysis accounting for these factors and using nationally representative data would be essential for the application of targeted cigarette smoking cessation public health programs.…”

Cigarette, E-cigarette, Alcohol, and Marijuana Use by Cancer Diagnosis Status: A Longitudinal Analysis

“…The following demographic characteristics were included in the analysis: age (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54), and 55 years old or older), sex (male or female), race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, or non-Hispanic other races), poverty status (<100% of poverty guideline, 100%-199% of poverty guideline, and ⩾200% of poverty guideline), education level (less than high school, high school graduate or equivalent, some college [no degree] or associate degree, bachelor's degree, or advanced degree), residential region (Northeast, Midwest, South, West), and other tobacco product use ("Yes" or "No"). The poverty income guideline was based on the 2015 poverty guidelines for the 48 contiguous states and the District of Columbia.…”

“…Prior studies reported that after cancer diagnosis, smoking-related cancer survivors have a higher risk of continued cigarette smoking than non-smoking-related cancer survivors. 22 Likewise, another study found that the smoking rate was higher in young cancer survivors (age ⩽40) than in young individuals who had never been diagnosed with cancer. 23 Among samples of cancer patients who smoked cigarettes, about 6.5% to 19% reported current e-cigarette use.…”

Association of Cigarette Use and Substance Use Disorders among US Adults with and without a Recent Diagnosis of Cancer

“…Individuals with cancer constitute one group particularly vulnerable to the negative health consequences of smoking [ 4 , 5 , 6 ]. Population-based smoking prevalence estimates among cancer patients vary widely, with some studies reporting a lower smoking prevalence in cancer vs. noncancer patients, [ 7 , 8 ] while other studies have reported a higher smoking prevalence, particularly for those with a smoking-related vs. non-smoking-related cancer [ 9 , 10 ]. The most recent (2017) estimates suggest a generally equivalent prevalence of smoking in cancer vs. noncancer patients (i.e., 13% vs. 14%) [ 10 ].…”