Smoking Cessation After Diagnosis of Lung Cancer Is Associated With a Beneficial Effect on Performance Status

Baser, Sevin; Shannon, Vickie R.; Eapen, Georgie A.; Jiménez, Carlos A.; Onn, Amir; Lin, Edward H.; Morice, Rodolfo C.

doi:10.1016/s0012-3692(15)50902-1

Cited by 125 publications

(102 citation statements)

References 29 publications

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“…As KRAS mutation is found mainly in smokers [6,33], the negative prognostic value of KRAS mutation may be related to the poor performance status associated with smoking [34]. In our study, no significant difference was observed in survival when stratified according to smoking status in the entire patient population.…”

Section: Discussioncontrasting

confidence: 48%

Effectiveness of erlotinib treatment in advanced KRAS mutation-negative lung adenocarcinoma patients: Results of a multicenter observational cohort study (MOTIVATE)

et al. 2014

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a b s t r a c tObjectives: Erlotinib is an epidermal growth factor receptor tyrosine-kinase inhibitor (EGFR-TKI), used for the treatment of non-small cell lung cancer. As the clinical significance of KRAS mutational status has not yet been clearly determined in this setting, our aim was to investigate the efficacy of erlotinib in advanced KRAS mutation-negative lung adenocarcinoma patients. Materials and methods:MOTIVATE is an open-label, multicenter, observational trial with Tarceva ® (erlotinib) monotherapy. Enrolled patients with advanced (stage IIIB/IV) KRAS wild type (WT) lung adenocarcinoma refractory to one or two courses of prior chemotherapy were treated with erlotinib at 150 mg/day. The primary endpoint was progression-free survival (PFS). Secondary endpoints were overall survival (OS) and best tumor response rate (RR). Results and conclusion: In total, 327 patients were included. Median PFS and OS were 3.3 and 14.4 months, respectively. Three patients (1.2%) had complete response, 51 patients (20.2%) had partial response and 123 patients (48.8%) had SD.Significantly longer median PFS and OS were observed in Eastern Oncology Cooperative Group Performance Status (ECOG PS) 0-1 patients, as compared to ECOG PS 2-3 patients. The longest median OS (20.5 months) was found in patients with ECOG PS 0-1 who received erlotinib as a second-line therapy. There was no difference in median OS in cohorts stratified to disease stage and smoking status. Female patients had both longer median PFS and OS. Disease control rate was 70.2%.Our results suggest that erlotinib represents a valid treatment option for patients with KRAS WT lung adenocarcinoma and, moreover, that KRAS mutation analysis could help to identify clinically relevant subgroups of NSCLC patients that may benefit from EGFR-TKI therapy.

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Section: Discussioncontrasting

confidence: 48%

Effectiveness of erlotinib treatment in advanced KRAS mutation-negative lung adenocarcinoma patients: Results of a multicenter observational cohort study (MOTIVATE)

et al. 2014

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“…34 Forty-five percent were current smokers, 48% were ex-smokers, and 7% never-smokers. Subjects who had quit smoking maintained a better performance status at 0 -6 months (odds ratio of 7.09, P ϭ .002) and at 0 -12 months (odds ratio of 6.99, P ϭ .006) than those who continued to smoke regardless of disease stage, age, race, sex, cancer-related treatment modality (surgical vs medical treatment), and comorbidities.…”

Section: Clinical Importance Of Smoking Cessation On Quality Of Lifementioning

confidence: 98%

“…The effect of post-diagnosis smoking cessation on performance status was evaluated in the study of Baser et al 34 in a population of subjects with non-small-cell lung cancer. Participants were classified as current smokers, neversmokers, and ex-smokers, and performance status was classified according to the criteria of the Eastern Cooperative Oncology Group.…”

Section: Clinical Importance Of Smoking Cessation On Quality Of Lifementioning

confidence: 99%

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Clinical Significance of Smoking Cessation in Subjects With Cancer: A 30-Year Review

Florou¹,

Gkiozos

Tsagouli

et al. 2014

Respir Care

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BACKGROUND: Despite the established causal relationship between tobacco smoking and cancer, many cancer patients continue to smoke after diagnosis. This partly reflects ignorance of the beneficial effects of smoking cessation, even after diagnosis. The aim of this study was to demonstrate the effects of continuing or quitting smoking in patients with diagnosed cancer. METHODS: The study was based on a review of medical databases (PubMed Central, MEDLINE, Cochrane Library) in the last 30 y. All articles included in the present analysis were in English. RESULTS: In subjects with early-stage lung cancer, continued smoking after diagnosis is associated with an increased risk of all-cause mortality and decreased survival. Research has demonstrated significant differences in actuarial overall survival favoring the non-smoking group among subjects with lung cancer. In subjects with oral cancer, smoking cessation or reduction leads to a significant reduction in mortality. There is also evidence that tobacco smoking aggravates and prolongs radiotherapyinduced complications. Of particular importance is evidence that continued smoking is associated with adverse effects during anti-cancer treatment. Smoking promotes tumor progression and increases resistance to chemotherapy due to nicotine-induced resistance to apoptosis by modulating mitochondrial signaling. Continued smoking is also related to inferior outcomes of treatment with novel targeted therapies such as erlotinib. Smoking in subjects with gastric and lung cancer is also associated with an increased risk of developing second primary tumors. Quitting smoking after lung cancer diagnosis is associated with a better performance status, whereas persistent smokers have worse overall quality of life. Subjects who continue to smoke despite being diagnosed with cancer report more severe pain than subjects who have never smoked and greater pain-related functional impairment. CONCLUSIONS: Continued smoking after cancer diagnosis is related to reduced treatment efficacy and reduced survival, increased risk for second primary malignancies, and deterioration of quality of life.

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“…Conversely, smoking cessation post-cancer diagnosis has been associated with better pain control and an improved quality of life (Garces et al, 2004;Baser et al, 2006;Daniel et al, 2009;Ditre et al, 2011). It is thus not surprising that tobacco cessation measures are now included in the evaluation of healthcare quality (Fiore et al, 2012), and the integration of tobacco dependence treatment (TDT) is emphasized as an important service to establish within oncology practice settings (Mazza et al, 2010;Goldstein et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

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

Hawari¹,

Obeidat²,

Ayub³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Background: Studies evaluating smoking cessation treatment outcomes in cancer patients are scarce, despite smoking cessation importance in cancer care. We sought to add to the literature by evaluating smoking cessation in a challenging group of cancer patients (medium-to-heavy smokers) visiting an out-patient smoking cessation clinic (SCC) in a cancer center in Amman, Jordan. Materials and Methods: Patients smoking >9 cigarettes per day (CPD) and referred to the SCC between June 2009 and May 2012 were studied. Clinic records were reviewed to measure demographic and baseline clinical characteristics, and longitudinal (3-, 6-and 12-month) followup by phone/clinic visit was conducted. At each follow-up, patients were asked if they experienced medication side-effects, if they had returned to smoking, and reasons for failing to abstain. Descriptive and multivariable logistic regression analyses were performed. Results: A total of 201 smokers were included in the analysis. The 3-month abstinence was 23.4% and significantly associated with older age, being married, and presenting with lower (≤10ppm) baseline carbon monoxide (CO) levels. On a multivariable level, lower CO levels, a higher income (relative to the lowest income group), being older, and reporting severe dependence (relative to dependence reported as 'somewhat' or 'not') were significant predictors of higher odds of abstinence at three months. Reasons for failing to quit included not being able to handle withdrawal and seeing no value in quitting. Longterm ARs did not reach 7%. Conclusions: In a sample of Jordanian smokers (>9CPD) with cancer and receiving smoking cessation treatment, ARs were low and further declined with time. Results underscore the need for more aggressive patient management and rigorous follow-up during and after smoking cessation treatment, particularly when this takes place in challenging settings. Observed reasons for failure to abstain should be used to tailor counseling practices.

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Smoking Cessation After Diagnosis of Lung Cancer Is Associated With a Beneficial Effect on Performance Status

Cited by 125 publications

References 29 publications

Effectiveness of erlotinib treatment in advanced KRAS mutation-negative lung adenocarcinoma patients: Results of a multicenter observational cohort study (MOTIVATE)

Effectiveness of erlotinib treatment in advanced KRAS mutation-negative lung adenocarcinoma patients: Results of a multicenter observational cohort study (MOTIVATE)

Clinical Significance of Smoking Cessation in Subjects With Cancer: A 30-Year Review

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

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