Smoking cessation and survival among people diagnosed with non-metastatic cancer

Abstract

Background: We aimed to estimate the effects of smoking cessation on survival among people diagnosed with cancer. Methods: We used data from a Comprehensive Community Cancer Program that is part of a large urban safety-net hospital system. Eligible patients were diagnosed with primary invasive solid tumors between 2013 and 2015, and were current smokers at time of diagnosis. Our exposure of interest was initiation of smoking cessation within 6 months of cancer diagnosis. We estimated inverse probability weighted restricted mean survival time (RMST) differences and risk ratio (RR) for all cause 3-year mortality. Results: Our study population comprised 369 patients, of whom 42% were aged < 55 years, 59% were male, 44% were racial/ethnic minorities, and 59% were uninsured. The 3-year RMST was 1.8 (95% CL: − 1.5, 5.1) months longer for individuals who initiated smoking cessation within 6 months of cancer diagnosis. The point estimate for risk of 3-year mortality was lower for initiation of smoking cessation within 6 months of diagnosis compared with no initiation within 6 months (RR = 0.72, 95% CL: 0.37, 1.4). Conclusions: Our point estimates suggest longer 3-year survival, but the results are compatible with 1.5 month shorter or 5.1 longer 3-year overall survival after smoking cessation within 6 months of cancer diagnosis. Future studies with larger sample sizes that test the comparative effectiveness of different smoking cessation strategies are needed for more detailed evidence to inform decision-making about the effect of smoking cessation on survival among cancer patients. Implications for Cancer survivors: The benefits of smoking cessation after cancer diagnosis may include longer survival, but the magnitude of benefit is unclear.

Treating Smoking in Cancer Patients: An Essential Component of Cancer Care—The New National Cancer Institute Tobacco Control Monograph

“…10 This Monograph identifies an additional eight studies published between 2017 and 2021 that have examined the association between quitting smoking and all-cause mortality in patient groups diagnosed with different types of cancers. 21-28 These studies provide additional evidence that quitting smoking after a cancer diagnosis is associated with reduced all-cause mortality relative to continued smoking.…”

Tobacco use and cancer‐related symptom burden: Analysis of the US Population Assessment of Tobacco and Health Study

“…Cigarette smoking is a major modifiable risk factor for cancer incidence and a leading cause of preventable cancer death 1 . Continued smoking after a diagnosis of cancer lowers survival rates, 2–6 increases the likelihood of recurrence and second malignancies, 3,5,7,8 and decreases the efficacy of cancer‐directed therapy (surgery, radiation, chemotherapy), 3,9–11 whereas quitting smoking postdiagnosis potentially improves these outcomes 12–14 . Approximately one in four adults with cancer reports current cigarette smoking at the time of their diagnosis 15 .…”

“…1 Continued smoking after a diagnosis of cancer lowers survival rates, [2][3][4][5][6] increases the likelihood of recurrence and second malignancies, 3,5,7,8 and decreases the efficacy of cancer-directed therapy (surgery, radiation, chemotherapy), 3,[9][10][11] whereas quitting smoking postdiagnosis potentially improves these outcomes. [12][13][14] Approximately one in four adults with cancer reports current cigarette smoking at the time of their diagnosis. 15 Most patients quit or attempt to quit shortly after their diagnosis, but as many as 58% of individuals smoking at the time of diagnosis report continued smoking postdiagnosis.…”

Effective Timing of Introducing an Inpatient Smoking Cessation Program to Cancer Patients

“…Among various risk factors, smoking among cancer patients is closely associated with adverse outcomes, including an increased risk of second primary cancer, postoperative complications, overall increased mortality/decreased efficacy, treatment tolerance (radiation, systemic therapy), and decreased health functioning and quality of life. 4 5 6 Multiple clinical practice guidelines by oncology organizations emphasize smoking cessation in all patients with cancer and suggest that smoking cessation should be considered in cancer treatment. 7 8 9 …”