Quitting Smoking After Cancer Diagnosis Sharply Improves Survival, Study Finds

Even successful precocious cancer, patients who discontinue smoking soon aft test lived longer, yet astir were ne'er offered meaningful cessation support.

Study: Smoking Cessation and Mortality Risk successful Cancer Survivorship: Real-World Data From a National Cancer Institute–Designated Cancer Center. Image Credit: Pixel-Shot / Shutterstock

In a caller study published successful the Journal of nan National Comprehensive Cancer Network, researchers assessed whether postdiagnosis smoking cessation is associated pinch wide endurance (OS) crossed crab stages utilizing physics wellness grounds (EHR) data.

Background

Quitting smoking aft a crab test is simply a elemental measurement that tin adhd years to life. Cigarette smoking causes astir 30% of crab deaths and 80% of lung crab deaths successful nan United States (US). Stopping astatine immoderate property lowers excess mortality. In clinics, baccy usage is not continually assessed, and curen is not consistently offered. Guidelines from nan National Comprehensive Cancer Network (NCCN) and nan American Society of Clinical Oncology (ASCO) telephone for regular screening and support. Still, clip limits and training gaps tin sideline cessation. Further investigation should explain really stopping aft test relates to wide endurance crossed stages, including successful real-world oncology settings wherever cessation support whitethorn vary.

About nan study

This observational cohort included adults pinch an progressive crab test who attended outpatient oncology clinics wrong six months of June 1, 2018, astatine a National Cancer Institute (NCI)-designated Comprehensive Cancer Center. Smoking position was recorded astatine each sojourn successful EHR utilizing Electronic Health Record-Enabled Evidence-Based Smoking Cessation Treatment (ELEVATE) prompts and was categorized arsenic never, former, aliases presently smoking; those precocious receiving cessation curen were counted arsenic presently smoking. The scale sojourn was nan first brushwood adjacent nan commencement of nan study. The superior result was OS to decease from immoderate cause, censored June 30, 2020.

In a secondary study among patients who smoked astatine nan scale visit, cessation wrong six months was defined arsenic seven-day self-reported abstinence pinch a documented discontinue betwixt January 1 and June 30, 2019. Demographics, crab type and stage, and years since test were abstracted from EHR and tumor registry data. Multivariable Cox proportional hazards models estimated adjusted hazard ratios (aHRs) pinch 95% assurance intervals (CIs). Survival analyses mixed Kaplan–Meier curves for visualization pinch model-based estimates from Cox models to deduce adjusted endurance probabilities. Analyses utilized Statistical Analysis System (SAS) type 9.4. Institutional Review Board (IRB) support covered nan study of deidentified outcomes from a value betterment database.

Study results

Among 13,282 patients, 6,568 (49.5%) had ne'er smoked, 4,989 (37.6%) were erstwhile smokers, and 1,725 (13.0%) were presently smoking astatine nan scale visit. Most were female (60.0%), White (83.0%), and aged 61 years aliases older (60.0%). Advanced-stage illness was common, pinch shape III successful 4,679 (35.2%) and shape IV successful 3,675 (27.7%). Compared pinch patients who ne'er smoked, mortality consequence was higher successful those who formerly smoked (aHR 1.13; CI 1.03 to 1.25) and successful those who presently fume (aHR 1.35; CI 1.20 to 1.53). Stage-specific analyses showed a accordant pattern.

Patients who presently fume had higher all-cause mortality than those who ne'er smoked successful stages I and II (aHR 1.37; CI 1.02 to 1.85), shape III (aHR 1.30; CI 1.05 to 1.61), and shape IV (aHR 1.35; CI 1.13 to 1.60). Two-year endurance estimates were 81.4% for ne'er smokers, 79.4% for erstwhile smokers, and 76.4% for existent smokers, pinch important differences.

Among nan 1,725 patients who smoked astatine nan scale visit, 381 (22.1%) discontinue wrong six months based connected seven-day abstinence and a documented discontinue status. After adjustment, continued smoking was associated pinch a higher consequence of decease than quitting (aHR 1.97; CI 1.53 to 2.55). Estimated adjusted endurance favored quitting astatine 1 twelvemonth (91% discontinue versus 83.9% continued) and 2 years (85.1% versus 74.7%). In stage-stratified analyses of postdiagnosis change, nan relation of continued smoking pinch mortality was strongest successful precocious disease. For stages III and IV combined, continued smoking carried a higher consequence than quitting (aHR 2.11; CI 1.60 to 2.79); for stages I and II, nan estimate was smaller and not statistically important (aHR 1.30; CI 0.67 to 2.51).

Among 719 patients who underwent cancer-related room adjacent nan scale visit, 118 were smokers; of these, 76 discontinue and 42 continued. Continued smoking successful this subgroup was associated pinch accrued mortality compared pinch quitting (aHR 4.41; CI 1.22 to 15.87). Across nan cohort, existent smoking astatine baseline clustered pinch antheral sex, property 70 years aliases younger, tobacco-related coagulated tumors, precocious stage, and less than 5 years since diagnosis. Overall, nan results bespeak that smoking astatine aliases aft test is linked to little OS, while postdiagnosis cessation is linked to improved OS, including successful advanced-stage illness.

Study limitations

Smoking position was self-reported and not biochemically verified, perchance underestimating nan existent use of cessation. Treatment information earlier mid-2018 were constricted owed to an EHR transition, and unmeasured factors, specified arsenic healthier lifestyles aliases amended curen adherence among quitters, whitethorn lend to endurance differences. Outcomes reflected wide survival, not cancer-specific mortality, which whitethorn limit causal interpretation. The single-center mounting and predominantly White organization whitethorn besides limit generalizability to much divers crab populations.

Conclusions

Postdiagnosis smoking cessation was associated pinch longer OS successful crab survivorship, including successful advanced-stage disease. Because only 1 successful 5 patients quits wrong six months, low-burden support is needed. EHR ELEVATE and nan National Cancer Institute Cancer Center Cessation Initiative (C3I) show really EHR devices grow scope and effectiveness. Embedding counseling, referrals, and pharmacotherapy alongside surgery, radiation therapy, and systemic therapy tin make cessation a 4th pillar of crab care.