Many Cancer Survivors Balk at Kicking the Smoking Habit

Roxanne Nelson

August 06, 2014

Almost 10% of cancer survivors continue to smoke, according to a survey published online August 6 in Cancer Epidemiology, Biomarkers & Prevention.

Researchers from the American Cancer Society found that approximately 9 years after receiving a cancer diagnosis, 9.3% of survivors were still smoking.

The prevalence of smoking was highest in survivors of bladder cancer (17.2%), lung cancer (14.9%), and ovarian cancer (11.6%).

"The risk for cancer patients who continue to smoke is that cigarette smoking decreases the effectiveness of cancer treatments, increases the probability of recurrence, and reduces survival time, so it's beneficial for cancer patients to quit smoking," said lead author Lee Westmaas, PhD, director of tobacco research at the American Cancer Society.

In addition, smoking can cause new mutations in cancer survivors that can lead to secondary and additional primary cancers, said Roy Herbst, MD, PhD, chief of medical oncology at Yale University in New Haven, Connecticut, and chair of the Tobacco and Cancer Subcommittee at the American Association for Cancer Research, who was not involved in the study.

"It can also affect physical function and interfere with the efficacy of therapies," he said in a statement. "We need to take note of this and target this population for intervention."

Reasons for Smoking

Even though it seems counterproductive, there are a number of reasons cancer patients continue to smoke after their diagnosis and treatment.

Some patients might think, "I have cancer anyway so I might as well smoke," said Sonia Duffy, PhD, RN, professor in the division of health promotion and risk reduction at the University of Michigan School of Nursing in Ann Arbor.

In addition, "cancer patients may have obstacles to quitting such as comorbid depression and alcohol use, low social support, low socioeconomic status, and other smokers in the home," she explained.

There are also provider and facility factors, she continued. "Institutions often do not provide smoking-cessation services because there is a low reimbursement rate for these services," Dr. Duffy said. "And providers may be too busy dealing with the acute and chronic symptoms of cancer to even think about smoking." Plus, physicians and nurses are often not trained to conduct cessation services.

"The bottom line is that it is known that cancer patients who quit smoking have better outcomes," and there are "effective behavioral interventions and pharmaceutical interventions are available," she noted.

Half Plan on Quitting

Of the 1938-patient cohort, 272 (9.3%) were current smokers, 209 (41.2%) were former smokers, and 1457 (49.6%) had never smoked. Of the 1209 former smokers, 1072 (88.6%) had quit prior to be diagnosed with cancer.

The majority of smokers (83.0%) smoked daily, averaging 14.7 cigarettes per day. Of the daily smokers, 40.0% smoked more than 15 cigarettes per day. The average number of days of smoking in the previous month by nondaily smokers was 10.9 days; on those days, they smoked an average of 5.7 cigarettes a day.

On multivariate analysis, the odds of quitting after the diagnosis were greater for survivors whose cancer was smoking-related (odds ratio [OR], 1.73; P = .01), who had a higher body mass index (OR, 1.06; P = .001), and who had more current comorbid medical conditions (OR, 1.10; P = .06).

Almost half of the current smokers (46.6%) said that they intended to quit, 43.3% said they were not sure, and 10.1% said they did not plan on quitting.

The odds of quitting were lower for married people (OR, 0.57; P = .04), for older people (OR, 0.96; P = .01), for people who smoked more cigarettes per day (OR, 0.96; P = .01), and for those who drank at least 2 alcoholic beverages per day (OR, 0.59; P = .06).

About 40% of those who planned to quit said they would do so in the next month; the rest said they planned to quit in the next 3 months or more.

Room for Improvement

There is room for improvement in getting cancer survivors to kick the habit. "Previous research has shown that although oncologists would like their patients to stop smoking and are willing to help, the reality is that many patients and survivors aren't asked about their smoking or given resources they can use to help quit," Dr. Westmaas told Medscape Medical News.

"Survivors whose cancers are not strongly associated with smoking may be even less likely to get the message that they need to quit, even though quitting still has advantages for their prognosis," he added.

Some hospitals, however, have in-house cessation programs specifically geared toward cancer patients and survivors. In addition, "telephone quitline counselors are usually given training on special issues relevant to survivors," Dr. Westmaas said. "And, of course, medications to help smokers quit will be helpful, although certain forms of nicotine replacement therapy may be contraindicated, depending on the type of cancer."

"We plan to tailor an email program that's been successful in helping smokers to cancer survivors, and there is current testing of relapse-prevention materials for cancer survivors being conducted at the H. Lee Moffitt Cancer Center," Dr. Westmaas reported.

"With increasingly greater recognition of the challenges survivors face in quitting smoking, we expect there will be more programs that cater to this population to help them quit and stay quit," he added.

The American Cancer Society (ACS) Studies of Cancer Survivors were funded as an intramural program of research conducted by the ACS Behavioral Research Center. The authors have disclosed no relevant financial relationships.

Cancer Epidemiol Biomarkers Prev. Published online August 6, 2014. Abstract


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