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Smoking relapse more common in patients who smoked before surgery
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Patients with thoracic or head and neck cancers who continued to smoke before surgery were more likely to relapse than patients who spontaneously quit after their diagnosis, according to study results.
“Cigarette smoking is responsible for 30% of all cancer-related mortalities,” Vani Nath Simmons, PhD, assistant member of the health outcomes and behavior program at Moffitt Cancer Center in Tampa, Fla., said in a press release. “Lung cancers and head and neck cancers are the most strongly linked to tobacco use. Many patients with these cancers make an attempt to quit smoking at the time of diagnosis.
“However, little attention has been paid to looking at how successful patients are at quitting and what predicts who is likely to resume smoking,” Simmons added. “This is particularly a concern for cancer patients because continued smoking can be related to cancer recurrence, cancer treatment complications, second primary tumors and poorer quality of life.”
Simmons and colleagues conducted a longitudinal study to evaluate smoking-related, affective, cognitive and physical variables as predictors of smoking after surgical treatment.
The investigators enrolled 154 patients with lung or head and neck cancers who had recently quit smoking, and they evaluated the patients’ smoking behavior at 2, 4, 6 and 12 months after surgery.
Cohort patients were recruited from the thoracic and head and neck clinics at Moffitt Cancer Center from March 1, 2008, to Dec. 31, 2009.
Eligible patients who were aged at least 18 years, exhibited a history of smoking at least 10 cigarettes per day for at least 1 year before diagnosis, and were scheduled to undergo surgical cancer treatment.
Additionally, all patients had either quit smoking at least 6 months before — confirmed biochemically via carbon monoxide breath sample — or were smoking in the week before surgery but planned to quit immediately after surgery.
According to follow-up evaluation performed 12 months after surgery, 60% of patients who smoked during the week before surgery had resumed smoking vs. 13% of patients who were abstinent before surgery.
For patients were continued to smoke before surgery (n=101), predictors of smoking relapse included lower quitting self-efficacy, higher depression proneness and greater fears about cancer recurrence. For patients who were abstinent before surgery (n=53), variables such as higher perceived difficulty quitting and lower cancer-related risk perceptions predicted smoking relapse.
“Given evidence that patients with cancer are highly motivated and can be readily engaged in quitting smoking, efforts aimed at helping patients with cancer maintain tobacco abstinence could have dramatic public health implications,” Simmons and colleagues wrote.
“Receiving a cancer diagnosis represents a ‘teachable moment’ for delivering smoking cessation and relapse prevention interventions,” they wrote. “The current study further supports the important role of smoking status prior to surgery and identifies several potential modifiable variables to address in future relapse prevention interventions targeted to patients with cancer.”
Perspective
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Michael Steinberg, MD, MPH, FACP
The article by Simmons and colleagues reports the benefit of tobacco abstinence prior to surgery for cancer. This study clearly demonstrates that smokers who are still smoking at the time of their surgery are much more likely to resume smoking after their surgery (60% relapse) than those who quit at least one week prior to surgery (13% relapse). Although not specifically a treatment trial, the findings underscore the critical importance of providing intensive tobacco treatment interventions to smokers with cancer. Physicians should not succumb to the myth that a cancer diagnosis is alone sufficient to “magically” produce cessation, nor is it a reason not to offer tobacco treatment to a smoker simply because they have cancer and “it is already too late.” As it turns out, it is even more important to treat these patients who continue to smoke with highly intensive and comprehensive, evidence-based tobacco interventions, such as outlined by the U.S. Public Health Service Clinical Practice Guidelines.
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