‘Alarming’ number of childhood cancer survivors currently smoke despite negative impacts
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Key takeaways:
- Childhood cancer survivors had higher prevalence of current smokers compared with general population.
- Survivors also had higher rates of physical inactivity.
Childhood cancer survivors had a significantly higher prevalence of smoking than the general population, contrary to previous research, according to a study published in BMC Cancer.
This national cohort, derived from the 2020 Behavioral Risk Factor Surveillance System, showed more than 25% of survivors are current smokers.
“It is alarming,” Van T. Nghiem, PhD, assistant professor of health policy and organization at The University of Alabama at Birmingham, told Healio.
Healio previously reported 85% of individuals with childhood cancer survive at least 5 years. More than 500,000 childhood cancer survivors are estimated to be living in the U.S., Nghiem and colleagues wrote in their study.
However, this patient population has a higher risk for long-term adverse events due to treatments for the primary cancer during childhood, developing secondary cancers, cardiovascular and chronic diseases and other health-related issues.
Negative health behaviors such as smoking, binge drinking and physical inactivity can exacerbate their burden.
“They seem to have double-negative health outcomes if they are childhood cancer survivors engaging in these risk behaviors,” Nghiem said.
A ‘very worrisome’ trend
Nghiem and colleagues wanted to gather updated data on the prevalence of these negative health behaviors and fill in gaps other studies missed.
“Previously, the literature has used data coming from hospital-based databases, or the data may come from a small number of health centers, which causes some potential drawbacks of the data sampling because patients with cancer from historically underserved populations usually live in and receive care in their ethnic community and their socioeconomic disadvantages are reportedly linked to their lack of participation in cancer research,” Nghiem said. “The current literature has discussed a lot about childhood cancer survivors at a younger age, like up to 26 up to 39, but since childhood cancer survivors in the United States have been living longer and longer, we don’t know about the health-related risk behaviors among the elder child cancer survivors whose age ranges widely beyond the age of 39 and could reach the 80s.”
Their cross-sectional study used the 2020 Behavioral Risk Factor Surveillance System, a phone survey that obtains sociodemographic data, health-related risk factors, chronic health conditions and preventive service use across the country.
The study cohort consisted of 372 survivors (median age, 45.5 years; 82.3% white; 61.1% women) matched with 1,107 healthy control subjects.
Survivors had a significantly higher likelihood of being current smokers (26.6% vs. 14.4%; P < .001) and physical inactivity (23.7% vs. 17.7%; P = .012) compared with control subjects. At roughly 18%, both populations had a similar proportion of binge drinkers.
Survivors had a significantly higher likelihood of having at least one of these behaviors (17.2% vs. 8.4%; P < .001).
Younger survivors (under 65 years) and those with a high school degree or below had higher odds of smoking, and those with lower incomes had higher rates of physical inactivity.
“Unfortunately, survivors of childhood cancer aren’t necessarily any better at aligning with desirable health behaviors than the general population,” Stephanie Dixon, MD, MPH, an assistant member in the division of cancer survivorship at St. Jude Children’s Research Hospital, told Healio.
The physical inactivity and binge drinking results did not surprise Dixon as they aligned with previous research, but the smoking results did.
Studies she previously read indicated lower smoking numbers for survivors, as did background information provided by researchers, which cited one study that found the proportion to be less than 20% for those between ages 18 to 49 years, although the study had been conducted in 2002.
“It’s very worrisome,” Dixon said. “Also, we know that this was in adult survivors, but there’s been some other studies that have demonstrated pretty high prevalence of vaping or e-cigarette use in adolescent and young adult survivors, and so as traditional cigarette use has gone down in the population, we’re now seeing this increase in vaping and e-cigarette use, and that’s quite concerning.”
Areas for investment
Dixon believes the national sampling used in the study by Nghiem and colleagues could shed light on the elevated numbers they found.
“It didn’t rely on an individual or institution that was related to the survivors’ cancer asking them the question, so you could imagine that they might have had more truthful responses to things like smoking behavior or vaping behavior,” she said.
“We think that there’s some social desirability bias in some of our studies,” she added. “If we, as the oncologist or as the treating institution, is saying, ‘Hey, tell us if you’re smoking,’ a survivor who knows that they probably shouldn’t be smoking for their health because they’ve been counseled may be less likely to truthfully report on their smoking status.”
Getting accurate information is essential to treatment, and Dixon believes this study may offer guidance on how clinicians should talk about issues like smoking and drinking with their patients.
How questions are asked regarding these behaviors should not elicit a particular response, she said.
“We need to frame questions around substance use, whether that be vaping or cigarette use, in the same way and normalize it, not because we want people to be doing it, but because if we don’t know that they’re doing it, then they’re never going to receive counseling or quit resources or education around the negative impacts on their health,” Dixon added.
Nghiem noted that her group’s study could have been impacted by COVID-19 because the information came from 2020, and follow-up may be needed to see if the pandemic had any impact on the results.
Nevertheless, she said the importance of tackling these health behaviors remains.
“Health risk behaviors are modifiable factors through health education,” Nghiem said. “Health-related risk behaviors can serve as a target that public health programs can intervene. We can provide counseling for smoking. We can provide counseling for increasing physical activity. Counseling is just one of the public health programs. Invest in programs to improve the situation. We need to provide resources.”
For more information:
Van T. Nghiem, PhD, can be reached at nghiem@uab.edu.
Stephanie Dixon, MD, MPH, can be reached at stephanie.dixon@stjude.org.
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