‘Real-life impact’: Early smoking cessation after cancer diagnosis maximizes survival benefit
Click Here to Manage Email Alerts
Key takeaways:
- Individuals who stopped smoking within 6 months of cancer diagnosis had improved survival.
- All comprehensive cancer centers should invest in smoking cessation programs, researchers concluded.
Smoking cessation within 6 months of a cancer diagnosis can significantly improve survival, according to results of a prospective study.
Individuals who quit smoking during that time survived nearly 2 years longer than those who did not, findings showed. The benefit of smoking cessation persisted across multiple cancer types.
“There are two messages here,” Paul M. Cinciripini, PhD, chair of behavioral science and executive director of the tobacco research and treatment program at The University of Texas MD Anderson Cancer Center, told Healio. “One: Let’s get our patients with cancer into smoking cessation treatment as quickly as possible. [Two]: Every comprehensive cancer center should invest in smoking cessation.”
Background and methods
The U.S. surgeon general reported tobacco use causes more death and disease in the country than any other preventable factor, according to study background.
Prior studies showed overall mortality increased 50% and cancer-related death rose 61% among people who continued smoking after cancer diagnosis.
Cinciripini and colleagues published a report in JAMA Network Open in 2019 that showed more than 40% of individuals stopped smoking once they entered the tobacco research and treatment program at MD Anderson.
“We know the treatment we provide is effective for many smokers in terms of getting people abstinent, but what does it do on their long-term impact?” Cinciripini said. “What’s different about this study is that this is prospective. There have been lots of studies that compared survival between current and former smokers with cancer using a retrospective design. Our study examined a cohort of tobacco users who entered the same tobacco treatment program and compared survival among those who quit smoking vs. those who didn’t at the same future timepoints. Prospective studies allow you to draw inferences on the direct impact of smoking cessation on survival at the individual patient level.”
The analysis included 4,526 adults (median age, 55 years; interquartile range, 47-62; 50.2% men) who smoked at diagnosis and received cessation treatment between Jan. 1, 2006, and March 3, 2022.
Smoking cessation treatment included six to eight counseling visits, most of which occurred via telemedicine, and 10 to 12 weeks of pharmacotherapy (eg, nicotine patch and prescription medicines).
The most common of the 22 malignancies represented in the cohort included breast cancer (17.5%), lung cancer (17.3%) and head and neck cancer (13%).
The association between time of entry into smoking cessation treatment after cancer diagnosis and survival served as the primary outcome measure.
Results
Researchers reported smoking abstinence rates of 42% at 3 months, 40% at 6 months and 36% at 9 months after they entered the program.
Median follow-up was 7.9 years (interquartile range, 3.3-11.8).
Patients who abstained from smoking at the 3-month time point appeared significantly more likely than those who had not abstained to achieve 5-year survival (77% vs. 65%) and 10-year survival (73% vs. 61%; P = .002).
An analysis performed by estimating survival at the 75th percentile showed longer time to death for patients who had abstained from smoking at 3 months (5.7 years; 95% CI, 5.1-6.5) than those who had not (4.4 years; 95% CI, 3.9-4.9).
Survival over 15 years increased for patients who had quit smoking at 3 months (adjusted HR = 0.75; 95% CI, 0.67-0.83), 6 months (adjusted HR = 0.79; 95% CI, 0.71-0.88) and 9 months (adjusted HR = 0.85; 95% CI, 0.76-0.95).
Among adults who stopped smoking within 6 months of entering the program, survival at the 75th percentile was 3.9 years (95% CI, 3.2-4.6) among abstainers vs. 2.1 years (95% CI, 1.8-2.4) for those who did not abstain from smoking.
The same analysis for patients who entered the program between 6 months and 5 years after diagnosis showed survival at the 75th percentile of 6 years (95% CI, 5.1-7.2) for abstainers vs. 4.8 years (95% CI, 4.3-5.3) for those who did not abstain.
Researchers observed no survival improvement for adults who entered the program more than 5 years after diagnosis.
“I was most surprised by the strength of the effect early on in the person’s cancer treatment journey,” Cinciripini said.
Multivariate Cox regression analyses adjusted for the potential effects of cancer staging showed smoking abstinence associated with reduced mortality at 3 months (22% reduction), 6 months (20% reduction) and 9 months (16% reduction).
Researchers acknowledged study limitations, including lack of data on noncancer conditions, and the fact patients participated in an institutionally sponsored tobacco treatment program.
Future research should focus on individuals who attempt smoking cessation treatments but are unable to stop, Cinciripini said.
“We can get people to quit and that’s great,” he added. “But if they don’t quit, what do you do next?”
Investment is a ‘win-win’
Many cancer centers do not receive optimal smoking cessation services, Cinciripini said.
“Many cancer centers make this a fee for service,” he said. “We tried that many years ago and we went from seeing about 400 people a year down to about 100. You really push people away who need the treatment when you put an economic barrier in front of them, even if they’re well insured.”
Now, MD Anderson makes smoking cessation part of the “patient experience” at the center, Cinciripini said.
“We have a myriad of services that are provided directly to all patients who want them, including the tobacco research and treatment program,” he said. “I believe every cancer center can do this. Our program has costs, to be sure, but MD Anderson provides the infrastructure for the clinical treatment and research components of the program. In doing so, it helps us generate research dollars, which then feeds back into the program to even make it better. It’s a win-win situation.”
Cinciripini called on oncologists to advocate for patients to quit smoking, and institutions to put more funding toward the cause.
“I’ve published a lot of papers over the course of my career” Cinciripini said. “But this is the one I’m most proud of because it’s real life. You see a real-life impact of the work that you’re doing — making a difference in a person’s life.”
References:
- Cinciripini PM, et al. JAMA Netw Open. 2019;doi:10.1001/jamanetworkopen.2019.12251.
- Cinciripini PM, et al. JAMA Oncol. 2024;doi:10.1001/jamaoncol.2024.4890.
- Quitting smoking after cancer diagnosis improves survival across a wide variety of cancers (press release). Available at https://www.mdanderson.org/newsroom/quitting-smoking-after-cancer-diagnosis-improves-survival-across-wide-variety-cancers.h00-159701490.html#. Published Oct. 31, 2024. Accessed Nov. 1, 2024.
For more information:
Paul M. Cinciripini, PhD, can be reached at pcinciri@mdanderson.org.
Collapse
Click Here to Manage Email Alerts