The 2014 Surgeon General’s Report concluded that smoking by cancer patients and survivors increases overall mortality, cancer- specific mortality, and risk for second primary cancers. Studies have found that quit rates are initially quite high for patients with definitive smoking-related cancers. However, research has not dug deeper to assess smoking patterns many years after a cancer diagnosis among survivors of non-smoking-related cancers.
For a study published in Cancer Epidemiology, Biomarkers, & Prevention, Lee Westmaas, PhD, and colleagues analyzed data on nearly 3,000 patients 9 years after a diagnosis of one of 10 cancer types. “We wanted to know the overall prevalence of smoking, and especially how common non-daily smoking was,” says Dr. Westmaas. “We also wanted to see if prevalence differed by whether or not the cancer was smoking-related.”
The researchers found that slightly more than 9% of all cancer survivors were current smokers. Among current smokers, 83% were deemed daily smokers, averaging nearly 15 cigarettes per day, and 40% smoked more than 15 cigarettes per day. The Figure depicts smoking prevalence by cancer type
Dr. Westmaas speculates that bladder cancer survivors were most likely to continue smoking because their disease is relatively more survivable than other types of cancer. “It’s possible that those who still smoked felt they were at lower risk than smokers with some of the other cancers,” he says. The relatively high rate of continued smoking among lung cancer survivors could be the result of unique issues facing these patients. “Survivors of smoking- related cancer might have feelings of guilt or stigma from their diagnosis,” Dr. Westmaas says. “When those emotions are coupled with probable nicotine dependence, it might make it more difficult for these people to quit smoking.”
Applying the Findings
According to the study, about 40% of current smokers intended to quit within the next month. “This shows that many patients are motivated and interested in quitting, even at 9 years after their diagnosis,” Dr. Westmaas says. “These patients were probably not getting the resources they needed to help them quit.” The study findings support the notion that physicians should ask cancer survivors about their smoking status throughout follow-up. “Providers should also ensure that cancer survivors know that there are effective medications available to help them achieve cessation and overcome withdrawal symptoms,” Dr. Westmaas adds.
ASCO Tobacco Cessation & Control Resources:
ASCO Tobacco Cessation Guide Brochure (PDF):
2014 Surgeon General’s Report: The Health Consequences of Smoking–50 Years of Progress:
Westmaas J, Alcaraz K, Berg C, Stein K. Prevalence and correlates of smoking and cessation-related behavior among survivors of ten cancers: findings from a nationwide survey nine years after diagnosis. Cancer Epidemiol Biomarkers Prev. 2014 Aug 6. [ePub ahead of print]. Available at http://cebp.aacrjournals.org/content/early/2014/07/28/1055-9965.EPI-14-0046.abstract?sid=447dd6c3-689a-4712-9eef-0619ee173b2a.
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Karam-Hage M, Cinciripini P, Gritz E. Tobacco use and cessation for cancer survivors: an overview for clinicians. CA Cancer J Clin. 2014;64:272-290.