Smoking Cessation in Cancer Care: Challenges and Opportunities

Based on the results of a cohort study reported in JAMA Network Open, smoking worsened both cancer symptom burden and severity. However, Rieth et al noted that oncologic surgery may present a unique teachable moment for smoking cessation, as patients appeared to be highly motivated to quit.

The investigators added, “Clinical guidelines, individual motivation, and efficacy of cessation treatments are aligned, but quitting smoking during cancer treatment is complex. Without tailored approaches [for quitting smoking] integrated into the continuum of cancer care, relapse may continue to be high, as identified in our study, which is consistent with reports of 70% of hospitalized smokers experiencing relapse by 6 to 12 months.”

Study Details

The investigators focused on data from a nationwide prospective cohort study of 1,003 patients with cancer enrolled through the University of Rochester Cancer Center National Cancer Institute Community Oncology Research Program.

Surveys were administered before the initiation of chemotherapy or radiation therapy; within 2 weeks after the completion of adjuvant treatment; and 6 months after the completion of treatment. Variables included smoking status and treatment-related side effects, evaluated via a 12-item inventory. The investigators defined motivation to quit smoking as planning to decrease smoking, quit after treatment, or quit immediately. Race and ethnicity were self-reported (Black, White, or other [American Indian or Alaska Native, Asian, Hispanic or Latino, and Native Hawaiian or Other Pacific Islander]) and were analyzed to explore disparities in smoking status and cessation outcomes.

Key Findings

A total of 71.6% of patients (n = 718) underwent surgery, of whom 12.5% (n = 90) reported current smoking before treatment. Smoking before treatment was found to be associated with younger age (< 45–54 vs ≥ 55 years: 51.1% vs 48.9%; P = .006) and Black race (vs other races and ethnicities: 12.2% vs 3.3%; P < .001). A total of 68.7% of smokers were diagnosed with tobacco-related cancer. Symptom burden and severity scores appeared to be significantly higher among patients who did vs did not smoke before treatment (23.7 vs 17.0 and 2.0 vs 1.4, respectively; both P < .001) and at 6 months follow-up after treatment (33.5 vs 21.3 and 2.8 vs 1.8; both P < .001).

According to the investigators, motivation to quit was sustained among patients currently smoking between the periods before and after treatment. Nearly two-thirds of smokers (64.4%) reported motivation to quit after surgery; 15.4% quit before adjuvant therapy, and half of those motivated to quit had relapsed by 6 months.

“As expected, patients who smoke experienced greater symptom burden during cancer treatment,” the investigators concluded. “Continued smoking after treatment led to significantly higher symptom severity scores at the 6-month follow-up, suggesting that ongoing smoking negatively affects quality of life.” Further emphasizing the importance of strategic interventions, they added, “Additional research is needed to evaluate integrated, longitudinal cessation programs in surgical oncology care to improve surgical and cancer-related outcomes.”

Katherine K. S. Rieth, MD, MPH, MA, of the University of Rochester Medical Center, New York, is the corresponding author of the JAMA Network Open article.  

Disclosure: The study was funded by grants from the National Cancer Institute. The study authors reported no conflicts of interest.