Early Smoking Cessation After Cancer Diagnosis Tied to Better Survival

Smokers who quit after a cancer diagnosis had increased survival, with the greatest benefit for those who initiated smoking cessation treatment within 6 months, a prospective cohort study showed.

Among over 4,500 patients diagnosed with cancer, survival over 15 years increased for those who quit smoking at 3 months (HR 0.75, 95% CI 0.67-0.83), 6 months (HR 0.79, 95% CI 0.71-0.88), and 9 months (HR 0.85, 95% CI 0.76-0.95) of follow-up, reported Paul M. Cinciripini, PhD, of the University of Texas MD Anderson Cancer Center in Houston, and colleagues.

The largest survival benefit was seen among patients who began receiving cessation treatment at the center’s Tobacco Research and Treatment Program within 6 months of diagnosis of cancer, including breast cancer, lung cancer, and head and neck cancer, they noted in JAMA Oncology.

Specifically, at the 75th survival percentile (the time at which 75% of patients had survived), survival increased from 2.1 years among continuing smokers (non-abstainers) compared with 3.9 years for patients who quit (abstainers). Similar but less pronounced outcomes were observed when cessation treatment began within 6 months to 5 years following diagnosis, with survival at the 75th percentile of 4.8 years for non-abstainers versus 6 years for abstainers.

“The results of this prospective cohort study suggest that evidence-based smoking cessation treatment within 6 months following a cancer diagnosis maximizes survival benefit,” Cinciripini and colleagues wrote. “This study supports smoking cessation as an important early clinical intervention for patients after being diagnosed with cancer.”

The data also showed that smoking cessation, regardless of time of entry into the program, was associated with improved survival, as abstinence at 3 months, 6 months, and 9 months after tobacco treatment onset reduced mortality across all cancer types by 26%, 22%, and 16%, respectively. When adjusted for cancer stage, abstinence at 3 months, 6 months, and 9 months was associated with reduced mortality by 22%, 20%, and 16%.

“It’s important to treat tobacco use in cancer patients as soon as possible, but that doesn’t always happen,” Cinciripini told MedPage Today. “Sometimes patients will decide they want to quit on their own and they aren’t successful. There could be a number of things that delay it.”

However, the results of this study show a “very robust association between the time a person entered the treatment program and their survival,” he noted. “So, the bottom line message here is the sooner a person enters treatment, the better their chances of survival.”

In explaining the rationale behind this study, Cinciripini and colleagues pointed out that the 2020 Surgeon General’s report, as well as a recent meta-analysis of patients with lung or head and neck cancer, supported improved survival with smoking cessation among cancer patients.

“However, a significant limitation noted by these reviews was the lack of clear, consistent smoking data and prospective longitudinal outcomes,” they wrote.

The program at MD Anderson was established in 2006. “Back then it was pretty much like all programs at the time, which was simply provider referral,” Cinciripini said. “But it has evolved quite dramatically to become what we call proactive referral.”

The process starts when a patient fills out the paperwork to receive care at the center. “If patients indicate they are tobacco users or have recently quit, we proactively reach out to those patients and provide them with various treatment options, which range from very low touch — where they want to quit on their own — all the way to a comprehensive program that involves behavioral counseling and psychopharmacologic treatment for comorbid psychiatric disorders,” Cinciripini explained.

This study focused solely on patients who entered the comprehensive smoking cessation program. Patients were excluded from the study if they died before tobacco treatment ended, received their diagnosis more than 6 months after beginning cessation treatment, or lacked staging information.

Cessation treatment consisted of 10 to 12 weeks of pharmacotherapy, and six to eight personalized counseling visits, 95% of which were provided via telemedicine.

The analysis included 4,526 currently smoking patients diagnosed with cancer and receiving cessation treatment (49.8% women, median age 55 years). Cancer diagnoses included breast cancer (17.5%), lung cancer (17.3%), head and neck cancer (13%), hematologic cancers (8.3%), genitourinary cancers (8%), prostate cancer (6.3%), and colon cancer (2.3%), among others.

The median follow-up time was 7.9 years. Overall intent-to-treat abstinence rates across this sample were 42% at 3 months, 40% at 6 months, and 36% at 9 months.

Cinciripini and colleagues acknowledged that their study had limitations, including the possibility that participants in MD Anderson’s structured program may not be representative of all patients with a cancer diagnosis. However, they pointed out that about half of incident cancers in the general population are comprised of lung, prostate, breast, and colorectal cancers — “similar to the 47% of cancers across these major disease sites observed in this study cohort.”