When Is It Best to Quit?

TOPLINE:

Starting smoking cessation treatment within 9 months of a cancer diagnosis was associated with improved survival across various cancer types, with the greatest survival benefit observed among patients who began the process within 6 months of their diagnosis. 

METHODOLOGY:

• The 2020 Surgeon General’s report and recent evidence indicate that quitting smoking improves survival among patients with lung and head and neck cancers. However, these studies lacked long-term prospective data as well as data on the optimal time to start a smoking cessation program after a cancer diagnosis.
• This prospective cohort study involved 4526 patients with cancer who smoked (median age, 55 years) and participated in the Tobacco Research and Treatment Program (TRTP) at the University of Texas MD Anderson Cancer Center, Houston, between 2006 and 2022.
• The smoking cessation program offered personalized, structured, evidence-based interventions and enrolled patients through electronic medical records and self- or clinician referral. Self-reported abstinence (defined as a self-report of no smoking in the 7 days before each assessment) was evaluated at 3, 6, and 9 months following the initial consultation.
• The primary outcome was survival. The study also evaluated time-dependent survival outcomes based on the time between cancer diagnosis and entry into the intervention program: Within 6 months, from 6 months to 5 years, and more than 5 years.
• The median follow-up duration was 7.9 years.

TAKEAWAY:

• Over a period of 15 years, survival rates improved for patients who quit smoking at 3 months (adjusted hazard ratio [aHR], 0.75), 6 months (aHR, 0.79), and 9 months (aHR, 0.85).
• Patients entering the tobacco cessation program within 6 months of their cancer diagnosis had the greatest survival benefit of 1.8 years of additional life (2.1 years for nonabstainers vs 3.9 years for abstainers) and improved survival at 5 years (abstainers vs nonabstainers, 71% vs 61%) and at 10 years (58% vs 52%).
• Compared with not abstaining from smoking, abstinence from smoking at 3 months was associated with significantly improved survival at 5 years (65% for abstainers vs 61% for nonabstainers) and at 10 years (77% vs 73%, respectively).
• Similar but less pronounced improvements in survival outcomes were observed among patients who entered the program between 6 months and 5 years from diagnosis (6.0 years for abstainers vs 4.8 years for nonabstainers vs), with 10-year survival rates of 59% for abstainers vs 67% for nonabstainers (P = .004).
• Smoking cessation, regardless of the time of entry, was associated with improved survival. Abstinence at 3, 6, and 9 months after the initiation of the smoking cessation treatment reduced mortality across all cancer types by 26%, 22%, and 16%, respectively.

IN PRACTICE:

“This cohort study provided clear evidence that quitting smoking at or following a cancer diagnosis improves survival across various types of cancer. The largest benefit was noted among patients who entered the TRTP within 6 months of diagnosis,” the authors wrote. “Early entry into tobacco treatment is associated with the best survival outcomes and justifies the need to prioritize tobacco cessation as a core element of first-line cancer care.”

SOURCE:

The study, led by Paul M. Cinciripini, PhD, University of Texas MD Anderson Cancer Center, was published online in JAMA Oncology.

LIMITATIONS:

The absence of non–cancer-related health information and treatments in the tumor registry may have affected the interpretation of survival outcomes. Participants in the TRTP may not fully represent all patients who smoke with a cancer diagnosis, which may have affected the generalizability of the findings. Additionally, the study relied on self-reported smoking status, which may have introduced bias.

DISCLOSURES:

The study was supported by grants from the State of Texas Permanent Health Funds awarded to the University of Texas MD Anderson Cancer Center. Three authors declared receiving grants or nonfinancial support or having other ties with various sources. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.