Early Smoking Cessation Treatment After Cancer Diagnosis Improves Survival

Evidence-based smoking cessation 6 months after a cancer diagnosis was found to maximize survival benefit, highlighting the importance of early clinical intervention for patients after being diagnosed with cancer.¹

Evidence-based smoking cessation 6 months after a cancer diagnosis was found to maximize survival benefit. | Image credit: ehabeljean - stock.adobe.com

The prospective cohort study is published in JAMA Oncology.

“Although smoking cessation as a part of cancer care is advocated by most large cancer organizations, many oncology clinicians do not regularly assist patients with quitting,” wrote the investigators of the study. “The Tobacco Research and Treatment Program (TRTP) at the University of Texas MD Anderson Cancer Center has been providing structured, evidence-based smoking cessation interventions for patients diagnosed with cancer since 2006. Data collected through the TRTP provide a unique opportunity to accurately assess the benefits of quitting smoking after diagnosis.”

Tobacco use remains the leading preventable cause of US deaths, accounting for about 1 in 5 deaths each year, according to the American Cancer Society.² Moreover, smoking is the cause of about 20% of all cancers and about 30% of all cancer deaths in the US.

In this study, the researchers aimed to measure the association between time of entry into smoking cessation following a cancer diagnosis and survival outcomes.¹

The study followed patients who entered the Tobacco Treatment Program at the MD Anderson Cancer Center within various time frames—within 6 months, from 6 months to 5 years, and over 5 years post-diagnosis.

The program was established in 2006 and funded by the Texas Tobacco Settlement Funds, providing free, evidence-based smoking cessation treatments, including behavioral counseling, motivational interviewing, and pharmacotherapies such as nicotine replacement, bupropion, and varenicline. Patients were enrolled through electronic medical records, clinician referrals, or self-referral, with telemedicine utilized in over 95% of visits. Primary exposure was measured by self-reported smoking abstinence at 3, 6, and 9 months post-enrollment.

The primary outcome was survival, with analyses conducted for the time between diagnosis and program enrollment. These models were adjusted for variables such as age, cancer stage, and time to treatment entry.

A total of 6593 individuals participated in the treatment program, and 4526 met inclusion criteria for analysis.

The study found that survival over 15 years was significantly higher among patients with cancer who quit smoking. Patients who quit smoking by 3 months post-treatment (adjusted HR [aHR], 0.75; 95% CI, 0.67-0.83), by 6 months (aHR, 0.79; 95% CI, 0.71-0.88), and by 9 months (aHR, 0.85; 95% CI, 0.76-0.95) had a reduced risk of mortality compared with those who continued smoking.

The optimal survival advantage was observed among those entering the tobacco treatment program within 6 months of cancer diagnosis, with median survival extending from 2.1 years (95% CI, 1.8-2.4 years) for non-abstainers to 3.9 years (95% CI, 3.2-4.6 years) for abstainers.

In patients who began tobacco treatment between 6 months and 5 years post-diagnosis, survival differences were also evident, with a 75th percentile survival of 4.8 years (95% CI, 4.3-5.3 years) for continuing smokers vs 6.0 years (95% CI, 5.1-7.2 years) for those who quit.

However, the researchers also acknowledged some limitations to the study. As with many tumor registry-based analyses, the data did not include non–cancer-related health conditions or treatments, limiting insights into interactions with other health issues. Additionally, while the study sample broadly represents common cancer types, it may not fully reflect the entire cancer-smoking population, particularly given that approximately half of eligible patients participated in the treatment program. Self-reported smoking abstinence also posed potential bias.

Despite these limitations, the researchers believe the consistent association between early smoking cessation and improved survival outcomes across varied analyses supports its role as a critical factor for patients with cancer.

“Advances that substantially improve delivery and effectiveness of evidence-based smoking cessation treatment at the time of diagnosis are expected to provide significant survival benefit to patients and value to oncology clinicians,” wrote the investigators.

References

1. Cinciripini PM, Kypriotakis G, Blalock JA, et al. Survival outcomes of an early intervention smoking cessation treatment after a cancer diagnosis. JAMA Oncol. October 31, 2024. https://jamanetwork.com/journals/jamaoncology/fullarticle/10.1001/jamaoncol.2024.4890?guestAccessKey=a32dd902-6749-44bd-918c-5d462b5d6e2e&utm_source=for_the_media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=103124

2. Health risks of smoking tobacco. American Cancer Society. October 28, 2020. Accessed October 31, 2024. https://www.cancer.org/cancer/risk-prevention/tobacco/health-risks-of-tobacco/health-risks-of-smoking-tobacco.html