Smoking Cessation Treatment Yields Greater Survival After Cancer Diagnosis

Patients who start smoking cessation treatment after cancer diagnosis are found to have higher rates of survival.

Smoking cessation treatment started sooner vs later after a cancer diagnosis maximized survival benefit in patients with cancer, investigators of a prospective cohort study published in JAMA Oncology found.

Survival over 15 years was higher for patients who quit smoking within 3 months (aHR, 0.75; 95% CI, 0.67-0.83), 6 months (aHR, 0.79; 95% CI, 0.71-0.88), and 9 months (aHR, 0.85; 95% CI, 0.76-0.95). Among patients who were abstinent at 3 months, those who entered the Tobacco Research and Treatment Program (TRTP) within 6 months of cancer diagnosis had 1.8 years (75th survival percentile) of added life.

For patients who received treatment within 6 months, survival at the 75th percentile survival increased from 2.1 years (95% CI, 1.8-2.4) in continuing smokers to 3.9 years (95% CI, 3.2-4.6) for patients who quit. For those who began within 6 months to 5 years, survival at the 75th percentile increased from 4.8 years (95% CI, 4.3-5.3) for nonabstainers to 6.0 years (95% CI, 5.1-7.2) for abstainers.

A multivariate Cox regression analysis, without adjusting for stage, demonstrated reduced mortality at abstinence of 3 months by 26%; 6 months, 22%; and 9 months, 16%. When adjusting for the potential effects of staging, the rates were 22%, 20%, and 16%, respectively.

“An important clinical inclination from this study is that providing a structured smoking cessation program at the time of a cancer diagnosis that is integrated with cancer care can have a demonstrable positive association with life expectancy,” the authors of the study wrote.

A total of 6593 currently smoking patients underwent treatment in the TRTP, and 4526 patients made up the primary analytic sample. Patients who died before the end of cessation treatment, were diagnosed more than 6 months after joining the TRTP, or lacked staging information were excluded. Median age was 55 years (IQR, 47-62), and 2254 patients (49.8%) were female.

Regarding diagnoses, 790 patients (17.5%) had breast cancer, 782 (17.3%) had lung cancer, 587 (13.0%) had head and neck cancer, and 375 (8.3%) had hematologic cancer.

Patients had to be diagnosed with cancer and receiving treatment within 6 months, from 6 months to 5 years, and greater than 5 years after diagnosis to be counted. TRTP treatment included cognitive behavioral counseling, motivational interviewing, and pharmacotherapy. Medications provided were nicotine replacement therapy, varenicline (Chantix), and bupropion (Aplenzin). Over 95% of visits in the study were conducted via telemedicine.

The study’s primary outcomes were survival as recorded in the MD Anderson Care Center tumor registry and the 7-day point prevalence abstinence at each follow-up.

In the study, abstinence was defined as a self-reported absence of smoking in the 7 days before each assessment. Patients who had missing smoking statuses at 3 months, 6 months, and 9 months were treated as nonabstainers.

Rates of overall abstinence in the intent-to-treat population were 42% (n = 1900/4526) at 3 months, 40% (n = 1811/4526) at 6 months, and 36% (n = 1635/4526) at 9 months. Data only among respondents indicated rates of 47% at 3 months, 50% at 6 months, and 50% at 9 months.

Among the primary cohort, abstinence vs nonabstinence at 3 months yielded improved survival at 5 years (65% vs 61%) and 10 years (77% vs 73%; P = .002). When estimating survival at the 75th percentile, time of death was 4.4 years (95% CI, 3.9-4.9) for nonabstainers vs 5.7 years (95% CI, 5.1-6.5) for abstainers at 3 months.

When patients entered the TRTP within 6 months of diagnosis, abstinence was associated with improved survival compared with nonabstinence at 5 years (61% vs 71%) and 10 years (52% vs 58%; P <.001). For patients who entered between 6 months and 5 years, 10 year survival was higher among patients who abstained than nonabstainers (59% vs 67%; P= .004).

There was no significant association with survival among patients who entered the TRTP more than 5 years after the diagnosis.

Per limitations, noncancer information and treatments being unavailable for analysis of potential interactions with non–cancer-related health conditions, individuals in a sponsored TRTP not being fully representative of patients who smoke with a cancer diagnosis, and the fact that all patients elected to receive tobacco treatment—which represented approximately 50% of individuals contacted—were cited as potential flaws in the study by the authors.

Regardless, the authors stated that smoking cessation treatment should be a standard component of cancer treatment.

Reference

Cinciripini PM, Kypriotakis G, Blalock JA, et al. Survival outcomes of an early intervention smoking cessation treatment after a cancer diagnosis. JAMA Oncol. Published online October 31, 2024. doi:10.1001/jamaoncol.2024.4890