Quitting smoking within 6 months of receiving a cancer diagnosis could add an average of 2 years to a patient’s life, according to a recent study published by Cinciripini et al in JAMA Oncology. The findings demonstrated a broad survival benefit of using evidence-based smoking cessation to help patients quit smoking just after a cancer diagnosis.
Background
Research has shown that smoking after a cancer diagnosis can decrease the effectiveness of cancer therapy and increase the likelihood of certain side effects or complications. Some studies have explored the survival benefit of smoking cessation in specific subgroups of patients with cancer, including lung cancer.
The study investigators emphasized that all cancer centers have an obligation to offer evidence-based smoking cessation to all patients. Often, cancer centers ask about a patient’s smoking status at diagnosis but don’t follow up throughout treatment to update the electronic health record. For instance, although up to 90% of patients are asked about smoking, only about 40% of centers provide smoking cessation assistance. The investigators noted that smoking cessation may be one of the most effective methods of improving cancer survival in the United States and internationally.
“This is a survival benefit we can achieve now. It isn't something we need to wait 10 years for trial results. If we miss patients now, they’ve missed the benefit they would gain from it,” stressed senior study author Graham Warren, MD, PhD, Vice Chair for Research in the Department of Radiation Medicine and the Mary Gilbreth Endowed Chair of Oncology at the Medical University of South Carolina Hollings Cancer Center. “[T]here’s an urgent responsibility to make this work. It is important to make sure we give everyone evidence-based care specifically to help them improve survival. This isn’t … optional,” he added.
Overview of the Tobacco Research and Treatment Program
The Tobacco Research and Treatment Program—established in 2014—offers evidence-based interventions with the goal of helping patients achieve smoking cessation. Patients involved in the program are assigned to a trained smoking cessation counselor, who assists them with pharmacotherapy and behavioral counseling to manage the physical need for nicotine and the mental load.
“Thanks to the work of Dr. Warren and others, since 2021, Hollings Cancer Center has implemented an opt-out tobacco treatment program—where every patient seen in a Hollings outpatient oncology clinic … is routinely screened to assess smoking status. [The program] automatically refers those who currently smoke to our telehealth-pharmacy assessed tobacco treatment program, where patients can receive behavioral support and stop smoking medications to assist them in their journey to get off cigarettes,” detailed K. Michael Cummings, PhD, of the Medical University of South Carolina Hollings Cancer Center.
The investigators have worked with cancer centers across the United States and Canada to set up smoking cessation programs. Through collaboration with the American College of Surgeons Commission on Cancer on the Just ASK and Beyond ASK Smoking Cessation initiatives, they have addressed smoking across more than 700 cancer centers in the United States.
Study Methods and Results
In the recent study, investigators used data from the Tobacco Research and Treatment Program to examine long-term survival across more than 4,500 patients with different types of cancers. The data from the program listed a patient’s current smoking status and use of a structured evidence-based tobacco program.
The investigators were able to subdivide the patients into three groups: those who stopped smoking within 6 months of a cancer diagnosis, those who stopped smoking between 6 months and 5 years after a cancer diagnosis, and those who stopped more than 5 years after a cancer diagnosis.
Quitting smoking after a cancer diagnosis improved survival across cancer as a whole, with the largest benefit among patients who quit within 6 months of a cancer diagnosis. Quitting smoking, even among patients with nontobacco-related cancers, may be one of the greatest contributors to improving overall survival.
Conclusions
The investigators revealed that the data likely represented the new gold standard—cementing the survival benefit for supporting smoking cessation programs at cancer centers.
“This isn’t like developing a new targeted agent. You don’t need new protocols or to buy new drugs,” Dr. Warren indicated. “If you understand the importance of this, you can start doing it this afternoon. The evidence is there. The treatments are there. It’s just a matter of getting clinicians to put it into practice and patients receiving evidence-based treatment,” he continued.
The investigators hope their findings will provide indisputable evidence of the significance of smoking cessation programs at cancer centers. “We now have a good estimate of how smoking cessation improves survival across cancer. This really shows us that if we provide an intervention, we improve survival,” Dr. Warren underscored.
The investigators suggested that the clear benefit of smoking cessation after a cancer diagnosis across all types of cancers places particular emphasis on the need to improve clinical treatment approaches for all patients.
“Most [patients with] prostate cancer don’t die of prostate cancer. It is often smoking-related conditions that contribute to patient deaths,” explained David Marshall, MD, Chair of Radiation Medicine and Medical Director of the Clinical Trials Office at the Medical University of South Carolina Hollings Cancer Center.
“This research shows in a very clear and straightforward manner what clinicians have often observed—their patients who continue to smoke fare worse than those who are able to stop smoking,” emphasized Raymond N. DuBois, MD, PhD, Director of the Medical University of South Carolina Hollings Cancer Center. “This is a significant finding for [patients] dealing with any type of cancer diagnosis, not just lung cancer, and for their [physicians]. Also, we have known that continued smoking after a cancer diagnosis weakens the immune system, making it harder for the body to fight off cancer cells,” he underlined.
The investigators highlighted that their results demonstrated the clinical necessity of offering smoking cessation programs. “Patients and family members need to be informed of the benefits of stopping smoking. Additionally, patients who smoke need to be given real help to stop smoking, recognizing that getting off cigarettes is not easy to do. Cigarette addiction is a chronic relapsing disorder, so one-off interventions for patients are inadequate,” concluded Dr. Cummings.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
