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Postdiagnosis Smoking Cessation and Lung Cancer Survival
Quick Takes
- This prospective study reports that quitting smoking after diagnosis of lung cancer improved overall and progression-free survival and decreased the risks for overall mortality and lung cancer–specific mortality in these patients.
- Furthermore, the protective effects of quitting smoking were noted across all subgroups, including mild to moderate and heavy smokers, patients with earlier and later tumor stages, and irrespective of chemotherapy or radiation therapy.
- These data make a robust case for making tobacco cessation treatment a standard component of routine health care for all patients with cancer and especially lung cancer, where 50% of active smokers are thought to continue smoking after diagnosis.
Study Questions:
Does smoking cessation affect overall and progression-free survival and the risk for all-cause and lung cancer–specific mortality after a diagnosis of lung cancer?
Methods:
The investigators conducted a prospective study of patients with non–small cell lung cancer (NSCLC) who were recruited between 2007 and 2016 and followed annually through 2020 at the N.N. Blokhin National Medical Research Center of Oncology and City Clinical Oncological Hospital No. 1, Moscow, Russia. A total of 517 current smokers who were diagnosed with early-stage (IA-IIIA) NSCLC were in the study cohort. Probabilities of overall survival, progression-free survival, and lung cancer–specific mortality and hazard ratios (HRs) for all-cause and cancer-specific mortality were calculated.
Results:
During an average of 7 years of follow-up, 327 (63.2%) deaths, 273 (52.8%) cancer-specific deaths, and 172 (33.7%) cases of tumor progression (local recurrence or metastasis) were recorded. The adjusted median overall survival time was 21.6 months higher among patients who had quit smoking than those who continued smoking (6.6 vs. 4.8 years, respectively; p = 0.001). Higher 5-year overall survival (60.6% vs. 48.6%; p = 0.001) and progression-free survival (54.4% vs. 43.8%; p = 0.004) were observed among patients who quit than those who continued smoking. After adjustments, smoking cessation remained associated with decreased risk for all-cause mortality (hazard ratio [HR], 0.67; 95% confidence interval [CI], 0.53-0.85), cancer-specific mortality (HR, 0.75; 95% CI, 0.58-0.98), and disease progression (HR, 0.70; 95% CI, 0.56-0.89). Similar effects were observed among mild to moderate and heavy smokers and patients with earlier and later cancer stages.
Conclusions:
The authors concluded that smoking cessation after diagnosis materially improved overall and progression-free survival among current smokers with early-stage lung cancer.
Perspective:
This prospective study reports that quitting smoking after diagnosis of lung cancer improved overall and progression-free survival and decreased the risks for overall mortality and lung cancer–specific mortality in these patients. Furthermore, the protective effects of quitting smoking were noted across all subgroups, including mild to moderate and heavy smokers, patients with earlier and later tumor stages, and patients who received and those who did not receive chemotherapy or radiation therapy. These data make a robust case for making tobacco cessation treatment a standard component of routine health care for all patients with cancer and especially lung cancer, where 50% of active smokers are thought to continue smoking after diagnosis.
Clinical Topics: Cardio-Oncology, Prevention, Smoking
Keywords: Carcinoma, Non-Small-Cell Lung, Cardiotoxicity, Disease-Free Survival, Lung Neoplasms, Medical Oncology, Neoplastic Processes, Primary Prevention, Radiation, Risk, Smoking, Smoking Cessation, Tobacco Use Cessation
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