Many Patients Continue to Smoke After Cancer Diagnosis

Elyse R. Park, PhD, MPH

Being newly diagnosed with lung or colorectal cancer is often not sufficient to motivate cigarette smokers to quit, researchers have found.

Results from a population-based study showed that 38.7% of lung cancer patients and 13.7% of colorectal cancer patients were smoking at the time of diagnosis. Five months later, 14.2% of lung cancer and 9.0% of colorectal cancer patients continued to smoke.

Patients most likely to relapse had the least social support, lower socioeconomic status, and higher rates of depression.

“These findings can help clinicians identify patients who are at risk for smoking and guide tobacco counseling treatment development for cancer patients,” Elyse R. Park, PhD, MPH, with Massachusetts General Hospital and Harvard Medical School in Boston, and coworkers elsewhere wrote in their article.

For their study, the investigators examined smoking rates at diagnosis and 5 months after diagnosis in 2456 lung and 3063 colorectal cancer patients.

Smoking cessation after a cancer diagnosis is especially important because it has been shown to improve the response to treatment, reduce the likelihood of secondary tumors, and, ultimately, increase survival, the authors observed. Given that “the stakes differ” between patients with early disease and patients with advanced disease, clinicians may manage the two groups of patients differently.

The study population was drawn from the prospective, multiregional Cancer Care Outcomes Research and Surveillance cohort. Participants were 21 years of age or older and were identified within weeks of their cancer diagnosis and surveyed by telephone roughly 5 months after their diagnosis. All of them had completed a comprehensive baseline survey.

The authors suggested that the higher quit rates among lung cancer patients may be related to widespread public awareness about the link between smoking and lung cancer. Lung cancer patients “may associate their diagnosis with smoking” and quit smoking as a result, while colorectal cancer patients may not consider their diagnosis as smoking-related, and are thus less likely to quit.

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These findings can help clinicians identify patients who are at risk for smoking and guide tobacco counseling treatment development for cancer patients. ”

—Elyse R. Park, PhD, MPH

The authors said that their results are bolstered by the large, geographically diverse cohort of cancer patients. They were quick to emphasize, however, that smoking status was based on self-report, and is thus likely to be an underestimate of the smoking prevalence. Prior research by the same group of investigators has shown that lung cancer patients may underreport their smoking rate.

Finally, the authors commented that they believe that theirs is the first large-scale study to look at the smoking behaviors of patients with lung and colorectal cancer at the time of diagnosis and during follow-up. Prior research in this area has involved single-site, cross-sectional studies with small samples or studies done “within the context of a clinical trial.”

Park ER, Japuntich SJ, Rigotti NA, et al. A snapshot of smokers after lung and colorectal cancer diagnosis [published online ahead of print January 23, 2012]. Cancer. doi:10.1002/cncr.26545.