Effects of a Cancer Diagnosis on Quitting Smoking and Remaining Abstinent
Most patients with a smoking-related cancer stop smoking or make
serious efforts to quit at the time of diagnosis.[1-4] One study reported that
approximately half of a group of patients with oral and pharyngeal cancers quit
at or after diagnosis;[5] heavier smokers were substantially more likely to
quit. Another study found a 12-month abstinence rate of 64.6% among head and
neck cancer patients.[2] A quit rate of 52% was reported in 115 head and neck
cancer patients just before diagnosis, suggesting that an increase in smoking
and cancer-related symptoms drives a substantial part of the decision to quit
smoking, in addition to knowledge of the diagnosis.[6] Even patients who
continue to smoke may remain motivated to quit. In a group of stage I small
cell lung cancer patients, almost 90% had made one or more attempts to quit smoking,
though 60% of survivors still smoked at 2 years.[1] In another study, 84% of
the sample had made at least one attempt to quit since surgery, and 69% had made
multiple attempts.[3] These studies found that while 80% of larynx and pharynx
cancer patients remained abstinent after surgery, only 20% of those with oral
cavity cancers did so. Patients who had undergone less intensive treatment (in
particular, radiation therapy) were more likely to remain smokers; if they
quit, they were 2.46 times more likely to resume tobacco use, even after controlling for
severity. Higher relapse rates have also been associated with less radical
treatment of head and neck cancers.[7] Such a relationship between continued
smoking and less severe disease has also been found in cardiac patients.[8]
Another group in which secondary prevention may be particularly important is
survivors of childhood cancer. In pediatric cancer survivors, initiation of
smoking may be as high as in a group of healthy peers. An excellent review of
the findings and recommendations in addressing smoking in this population has
been published.[9]
References
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Gritz ER, Nisenbaum R, Elashoff RE, et al.: Smoking behavior following diagnosis in patients with stage I non-small cell lung cancer. Cancer Causes Control 2 (2): 105-12, 1991.
[PUBMED Abstract]
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Gritz ER, Carr CR, Rapkin D, et al.: Predictors of long-term smoking cessation in head and neck cancer patients. Cancer Epidemiol Biomarkers Prev 2 (3): 261-70, 1993 May-Jun.
[PUBMED Abstract]
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Ostroff JS, Jacobsen PB, Moadel AB, et al.: Prevalence and predictors of continued tobacco use after treatment of patients with head and neck cancer. Cancer 75 (2): 569-76, 1995.
[PUBMED Abstract]
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Vander Ark W, DiNardo LJ, Oliver DS: Factors affecting smoking cessation in patients with head and neck cancer. Laryngoscope 107 (7): 888-92, 1997.
[PUBMED Abstract]
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Day GL, Blot WJ, Shore RE, et al.: Second cancers following oral and pharyngeal cancers: role of tobacco and alcohol. J Natl Cancer Inst 86 (2): 131-7, 1994.
[PUBMED Abstract]
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Browman GP, Wong G, Hodson I, et al.: Influence of cigarette smoking on the efficacy of radiation therapy in head and neck cancer. N Engl J Med 328 (3): 159-63, 1993.
[PUBMED Abstract]
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Gritz ER, Schacherer C, Koehly L, et al.: Smoking withdrawal and relapse in head and neck cancer patients. Head Neck 21 (5): 420-7, 1999.
[PUBMED Abstract]
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Ockene J, Kristeller JL, Goldberg R, et al.: Smoking cessation and severity of disease: the Coronary Artery Smoking Intervention Study. Health Psychol 11 (2): 119-26, 1992.
[PUBMED Abstract]
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Tyc VL, Hudson MM, Hinds P, et al.: Tobacco use among pediatric cancer patients: recommendations for developing clinical smoking interventions. J Clin Oncol 15 (6): 2194-204, 1997.
[PUBMED Abstract]
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