Assessment of Duration of Smoking Cessation Prior to Surgical Treatment of Non-small Cell Lung Cancer

Abstract

Objective: To define the relationship between the duration of smoking cessation and postoperative complications for patients with lung cancer undergoing surgical treatment. Background: Smoking increases the risk of postoperative morbidity and mortality in patients with lung cancer undergoing surgical treatment. Although smoking cessation before surgery can mitigate these risks, the ideal duration of preoperative smoking cessation remains unclear. Methods: Using a uniquely compiled Veterans Health Administration dataset, we performed a retrospective cohort study of patients with clinical stage I non-small cell lung cancer undergoing surgical treatment between 2006 and 2016. We characterized the relationship between duration of preoperative smoking cessation and risk of postoperative complications or mortality within 30-days using multivariable restricted cubic spline functions. Results:The study included a total of 9509 patients, of whom 6168 (64.9%) were smoking at the time of lung cancer diagnosis. Among them, only 662 (10.7%) patients stopped smoking prior to surgery. Longer duration between smoking cessation and surgery was associated with lower odds of major complication or mortality (adjusted odds ratio [aOR] for every additional week, 0.919; 95% confidence interval [CI], 0.850-0.993; P = 0.03). Compared to nonsmokers, patients who quit at least 3 weeks before surgery had similar odds of death or major complication (aOR, 1.005; 95% CI, 0.702-1.437; P = 0.98) whereas those who quit within 3 weeks of surgery had significantly higher odds of death or major complication (aOR, 1.698; 95% CI, 1.203-2.396; P = 0.003). Conclusion: Smoking cessation at least 3 weeks prior to the surgical treatment of lung cancer is associated with reduced morbidity and mortality. Providers should aggressively encourage smoking cessation in the preoperative period, since it can disproportionately impact outcomes in early-stage lung cancer.

Underutilization of Guideline-Concordant Smoking Cessation Treatments in Surgical Patients: Lessons From a Learning Health System

“…Despite the relatively high smoking prevalence among surgical patients (14.7%), guideline-concordant treatment rates were very low, with only 12.7% receiving pharmacotherapy and 31.7% receiving any treatment 3 . This is concerning given the well-established relationship between smoking and multiple adverse outcomes following surgery 2,9 . Further, while our study assessed any treatment, some guidelines suggest that both behavioral support and pharmacotherapy should be the standard of care 4 ; if so, then the guideline-concordant treatment rates in our study are much lower (<5%).…”

Association between body mass index and incidence of breast cancer in premenopausal women: A Japanese nationwide database study

“…Second, we performed RCS functions to investigate nonlinear associations between BMI and the incidence of breast cancer. As the RCS function enables a continuous variable to be analyzed without categorization, information and statistical power are not lost in RCS analysis, unlike general regression analysis, which requires categorization of continuous variables such as BMI [13][14][15][16][17]. In this study, we used 4 points (18.5, 22.0, 25.0, and 30.0 kg/m 2 ) as the knots in the cubic splines to allow for nonlinear dose-response effects of continuous BMI measurement, similar to that in previous studies [29,30].…”

Confronting the Negative Impact of Cigarette Smoking on Cancer Surgery

“…For wound healing, the risk was lower in smokers who quit more than 3–4 weeks before surgery than in current smokers. In a recent study by Heiden et al, in patients with early-stage NSCLC, those who were able to stop smoking at least 3 weeks before surgery had reduced postoperative mortality and complications [ 21 ]. For each extra week of abstinence before surgery, the authors found an 8.1% reduction rate in the odds of major complication or mortality cessation (OR for every additional week, 0.919; 95% CI 0.850–0.993, p = 0.03) [ 21 ].…”