Factors associated with smoking abstinence among smokers and recent-quitters with lung and head and neck cancer

Abstract

Introduction Smoking cessation among cancer patients is critical for improving outcomes. Understanding factors associated with smoking abstinence after the diagnosis of cancer can provide direction to develop and test interventions to enhance cessation rates. The purpose of this study was to identify determinants of smoking outcomes among cancer patients. Methods Standardized questionnaires were used to collect data from 163 smokers or recent-quitters (quit ≤ 6 mo) at study entry of which 132 and 121 had data collected at 3 and 6-months. Biochemical verification was conducted with urinary cotinine and carbon monoxide. Descriptive statistics, Cronbach alpha coefficients, Pearson correlations, Fisher’s exact test, and multivariable logistic regression were used for analyses. Results Seven-day-point-prevalence-abstinence (PPA) rates were 90/132 (68%) at 3-months; 46/71 (65%) among lung and 44/61 (72%) among head and neck cancer patients, whereas 7-day-PPA rates were 74/121 (61%) at 6-months; 31/58 (53%) among lung and 43/63 (68%) among head and neck cancer patients. Continuous abstinence rates were 63/89 (71%) at 3-months; 32/45 (71%) among lung and 31/44 (70%) among head and neck cancer patients, whereas continuous abstinence rates were 46/89 (52%) at 6-months; 18/45 (40%) among lung and 28/44 (64%) among head and neck cancer patients. Lower cancer-related, psychological and nicotine withdrawal symptoms were associated with increased 7-D-PPA abstinence rates at 3 and 6 months in univariate models. In multivariable models, however, decreased craving was significantly related with 7-day-PPA at 3-months and decreased craving and increased self-efficacy were associated with 7-D-PPA at 6-months. Decreased craving was the only factor associated with continuous abstinence at 6-months. Conclusions Smoking outcomes among lung and head and neck cancer patients appear to have remained the same over the last two decades despite the availability of an increased number of pharmacotherapy options to treat tobacco dependence. Decreased craving and increased self-efficacy were the most consistent factors associated with improved smoking outcomes but symptom control may also play a role in optimal management. Use of combined, and/or higher doses of pharmacotherapy along with behavioral interventions that increase self-efficacy and manage symptoms may promote enhanced cessation rates.

Systematic Review of Tobacco Use after Lung or Head/Neck Cancer Diagnosis: Results and Recommendations for Future Research

“…Most studies were conducted in the United States (60.3%, n =79; e.g., (74, 99, 101, 114, 134)), with the next most common study locations being in Canada (7.6%, n =10; (30, 38, 39, 44, 65, 84, 97, 104, 147, 148)) and France (4.6%, n =6; (32, 37, 100, 108, 113, 146)). Most papers described cross-sectional studies (75.6%, n =99), but some described longitudinal studies (24.4%, n =32) (10, 35, 38, 42, 45, 46, 52-54, 56, 62, 65, 69, 73, 75, 76, 80, 84, 89, 90, 98, 100, 103, 104, 118, 121, 123, 126, 129, 135, 149, 152). For the longitudinal studies, the number of tobacco use assessments ranged from two (e.g., (42, 100, 123)) to ≥ 5 (e.g., (69, 103, 121)); the number of assessments was sometimes unclear (e.g., (35, 118, 152)).…”

Addressing Tobacco Use in Patients With Cancer: A Survey of American Society of Clinical Oncology Members

“…Efforts are ongoing to improve tobacco cessation efficacy in patients with cancer, including consideration of psychological or behavioral comorbidity, social environment, and diseaserelated variables. [24][25][26][27][28][29][30] These efforts may ultimately result in improved tobacco cessation outcomes, but they will not be realized if patients are not offered tobacco cessation support. Improved education and training may be needed, but improving access to dedicated cessation support is also necessary to improve overall tobacco cessation outcomes.…”

Accuracy of self-reported tobacco use in newly diagnosed cancer patients

“…Warren et al demonstrate that 29.4 % of head and neck cancer patients require biochemical confirmation for accurate assessment of tobacco use [22]. Cooley et al also demonstrate that 18.9 % of smokers misrepresent true tobacco use on follow-up evaluation [41]. The authors are unaware of any studies that have evaluated the accuracy of self-reported tobacco use in breast cancer patients, but our results demonstrate a consistent finding that misrepresentation occurs in patients with tobacco-related or non-tobacco-related cancers.…”