Impact of a Bladder Cancer Diagnosis on Smoking Behavior

Bassett, John Spencer; Gore, John L.; Amanda, C.; Kwan, Lorna; McCarthy, William J.; Chamie, Karim; Saigal, Christopher S.

doi:10.1200/jco.2011.36.6518

Cited by 92 publications

(68 citation statements)

References 60 publications

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“…7,21,22 O género feminino era na sua quase totalidade não fumador, refletindo os padrões de consumo no passado em que as mulheres não eram habitualmente fumadoras. De salientar que o tabagismo ao diagnóstico parece condicionar uma maior precocidade e extensão do CB, corroborando estudos epidemiológicos que apontam para uma associação entre o tabagismo e o tumor músculo-invasivo.…”

Section: Discussionunclassified

“…Para justificar esta diferença poderão ter contribuído as recomendações e os alertas dos urologistas, habitualmente a principal fonte de informação dos fumadores. 7,25 Tal como em estudos prévios, os doentes estabeleceram uma relação mais direta do tabaco com outras patologias, nomeadamente com o cancro do pulmão e a doença cardiovascular, do que com o seu próprio cancro. 7,25,27 Tal decorre, possivelmente, da baixa divulgação da relação do tabaco com o CB na população em geral.…”

Section: Discussionunclassified

“…5 O CB é um dos principais carcinomas associados ao tabaco; estudos epidemiológicos evidenciam uma relação consistente entre o tabagismo e o risco de CB, responsável por mais de 50% dos casos nos países desenvolvidos. 1,[6][7][8][9] Os ex-fumadores e os fumadores apresentam um risco duas e quatro vezes superior, respetivamente, com maiores incrementos deste consoante a intensidade e a duração do consumo. 7,9 O consumo de tabaco no contexto oncológico não é apenas relevante pelo seu potencial carcinogénico.…”

Section: Introductionunclassified

“…1,[6][7][8][9] Os ex-fumadores e os fumadores apresentam um risco duas e quatro vezes superior, respetivamente, com maiores incrementos deste consoante a intensidade e a duração do consumo. 7,9 O consumo de tabaco no contexto oncológico não é apenas relevante pelo seu potencial carcinogénico. A evidência científica atual aponta para um pior prognóstico, maior risco de recorrência e de progressão nos doentes Revista Científica da Ordem dos Médicos www.actamedicaportuguesa.com Mota P, et al Cancro da bexiga e cessação tabágica, Acta Med Port 2018 Feb;31 (2): [101][102][103][104][105][106][107][108] que mantém o consumo, à semelhança do que se verifica no cancro do pulmão e cabeça/pescoço.…”

Section: Introductionunclassified

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Smoking Cessation after Bladder Cancer Diagnosis

Mota

Sousa

Botelho³

et al. 2018

Acta Med Port

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RESUMOIntrodução: O tabagismo é um importante fator de risco para o desenvolvimento, recorrência e progressão do cancro da bexiga. Este estudo pretendia analisar os hábitos tabágicos após o diagnóstico em doentes com cancro da bexiga. Adicionalmente, foi avaliado o reconhecimento do tabagismo como fator de risco e a atuação médica na promoção da cessação tabágica. Smoking was acknowledged as a risk factor by 74.4% of the sample, with only 51.3% of ever smokers and 24.4% of non-smokers recognizing smoking as the leading risk factor (p = 0.008). The presence of other household smokers were significantly higher in patients who continued smoking (40%) than in ex-smokers after diagnosis (4.2%) (p = 0.005). The majority of smokers at diagnosis (83.1%) were advised to quit by their urologist, but only one smoker (1.7%) was offered any specific intervention to aid in cessation. Discussion: Smoking is not recognized as the leading risk factor for bladder cancer. This limited awareness, associated with the known difficulties in quitting smoking and the observed lack of smoking cessation interventions, may account for the high current smoking prevalence, albeit in line with other studies. Conclusion: This study highlights the need for efficient smoking cessation programs directed to bladder cancer patients. Keywords: Smoking; Smoking Cessation; Urinary Bladder Neoplasms INTRODUÇÃOO cancro da bexiga (CB) é uma das neoplasias malignas mais frequente do trato urinário, com uma incidência 3 -4 vezes mais elevada nos homens do que nas mulheres. [1][2][3] É o sétimo cancro mais frequente no mundo, com aproximadamente 336 000 novos casos estimados/ano, em particular nos países desenvolvidos.2,4 Em Portugal, segundo dados do relatório de doenças oncológicas, o CB tem a oitava maior taxa de incidência, tendo sido responsável pela morte de 940 doentes no ano de 2014, valor que manifesta uma tendência de crescimento face aos anos anteriores. 5O CB é um dos principais carcinomas associados ao tabaco; estudos epidemiológicos evidenciam uma relação consistente entre o tabagismo e o risco de CB, responsável por mais de 50% dos casos nos países desenvolvidos. 1,[6][7][8][9] Os ex-fumadores e os fumadores apresentam um risco duas e quatro vezes superior, respetivamente, com maiores incrementos deste consoante a intensidade e a duração do consumo. 7,9 O consumo de tabaco no contexto oncológico não é apenas relevante pelo seu potencial carcinogénico. A evidência científica atual aponta para um pior prognóstico, maior risco de recorrência e de progressão nos doentes

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Section: Discussionunclassified

Section: Introductionunclassified

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Smoking Cessation after Bladder Cancer Diagnosis

Mota

Sousa

Botelho³

et al. 2018

Acta Med Port

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“…Similarly, urologists may help patients engage in behaviour change through their influential role as healthcare professionals. The patient's visit to the urologist's office may present an opportunity for a "teachable moment" 27 that can serve to motivate healthy behaviour change that could include something as specific as smoking cessation to something as broad as seeking help from a mental health professional. The relationship between the urologist and the patient through regular visits may also serve to help normalize mental health issues and combat stigma.…”

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Men’s mental health: Connection to urologic health

Matthew¹

2014

CUAJ

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Historically,thespecialtyofurologyhasfocusedonsingle-systemdiseases.Inrecentyears,however,therehasbeenincreasingrecognition oftheinterconnectivitybetweenthevarioussystems,suchascardiovasculardisease,metabolicsyndrome,erectiledysfunctionandprostatecancer.Thisconstellationofdisease/syndromeanddysfunction mayplaceurologistsatthecentreofmen'soverallhealthconcerns. Asurologistsconsideringtakingonaleadershiproleinmen'shealth, theyshouldalsoconsidertheirpotentialinhelpingmensufferingfrom thesignificantburdenofamentalhealthdisorder.Urologistsmay haveauniqueopportunitytoidentifymentalhealthissuesintheir malepatients,influencehealthybehaviourchange,andsuccessfully refermen,whomightotherwisenotseekhelp,toappropriatemedical/ psychologicalcare. Men's mental healthAn estimated 3.4 million Canadian men are currently living with mental illness. 1 This number is likely an underestimation given that a large proportion of men experiencing symptoms of mental illness do not seek the help of a professional. [2][3][4] This gap in care has grave outcomes as Canadian men are at least 3 times more likely to die by suicide than Canadian women 5 -a figure that increases to 7 times among elderly men.6 Specific to urologic diseases/disorders, such as urologic cancers, lower urinary tract symptoms and erectile dysfunction (ED), men experience elevated levels of anxiety and depression. 7,8 For example, the risk of suicide in men with prostate cancer is over 4 times that of a similarly aged man without prostate cancer. 9 Patients with lower urinary tract symptoms (LUTS) experience elevated levels of psychosocial distress, with depression rates of 6% to 21% and anxiety rates of 3% to 10%. 10 An estimated 10% of men with ED suffer from depression, and 2.5% to 37% suffer from anxiety.11 Given the relationship between mental health and overall health-related quality of life, it is clear that increasing numbers of men in general, and men with urologic disease, are suffering a significant burden and that most of this burden remains untreated by healthcare professionals. Barriers to accessing mental health services include stigma, differences in expression of emotional problems (compared to women), maladaptive coping, and lack of awareness of support services in the community. StigmaResults suggest that the most prominent barrier to seeking and accessing mental health services is stigma.12,13 Seeking mental healthcare services remains a secretive and shameful activity for many individuals.14 The anticipation of social consequences and discrimination is often enough to force men into silence. While mental health stigma is not exclusively a male issue, men face a disproportionate amount of stigma, which is often perpetuated by masculine ideals of strength and self-reliance. A firm belief in stoicism and the need to control emotions may lead some men with anxiety and depression to perceive emotional distress as shameful, and hide their symptoms from others. 13,15 Differences in expression of emotional problemsAnother factor that may complicate se...

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Smoking Behaviors and Prognosis in Patients With Non–Muscle-Invasive Bladder Cancer in the Be-Well Study

et al. 2022

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ImportanceTobacco smoking is an established risk factor associated with bladder cancer, yet its impact on bladder cancer prognosis is unclear.ObjectiveTo examine associations of use of tobacco (cigarettes, pipes, and cigars), e-cigarettes, and marijuana with risk of recurrence and progression of non–muscle-invasive bladder cancer (NMIBC) and to explore use of smoking cessation interventions.Design, Setting, and ParticipantsThe Be-Well Study is a prospective cohort study of patients with NMIBC diagnosed from 2015 to 2019 and followed-up for 26.4 months in the Kaiser Permanente Northern and Southern California integrated health care system. Eligibility criteria were age at least 21 years, first NMIBC diagnosis (stages Ta, Tis, or T1), alive, and not in hospice care. Exclusion criteria were previous diagnosis of bladder cancer or other cancer diagnoses within 1 year prior to or concurrent with NMIBC diagnosis. Data were analyzed from April 1 to October 4, 2022.ExposuresUse of cigarettes, pipes, cigars, e-cigarettes, and marijuana was reported in the baseline interview. Use of smoking cessation interventions (counseling and medications) was derived from electronic health records.Main Outcomes and MeasuresHazard ratios (HRs) and 95% CIs of recurrence and progression of bladder cancer were estimated by multivariable Cox proportional hazards regression.ResultsA total of 1472 patients (mean [SD] age at diagnosis, 70.2 [10.8%] years; 1129 [76.7%] male patients) with NMIBC were enrolled at a mean (SD) of 2.3 (1.3) months after diagnosis, including 874 patients (59.4%) who were former smokers and 111 patients (7.5%) who were current cigarette smokers; 67 patients (13.7%) smoked pipes and/or cigars only, 65 patients (4.4%) used e-cigarettes, 363 patients (24.7%) used marijuana. Longer cigarette smoking duration and more pack-years were associated with higher risk of recurrence in a dose-dependent manner, with the highest risks for patients who had smoked for 40 or more years (HR, 2.36; 95% CI, 1.43-3.91) or 40 or more pack-years (HR, 1.97; 95% CI, 1.32-2.95). There was no association of having ever smoked, being a former or current cigarette smoker, and years since quit smoking with recurrence risk. No associations with pipes, cigars, e-cigarettes, or marijuana were found. Of 102 patients offered a smoking cessation intervention, 57 (53.8%) received an interventions after diagnosis, with female patients more likely than male patients to engage in such interventions (23 of 30 female patients [76.7%] vs 34 of 76 male patients [44.7%]; P = .003).Conclusions and RelevanceThese findings suggest that longer duration and more pack-years of cigarette smoking were associated with higher risk of NMIBC recurrence. Cigarette smoking remains a critical exposure before and after diagnosis in survivors of NMIBC.

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Impact of a Bladder Cancer Diagnosis on Smoking Behavior

Abstract: The diagnosis of bladder cancer is an opportunity for smoking cessation. Urologists can play an integral role in affecting the patterns of tobacco use of those newly diagnosed.

Cited by 92 publications

References 60 publications

Smoking Cessation after Bladder Cancer Diagnosis

Smoking Cessation after Bladder Cancer Diagnosis

Men’s mental health: Connection to urologic health

Smoking Behaviors and Prognosis in Patients With Non–Muscle-Invasive Bladder Cancer in the Be-Well Study

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