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Grand Rounds

New Lung Cancer Diagnosis: Does Quitting Smoking Help Improve Outcomes?

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BACKGROUND AND PURPOSE:

  • Evidence is limited if smoking cessation following a diagnosis of non-small cell lung cancer (NSCLC) is beneficial
  • Sheikh et al. (Ann. Intern. Med., 2021) examined whether quitting smoking after diagnosis of lung cancer affects the risk for disease progression and mortality

METHODS:

  • Prospective study
  • Participants
    • Early-stage (IA-IIIA) NSCLC
    • Current smokers at time of diagnosis
  • Exposure
    • Cessation of smoking
  • Study design
    • Recruitment occurred between 2007 and 2016
    • Follow-up annually through 2020
  • Primary outcomes
    • Overall survival
    • Progression-free survival
    • Lung cancer-specific mortality

RESULTS:

  • 517 current smokers
    • Average 7 years follow-up
  • Mortality and cancer progression
    • Death: 63.2%
    • Cancer-specific deaths: 52.8%
    • Tumor progression (local recurrence or metastasis): 33.7%
  • Adjusted median overall survival time was 21.6 months higher among patients who had quit smoking than those who continued smoking (P=0.001)
    • Quit smoking: 6.6 years
    • Continued smoking: 4.8 years
  • Patients who quit smoking also had a higher 5-year
    • Overall survival (P=0.001)
      • Quit smoking: 60.6%
      • Continued smoking: 48.6%
    • Progression-free survival (P=0.004)
      • Quit smoking: 54.4%
      • Continued smoking: 43.8%
  • After adjustments, smoking cessation remained associated with decreased risk for
    • All-cause mortality
      • Hazard ratio (HR) 0.67 (95% CI, 0.53 to 0.85)
    • Cancer-specific mortality
      • HR 0.75 (95% CI, 0.58 to 0.98)
    • Disease progression
      • HR 0.70 (95% CI, 0.56 to 0.89)
  • Similar effects were observed among
    • Mild to moderate and heavy smokers
    • Patients with earlier and later cancer stages

CONCLUSION:

  • Those who quit had a lower risk of all-cause and cancer-specific mortality, as well as disease progression, at 5 years
  • An editorial notes that this study fills important knowledge gaps including large sample size and longer follow-up and therefore

The results of this new study strengthen the case for making tobacco cessation treatment a standard component of routine health care for all patients with cancer

It is not too late for cigarette smokers with cancer and cancer survivors to benefit from becoming smoke-free

Learn More – Primary Sources:

Postdiagnosis Smoking Cessation and Reduced Risk for Lung Cancer Progression and Mortality: A Prospective Cohort Study

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Related ObG Topics:

Lung Cancer Incidence Now Higher in Younger Women – Does Smoking Fully Account for This Change?
Does Prenatal Smoking Increase the Risk of GDM?
Time for a Second Look: Are the “New Tobacco” Products Safer than in Years Past?

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