Smoking Cessation Following Lung Cancer Diagnosis Reduces Cancer Mortality Risk

New data support smoking cessation for patients with lung cancer following their diagnosis.

Patients with lung cancer who quit smoking at or around their cancer diagnosis may be able to improve their rate of survival, according to a meta-analysis published in the Journal of Thoracic Oncology. Furthermore, the data suggest that smoking cessation education and support is vital even after diagnosis.1

Specifically, the findings revealed that patients who successfully stopped smoking improved their overall survival (OS). These findings were consistent across different subtypes, including patients with non–small cell lung cancer (summary relative risk [SRR], 0.77; 95% CI, 0.66-0.90, n studies = 8), small cell lung cancer (SRR, 0.75; 95% CI, 0.57-0.99; n studies = 4), or lung cancer of both or unspecified histological type (SRR, 0.81; 95% CI, 0.68-0.96; n studies = 6).

In the meta-analysis, smoking cessation was defined as ceasing to smoke either at moment of diagnosis, during treatment, or in the 12 months leading up to the diagnosis.

“Lung cancer remains a disease with poor prognosis despite recent advances in treatments. Here, we aimed at summarizing the current scientific evidence on whether quitting smoking at or around diagnosis has a beneficial effect on the survival of [these] patients,” lead investigator Saverio Caini, MD, of the Institute for Cancer Research, Prevention and Clinical Network in Florence, Italy, and colleagues, said.

“Our study suggests that treating physicians should educate patients with lung cancer about the benefits of quitting smoking even after diagnosis and provide them with the necessary smoking cessation support,” Caini added in a news release.2

Researchers analyzed articles published between 1980 and October 31, 2021 via MEDLINE and EMBASE and successfully identified 21 evaluable articles, which quantified the impact of smoking cessation and patient survival in lunger cancer. Among these articles, over 10,000 patient cases were examined.

In the study, the authors note that there are different biological mechanisms related to tobacco that may explain these findings and provide a basis for further research. For example, tobacco use is associated with tumor growth, progression, and dissemination. It is also linked to reduced efficacy in radiation and systematic therapy, as well as a reduction in tolerance to therapy. Lastly, tobacco use has been observed to increase the risk of postoperative complications and second primary cancers.

Study authors also noted that systematic differences could factor into the findings, explaining that between patients who ceased to smoke and those who did not, variables in demographics, tumor characteristics, and disease stage may also contribute to OS rates. Furthermore, patients who can quit may be at an increased likelihood of undergoing resection with curative intent.

“The meta-analysis has implications beyond clinical practice,” Caini concluded. “Since heavy smokers would be primarily targeted by lung cancer screening programs, screening could serve as a teachable moment to help participants quit smoking by integrating a structured cessation program into the screening activities.”

References

  1. Caini S, Riccio MD, Vettori V, et al. Quitting smoking at or around diagnosis improves the overall survival of lung cancer patients: a systematic review and meta-analysis. J. Thorac Oncol. Published onlineJanuary 4, 2021. Accessed January 5, 2021.doi:10.1016/j.jtho.2021.12.005
  2. Smoking Cessation After Cancer Diagnosis Associated With Improved Survival. International Association for the Study of Lung Cancer. News release. January 4, 2021. Accessed January 5, 2021. https://bit.ly/3JMiAH1