medwireNews: Smokers who quit after receiving a diagnosis of early-stage non-small-cell lung cancer (NSCLC) significantly improve their likelihood of survival relative to those who continue smoking, shows a large prospective cohort study.
In time-dependent models that adjusted for a raft of potential confounders and risk factors, the all-cause mortality risk was a significant 33% lower for participants who quit smoking than those who continued, while the risk for progression or death was reduced by 30% and the risk for lung cancer-specific mortality by 25%.
“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,” says the author of an editorial accompanying the research in the Annals of Internal Medicine.
Nancy Rigotti (Massachusetts General Hospital, Boston, USA) notes that challenges remain despite ongoing efforts such as “the National Cancer Institute’s [NCI’s] Cancer Center Cessation Initiative, which has provided initial funds to more than 40 NCI-designated cancer centers through the Cancer Moonshot Initiative to implement smoking cessation treatment programs.”
She continues: “As these initial funds end, programs are working—and sometimes struggling—to sustain viability.
“Additionally, tobacco cessation treatment must extend beyond large cancer centers to reach community cancer centers, community health centers, lung cancer screening sites and other settings in which individuals receive cancer diagnoses and treatment.”
For the current study, the researchers drew on a multisite, prospective study of lung cancer in Russia to identify 517 individuals who were smokers at the time of stage I–IIIA NSCLC diagnosis and were actively followed up for an average of 7 years. Of these, 42.6% reported that they quit smoking after diagnosis (eight individuals relapsed during follow-up), while the remaining 57.4% did not.
The adjusted median overall survival was significantly longer among participants who did versus did not quit smoking, at 6.6 and 4.8 years, respectively, and the estimated 3- and 5-year survival rates were higher, at 74.5% versus 66.2% and 60.6% versus 48.6%, respectively.
Median progression-free survival (PFS) was similarly significantly improved for people who quit, at 5.7 months after adjustment compared with 3.9 months for those who continued. The respective estimated PFS rates at 3 years were 67.2% and 58.3%, while the 5-year rates were 54.4% and 43.8%.
Smoking cessation was also associated with a significantly prolonged adjusted median time to lung cancer-specific mortality compared with not quitting, at 7.9 versus 6.0 months. And the probability of lung cancer-specific death was lower among quitters than smokers at the 3- and 5-year timepoints, at 23.7% versus 30.1% and 35.0% versus 43.5%, respectively.
“The protective effects of smoking cessation [were] observed among all subgroups of patients with lung cancer, including those with earlier and later tumor stage, mild to moderate and heavy smokers, and those who received and those who did not receive chemotherapy or radiation therapy,” say Paul Brennan (International Agency for Research on Cancer, Lyon, France) and co-authors.
They add: “Our results strongly suggest that patients with lung cancer who smoke should be encouraged to stop smoking at any time and at each visit after diagnosis, regardless of their history of cumulative cigarettes smoked, tumor stage, and treatment status.”
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Ann Intern Med 2021; doi:10.7326/M21-0252
Ann Intern Med 2021; doi:10.7326/M21-2997