Elyse R Park1,2,3,4, Sarah E Skurla5, Grelda Yazmin Juarez Caballero6, Emily R Friedman7,8, Colin Ponzani7, Robert Wallace9, Jennifer Malin10, Nancy L Keating11,12. 1. Health Policy Research Center at the Mongan Institute, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA. epark@mgh.harvard.edu. 2. Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MB, USA. epark@mgh.harvard.edu. 3. Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. epark@mgh.harvard.edu. 4. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. epark@mgh.harvard.edu. 5. Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, MI, USA. 6. Center for Public Health Statistics, University of Iowa College of Public Health, Iowa City, IA, USA. 7. Health Policy Research Center at the Mongan Institute, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA. 8. Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. 9. Department of Epidemiology, The University of Iowa, Iowa City, IA, USA. 10. Optum, Eden Prairie, MN, USA. 11. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. 12. Division of General Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Abstract
BACKGROUND: Continued smoking after a cancer diagnosis limits the effectiveness of treatment, increases the risk of cancer recurrence or secondary malignancies, and is associated with poorer quality of life and survival. A cancer diagnosis may provide a meaningful timepoint for quitting, but the prevalence and characteristics of continued smoking through survivorship are poorly understood. METHODS: In the multi-regional Cancer Care Outcomes Research and Surveillance (CanCORS) cohort, we examined smoking rates and factors associated with continued smoking at long-term follow-up among lung and colorectal cancer patients. This paper builds upon previous CanCORS participant data addressing quit rates and associated characteristics at baseline and 5 months post-diagnosis. RESULTS: At long-term follow-up (median 7.3 years post-diagnosis [IQR = 5.9-8.7]), 16.7% of lung cancer and 11.6% of colorectal cancer survivors continued to smoke combustible cigarettes. Factors independently associated with continued smoking at long-term follow-up included being male, younger, not married or partnered, having Medicare, Medicaid/other public or no insurance, more depression symptoms, smoking more cigarettes per day, and having a history of lung disease (p < .05). Continued smoking did not vary by lung vs. colorectal cancer diagnosis. CONCLUSION: Of active smokers at the time of diagnosis, an important minority of lung and colorectal cancer survivors continued to smoke well into survivorship. Understanding characteristics associated with continued smoking after a cancer diagnosis may help inform the development of tobacco treatment programs for cancer patients and survivors. IMPLICATIONS FOR SURVIVORS: While addressing smoking cessation at the time of diagnosis is critical to ensure better long-term treatment outcomes and quality of life, it is essential to continue smoking cessation discussions and efforts throughout care and survivorship.
BACKGROUND: Continued smoking after a cancer diagnosis limits the effectiveness of treatment, increases the risk of cancer recurrence or secondary malignancies, and is associated with poorer quality of life and survival. A cancer diagnosis may provide a meaningful timepoint for quitting, but the prevalence and characteristics of continued smoking through survivorship are poorly understood. METHODS: In the multi-regional Cancer Care Outcomes Research and Surveillance (CanCORS) cohort, we examined smoking rates and factors associated with continued smoking at long-term follow-up among lung and colorectal cancer patients. This paper builds upon previous CanCORS participant data addressing quit rates and associated characteristics at baseline and 5 months post-diagnosis. RESULTS: At long-term follow-up (median 7.3 years post-diagnosis [IQR = 5.9-8.7]), 16.7% of lung cancer and 11.6% of colorectal cancer survivors continued to smoke combustible cigarettes. Factors independently associated with continued smoking at long-term follow-up included being male, younger, not married or partnered, having Medicare, Medicaid/other public or no insurance, more depression symptoms, smoking more cigarettes per day, and having a history of lung disease (p < .05). Continued smoking did not vary by lung vs. colorectal cancer diagnosis. CONCLUSION: Of active smokers at the time of diagnosis, an important minority of lung and colorectal cancer survivors continued to smoke well into survivorship. Understanding characteristics associated with continued smoking after a cancer diagnosis may help inform the development of tobacco treatment programs for cancer patients and survivors. IMPLICATIONS FOR SURVIVORS: While addressing smoking cessation at the time of diagnosis is critical to ensure better long-term treatment outcomes and quality of life, it is essential to continue smoking cessation discussions and efforts throughout care and survivorship.
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