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Mattila K, Vihinen H, Karlsson A, Minn H, Vihinen P, Heervä E. Smoking is an Independent Marker of Poor Prognosis in Cutaneous Melanoma. Acta Derm Venereol 2023; 103:adv00860. [PMID: 36748330 PMCID: PMC10391787 DOI: 10.2340/actadv.v103.3209] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 01/04/2023] [Indexed: 02/08/2023] Open
Abstract
Previous studies have suggested that persistent tobacco smoking impairs survival in cutaneous melanoma, but the effects of smoking and other prognostic factors have not been described in detail. This study examined the association of smoking (persistent, former, or never) with melanoma-specific (MSS) and overall survival (OS) in patients with cutaneous melanoma treated in Southwest Finland during 2005 to 2019. Clinical characteristics were obtained from electronic health records for 1,980 patients. Smoking status was available for 1,359 patients. Patients were restaged according to the 8th edition of the tumour-node-metastasis (TNM) classification. Smoking remained an independent prognostic factor for inferior melanoma-specific survival regardless of age, sex, stage, and comorbidities. The hazard ratio of death from melanoma was 1.81 (1.27-2.58, p = 0.001) in persistent and 1.75 (1.28-2.40, p = 0.001) in former smokers compared with never smokers. In 351 stage IV patients, smoking was associated with increased melanoma-specific and overall mortality: median MSS 10.4 (6.5-14.3), 14.6 (9.1-20.1), and 14.9 (11.4-18.4) months, p = 0.01 and median OS 10.4 (6.5-14.3), 13.9 (8.6-19.2), and 14.9 (11.7-18.1) months, p = 0.01 in persistent, former, and never smokers, respectively. In conclusion, since smoking represents an independent modifiable poor prognostic factor in patients with cutaneous melanoma, smoking habits should be proactively asked about by healthcare professionals, in order to support smoking cessation.
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Affiliation(s)
- Kalle Mattila
- Department of Oncology and FICAN West Cancer Centre, Turku University Hospital and University of Turku, Turku, Finland; InFLAMES Research Flagship Center, University of Turku, Turku, Finland
| | - Helmi Vihinen
- Turku School of Economics, University of Turku, Turku, Finland
| | - Antti Karlsson
- Auria Biobank and Turku University Hospital, Turku Finland
| | - Heikki Minn
- Department of Oncology and FICAN West Cancer Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Pia Vihinen
- Department of Oncology and FICAN West Cancer Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Eetu Heervä
- Department of Oncology and FICAN West Cancer Centre, Turku University Hospital and University of Turku, Turku, Finland.
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2
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Eng L, Brual J, Nagee A, Mok S, Fazelzad R, Chaiton M, Saunders D, Mittmann N, Truscott R, Liu G, Bradbury P, Evans W, Papadakos J, Giuliani M. Reporting of tobacco use and tobacco-related analyses in cancer cooperative group clinical trials: a systematic scoping review. ESMO Open 2022; 7:100605. [PMID: 36356412 PMCID: PMC9646674 DOI: 10.1016/j.esmoop.2022.100605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Continued smoking after a diagnosis of cancer negatively impacts cancer outcomes, but the impact of tobacco on newer treatments options is not well established. Collecting and evaluating tobacco use in clinical trials may advance understanding of the consequences of tobacco use on treatment modalities, but little is known about the frequency of reporting and analysis of tobacco use in cancer cooperative clinical trial groups. PATIENTS AND METHODS A comprehensive literature search was conducted to identify cancer cooperative group clinical trials published from January 2017-October 2019. Eligible studies evaluated either systemic and/or radiation therapies, included ≥100 adult patients, and reported on at least one of: overall survival, disease/progression-free survival, response rates, toxicities/adverse events, or quality-of-life. RESULTS A total of 91 studies representing 90 trials met inclusion criteria with trial start dates ranging from 1995 to 2015 with 14% involving lung and 5% head and neck cancer patients. A total of 19 studies reported baseline tobacco use; 2 reported collecting follow-up tobacco use. Seven studies reported analysis of the impact of baseline tobacco use on clinical outcomes. There was significant heterogeneity in the reporting of baseline tobacco use: 7 reported never/ever status, 10 reported never/ex-smoker/current smoker status, and 4 reported measuring smoking intensity. None reported verifying smoking status or second-hand smoke exposure. Trials of lung and head and neck cancers were more likely to report baseline tobacco use than other disease sites (83% versus 6%, P < 0.001). CONCLUSIONS Few cancer cooperative group clinical trials report and analyze trial participants' tobacco use. Significant heterogeneity exists in reporting tobacco use. Routine standardized collection and reporting of tobacco use at baseline and follow-up in clinical trials should be implemented to enable investigators to evaluate the impact of tobacco use on new cancer therapies.
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Affiliation(s)
- L. Eng
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre/University Health Network and University of Toronto, Toronto, Canada,Prof L. Eng, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada. Tel: +1-416-946-2953; Fax: +1-416-946-6546 @Lawson_Eng@MeredithGiulia1@PMcancercentre
| | - J. Brual
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - A. Nagee
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - S. Mok
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - R. Fazelzad
- Library and Information Services, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - M. Chaiton
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - D.P. Saunders
- Northeast Cancer Centre of Health Sciences North, Northern Ontario School of Medicine, Sudbury, Canada
| | - N. Mittmann
- Canadian Agency for Drugs and Technologies in Health, Toronto, Canada
| | - R. Truscott
- Division of Prevention Policy and Stakeholder Engagement, Ontario Health (Cancer Care Ontario), Toronto, Canada
| | - G. Liu
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre/University Health Network and University of Toronto, Toronto, Canada
| | - P.A. Bradbury
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre/University Health Network and University of Toronto, Toronto, Canada
| | - W.K. Evans
- Department of Oncology, McMaster University, Hamilton, Canada
| | - J. Papadakos
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Canada,Patient Education, Ontario Health (Cancer Care Ontario), Toronto, Canada
| | - M.E. Giuliani
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Canada,Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada,Correspondence to: Prof M. Giuliani, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada. Tel: +1-416-946-2983; Fax: +1-416-946-6546
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3
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Di Meglio A, Havas J, Gbenou AS, Martin E, El-Mouhebb M, Pistilli B, Menvielle G, Dumas A, Everhard S, Martin AL, Cottu PH, Lerebours F, Coutant C, Lesur A, Tredan O, Soulie P, Vanlemmens L, Joly F, Delaloge S, Ganz PA, André F, Partridge AH, Jones LW, Michiels S, Vaz-Luis I. Dynamics of Long-Term Patient-Reported Quality of Life and Health Behaviors After Adjuvant Breast Cancer Chemotherapy. J Clin Oncol 2022; 40:3190-3204. [PMID: 35446677 PMCID: PMC9509127 DOI: 10.1200/jco.21.00277] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We aimed to characterize long-term quality of life (QOL) trajectories among patients with breast cancer treated with adjuvant chemotherapy and to identify related patterns of health behaviors.
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Affiliation(s)
- Antonio Di Meglio
- Medical Oncology, Gustave Roussy, Villejuif, France.,INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Julie Havas
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Arnauld S Gbenou
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Elise Martin
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Mayssam El-Mouhebb
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Barbara Pistilli
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | | | - Agnes Dumas
- Université de Paris, ECEVE UMR 1123, INSERM, Paris, France
| | | | | | | | | | | | - Anne Lesur
- Institut de Cancérologie de Lorraine, Nancy, France
| | | | | | | | | | | | | | - Fabrice André
- Medical Oncology, Gustave Roussy, Villejuif, France.,INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | | | - Lee W Jones
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stefan Michiels
- Service de Biostatistique et d'Epidémiologie, Oncostat Inserm U1018, Université Paris- Saclay, Equipe labellisée Ligue Contre le Cancer, Gustave Roussy, Villejuif, France
| | - Ines Vaz-Luis
- Medical Oncology, Gustave Roussy, Villejuif, France.,INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
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Has the National Fall in Smoking Rates in Ireland Been Replicated in Cancer Patients? A 5-Year Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042348. [PMID: 35206536 PMCID: PMC8874430 DOI: 10.3390/ijerph19042348] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/12/2022] [Accepted: 02/16/2022] [Indexed: 02/04/2023]
Abstract
Smoking among cancer patients leads to poorer outcomes, yet many patients continue smoking. As part of a feasibility study of smoking cessation for cancer patients in Ireland, smoking rates were reviewed. Hospital Inpatient Enquiry (HIPE) data on the smoking status of discharges with a cancer diagnosis (overall, breast, lung, cervical and head and neck cancer) were used (2014–2018). During 2014–2017, current smoking increased for overall (10.5–11.7%) and lung cancer (24.7–27.2%), then decreased to 11.4% and 24.1%, respectively, in 2018. Current smoking increased for cervical during 2014–2018 (11–19.8%) and initially (2014–2016) for head and neck (3–12.7%) cancer, decreasing to 7.6% in 2018; breast cancer was stable at 6 ± 0.6%. These rates are lower than the Irish (23–20%) and European (29% (average)) general population. During 2014–2017, past smoking increased among overall (15.2–21%) and specific cancers, which was lower than the Irish general population (23–28%). Current smoking was highest among 50–59-year-olds (14–16%), which contrasts with the Irish general population (24–35 years at 32–28%). HIPE data are subject to potential duplicate episodes of care and under-documentation of smoking. However, trend analysis is useful, as these limitations should be stable. Rates remain high; therefore, robust documentation and smoking cessation referrals for cancer patients are important.
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Persistent deficiencies in the measurement and reporting of tobacco use in contemporary genitourinary oncology clinical trials. Cancer Epidemiol 2021; 78:102022. [PMID: 34670728 DOI: 10.1016/j.canep.2021.102022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 11/23/2022]
Abstract
Smoking is a causal or contributory factor for nearly all genitourinary cancers and exerts significant influence on treatment, quality of life, and survival outcomes. In order to understand the influence smoking has on the outcomes of contemporary therapies, pertinent smoking-related data must be systematically collected and report. We sought to determine how often and how rigorously smoking status is collected and reported in publications of clinical trials in genitourinary cancers by conducting a systematic review. Our initial search yielded 622 articles, 354 of which met criteria. The vast majority of included studies (91.8%) did not report any details about trial participants' smoking status. When included, 96.3% of studies reported baseline status qualitatively. No studies used a validated measurement instrument or reported change in participants' smoking status over the study period. Absence of the collection and reporting of smoking-related data precludes further study of how smoking impacts outcomes and highlights an important deficiency in GU oncology clinical trial design.
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Nicolas M, Grandal B, Dubost E, Kassara A, Guerin J, Toussaint A, Laas E, Feron JG, Fourchotte V, Lecuru F, Girard N, Coussy F, Lavielle B, Kriegel I, Kirova Y, Pierga JY, Reyal F, Hamy AS. Breast Cancer (BC) Is a Window of Opportunity for Smoking Cessation: Results of a Retrospective Analysis of 1234 BC Survivors in Follow-Up Consultation. Cancers (Basel) 2021; 13:2423. [PMID: 34067742 PMCID: PMC8156674 DOI: 10.3390/cancers13102423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 12/24/2022] Open
Abstract
Breast cancer (BC) is the most commonly diagnosed type of cancer and the leading cause of cancer deaths in women. Smoking is the principal modifiable risk factor for cancers and has a negative influence on long-term survival. We conducted a retrospective study on consecutive BC survivors seen at follow-up consultations between 3 June and 30 October 2019 at Institut Curie, Paris, France. Smoking behaviors were evaluated prospectively via interviewer-administered questionnaires. The aim of this study was to describe smoking-related patient care at diagnosis and smoking cessation patterns in women with a history of BC. A total of 1234 patients were included in the study. Smoking status at diagnosis was missing from electronic health records in 32% of cases, including 13% of patients who smoke. Only 20% of the 197 patients currently smoking at diagnosis recalled having a discussion about smoking with a healthcare professional. Radiotherapists and surgeons were more likely to talk about complications than other practitioners. The main type of information provided was general advice to stop smoking (n = 110), followed by treatment complications (n = 48), while only five patients were referred to tobaccologists. Since diagnosis, 33% (n = 65) of the patients currently smoking had quit. Patients who quit had a lower alcohol consumption, but no other factor was associated with smoking cessation. The main motivation for tobacco withdrawal was the fear of BC relapse (63%). This study highlights room for improvement in the assessment of smoking behavior. Our data raise important perspectives for considering BC treatment and follow-up as a window of opportunity for smoking cessation.
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Affiliation(s)
- Marion Nicolas
- Faculty of Medicine, Sorbonne Université, 75006 Paris, France;
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Beatriz Grandal
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Emma Dubost
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Amyn Kassara
- Data Factory, Institut Curie, Université Paris, 75005 Paris, France; (A.K.); (J.G.)
| | - Julien Guerin
- Data Factory, Institut Curie, Université Paris, 75005 Paris, France; (A.K.); (J.G.)
| | - Aullene Toussaint
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Enora Laas
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Jean-Guillaume Feron
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Virginie Fourchotte
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Fabrice Lecuru
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Noemie Girard
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Florence Coussy
- Department of Medical Oncology, Institut Curie, Université Paris, 75005 Paris, France; (F.C.); (B.L.); (J.-Y.P.); (A.-S.H.)
| | - Beatrice Lavielle
- Department of Medical Oncology, Institut Curie, Université Paris, 75005 Paris, France; (F.C.); (B.L.); (J.-Y.P.); (A.-S.H.)
| | - Irene Kriegel
- Department of Anesthesiology, Institut Curie, Université Paris, 75005 Paris, France;
| | - Youlia Kirova
- Department of Radiotherapy, Institut Curie, Université Paris, 75005 Paris, France;
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, Université Paris, 75005 Paris, France; (F.C.); (B.L.); (J.-Y.P.); (A.-S.H.)
| | - Fabien Reyal
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, INSERM, U932 Immunity and Cancer, Institut Curie, Université Paris, 75005 Paris, France
| | - Anne-Sophie Hamy
- Department of Medical Oncology, Institut Curie, Université Paris, 75005 Paris, France; (F.C.); (B.L.); (J.-Y.P.); (A.-S.H.)
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, INSERM, U932 Immunity and Cancer, Institut Curie, Université Paris, 75005 Paris, France
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7
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The characteristics of patients who quit smoking in the year following a cancer diagnosis. J Cancer Surviv 2021; 16:111-118. [PMID: 33641030 PMCID: PMC10117081 DOI: 10.1007/s11764-021-01009-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/17/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Continued tobacco smoking following a cancer diagnosis is associated with adverse outcomes. Our study aims to identify the demographic and clinical characteristics of survivors who quit smoking within a year of diagnosis. METHODS We conducted a secondary analysis of the Measuring Your Health (MY-Health) study, a community-based survey cohort of 5506 cancer patients registered across four Surveillance, Epidemiology, and End Results (SEER) cancer registries. Using surveys completed 6-13 months after diagnosis, we identified 868 participants who reported smoking around the time of cancer diagnosis and compared their current smoking status. We employed logistic regression models to predict current smoking status, adjusting for clinical and demographic variables. RESULTS The overall smoking cessation rate was 35% (n = 306). Survivors with non-small cell lung cancer were three times more likely to quit smoking compared to patients with non-smoking-related cancers (aOR = 3.23, 95% CI = 2.20-4.74). Participants with advanced stage cancer reported higher odds of quitting compared to those with localized cancer (aOR = 1.42, 95% CI = 1.02-1.96). Other characteristics that predicted quitting included being married, higher education level, and female sex (aOR = 2.01, 95% CI = 1.46-2.77; aOR = 1.74, 95% CI = 1.27-2.39; aOR = 1.54, 95% CI = 1.11-2.13, respectively). CONCLUSIONS This is one of the first studies to examine smoking cessation trends in a community-based, US cancer cohort during the year after diagnosis. Survivors with lung cancer and advanced cancer were significantly more likely to quit smoking. IMPLICATIONS FOR CANCER SURVIVORS Practitioners may use this knowledge to target interventions and address substantial disparities in cessation rates among survivors with early stage and non-lung cancers.
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Steuer CE, Jegede OA, Dahlberg SE, Wakelee HA, Keller SM, Tester WJ, Gandara DR, Graziano SL, Adjei AA, Butts CA, Ramalingam SS, Schiller JH. Smoking Behavior in Patients With Early-Stage NSCLC: A Report From ECOG-ACRIN 1505 Trial. J Thorac Oncol 2021; 16:960-967. [PMID: 33539971 DOI: 10.1016/j.jtho.2020.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Smoking cessation has been reported to benefit patients even after a diagnosis of lung cancer. We studied the smoking behavior of patients who participated in a phase 3 trial of adjuvant therapy following resection of stages IB-IIIA NSCLC. METHODS The ECOG-ACRIN 1505 was conducted to determine whether the addition of bevacizumab to adjuvant chemotherapy would improve overall survival (OS) for patients with early-stage NSCLC. Studying the association between smoking status and OS was a secondary end point. Patients completed a questionnaire on their smoking habits at baseline, 3, 6, 9, and 12 months. RESULTS A total of 1501 patients were enrolled, and 99.8%, 95%, 94%, 93%, and 93% responded to the questionnaire at baseline, 3, 6, 9, and 12 months, respectively. A total of 90% reported a current or previous history of cigarette smoking. In addition, 60% of nonsmokers at enrollment reported smoking after diagnosis (before randomization); however, 1% of them reported smoking at 12 months. Furthermore, 94% of the respondents smoked none/fewer cigarettes daily at 12 months. The incidence of grades 3-5 toxicity on treatment was 68%, 76%, and 72% in never, former, and current smokers, respectively (p = 0.05). The disease-free survival for never-smokers relative to current and former smokers was (hazard ratio [HR] 0.93, p = 0.64 and HR 1.05, p = 0.72), and OS was (adjusted HR for death 0.54, p = 0.005 and adjusted HR for death 0.68, p = 0.03), respectively. CONCLUSIONS This is the first comprehensive, prospective report of smoking habits in patients with NSCLC patients from a phase III early-stage trial. There was a high rate of smoking reduction and cessation following study entry. The disease-free survival did not differ significantly between smokers and never smokers, though there were less grade 3-5 toxicities and more favorable OS in never-smokers.
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Affiliation(s)
- Conor E Steuer
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia.
| | - Opeyemi A Jegede
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | | | - Heather A Wakelee
- Stanford University School of Medicine and Stanford Cancer Institute, Stanford, California
| | | | - William J Tester
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - David R Gandara
- University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Stephen L Graziano
- State University of New York Upstate Medical University, Syracuse, New York
| | | | | | - Suresh S Ramalingam
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
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9
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Enyioha C, Warren GW, Morgan GD, Goldstein AO. Tobacco Use and Treatment among Cancer Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239109. [PMID: 33291274 PMCID: PMC7730918 DOI: 10.3390/ijerph17239109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 05/08/2023]
Abstract
Tobacco use is causally associated with the risk of developing multiple health conditions, including over a dozen types of cancer, and is responsible for 30% of cancer deaths in the U [...].
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Affiliation(s)
- Chineme Enyioha
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (C.E.); (G.D.M.)
| | - Graham W. Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Glen D. Morgan
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (C.E.); (G.D.M.)
| | - Adam O. Goldstein
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (C.E.); (G.D.M.)
- Correspondence:
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10
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Warren GW, Alberg AJ, Cummings KM, Dresler C. Smoking Cessation After a Cancer Diagnosis Is Associated With Improved Survival. J Thorac Oncol 2020; 15:705-708. [PMID: 32197939 DOI: 10.1016/j.jtho.2020.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/07/2020] [Accepted: 02/09/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Graham W Warren
- Department of Radiation Oncology, Medical University of South Carolina (MUSC), Charleston, South Carolina; Department of Cell and Molecular Pharmacology, MUSC, Charleston, South Carolina.
| | - Anthony J Alberg
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, South Carolina
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11
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Warren GW. Mitigating the adverse health effects and costs associated with smoking after a cancer diagnosis. Transl Lung Cancer Res 2019; 8:S59-S66. [PMID: 31211106 DOI: 10.21037/tlcr.2019.04.07] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Smoking after a cancer diagnosis causes adverse outcomes and is associated with substantial additional treatment cost. Mitigation of the adverse effects of smoking require active commitment from health systems, providers, and patients. Three areas of mitigation are discussed: (I) smoking cessation after a cancer diagnosis to improve cancer treatment outcomes; (II) identifying optimal cancer treatment strategies for patients who smoke at the time of diagnosis; and (III) how health systems can prioritize the effect modification caused by smoking. As innovation continues for healthcare delivery, priority should be placed on interventions that reduce the effect modification and associated costs caused by continued smoking after a cancer diagnosis.
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Affiliation(s)
- Graham W Warren
- Department of Radiation Oncology, Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC, USA
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Abstract
Tobacco smoking accounts for at least 30% of all cancer deaths and nearly 90% of lung cancer deaths. Smoking cessation significantly reduces the risk of developing tobacco-related malignancies. Smoking after cancer diagnosis is also associated with multiple risks, including worse tolerance of treatment, higher risk of a failure and second primary tumors, and poorer quality of life. Apart from disease site and stage, continued smoking is considered the strongest adverse predictor of survival in cancer patients. However, the benefits of smoking cessation are undervalued: many patients are not aware of harms related to continued tobacco use after cancer diagnosis. Furthermore, health care professionals often do not encourage their patients to quit, and do not provide tobacco cessation assistance for continuing tobacco users. Despite the apparent impact of tobacco use on treatment outcomes, data on current smoking status is only rarely captured in clinical trials This article reviews the most important clinical aspects of smoking after the diagnosis of cancer.
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Affiliation(s)
- Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
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13
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Hwang ES, Hyslop T, Lynch T, Frank E, Pinto D, Basila D, Collyar D, Bennett A, Kaplan C, Rosenberg S, Thompson A, Weiss A, Partridge A. The COMET (Comparison of Operative versus Monitoring and Endocrine Therapy) trial: a phase III randomised controlled clinical trial for low-risk ductal carcinoma in situ (DCIS). BMJ Open 2019; 9:e026797. [PMID: 30862637 PMCID: PMC6429899 DOI: 10.1136/bmjopen-2018-026797] [Citation(s) in RCA: 188] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Ductal carcinoma in situ (DCIS) is a non-invasive non-obligate precursor of invasive breast cancer. With guideline concordant care (GCC), DCIS outcomes are at least as favourable as some other early stage cancer types such as prostate cancer, for which active surveillance (AS) is a standard of care option. However, AS has not yet been tested in relation to DCIS. The goal of the COMET (Comparison of Operative versus Monitoring and Endocrine Therapy) trial for low-risk DCIS is to gather evidence to help future patients consider the range of treatment choices for low-risk DCIS, from standard therapies to AS. The trial will determine whether there may be some women who do not substantially benefit from current GCC and who could thus be safely managed with AS. This protocol is version 5 (11 July 2018). Any future protocol amendments will be submitted to Quorum Centralised Institutional Review Board/local institutional review boards for approval via the sponsor of the study (Alliance Foundation Trials). METHODS AND ANALYSIS COMET is a phase III, randomised controlled clinical trial for patients with low-risk DCIS. The primary outcome is ipsilateral invasive breast cancer rate in women undergoing GCC compared with AS. Secondary objectives will be to compare surgical, oncological and patient-reported outcomes. Patients randomised to the GCC group will undergo surgery as well as radiotherapy when appropriate; those in the AS group will be monitored closely with surgery only on identification of invasive breast cancer. Patients in both the GCC and AS groups will have the option of endocrine therapy. The total planned accrual goal is 1200 patients. ETHICS AND DISSEMINATION The COMET trial will be subject to biannual formal review at the Alliance Foundation Data Safety Monitoring Board meetings. Interim analyses for futility/safety will be completed annually, with reporting following Consolidated Standards of Reporting Trials (CONSORT) guidelines for non-inferiority trials. TRIAL REGISTRATION NUMBER NCT02926911; Pre-results.
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Affiliation(s)
- E Shelley Hwang
- Department of Surgery, Division of Surgical Oncology, Duke University, Durham, North Carolina, USA
| | - Terry Hyslop
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Thomas Lynch
- Department of Surgery, Division of Surgical Oncology, Duke University, Durham, North Carolina, USA
| | | | | | | | | | - Antonia Bennett
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Celia Kaplan
- Department of Medicine, University of California, San Francisco, California, USA
| | - Shoshana Rosenberg
- Department of Medicine, Brigham and Women’s Hospital, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Alastair Thompson
- Department of Breast Surgery, Division of Surgical Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Anna Weiss
- Alliance Foundation Trials, Boston, Massachusetts, USA
| | - Ann Partridge
- Department of Medicine, Brigham and Women’s Hospital, Dana Farber Cancer Institute, Boston, Massachusetts, USA
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14
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Akinboro O, Olorunfemi O, Basak P, Phillips E, Pomerantz D, Bernhardt B, Gucalp R, Jesmajian S, Ostroff JS. Secondhand Smoke Exposure Among Community-Dwelling Adult Cancer Survivors in the United States: 1999-2012. Cancer Epidemiol Biomarkers Prev 2017; 26:1296-1305. [PMID: 28642231 PMCID: PMC5671647 DOI: 10.1158/1055-9965.epi-16-0777] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/01/2016] [Accepted: 04/12/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Little is known about the prevalence of secondhand smoke exposure (SHSe) among cancer survivors. We sought to determine the prevalence, trends, and correlates of SHSe among nonsmoking adult cancer survivors in the United States.Methods: Interview and serum cotinine data for nonsmoking adults, age 20 years and older, with a history of cancer (N = 686) were obtained from consecutive two-year cross-sectional cycles of the National Health and Nutrition Examination Survey from 1999 to 2012. SHSe was defined as serum cotinine 0.05-10 ng/mL among nonsmokers. We calculated and trended the prevalence of SHSe among nonsmoking cancer survivors. Multivariable logistic regression was used to examine the associations of SHSe with sociodemographic, smoking, and clinical characteristics. Survey weights were applied in estimating prevalence rates, adjusted ORs, and confidence intervals (CI).Results: The weighted aggregate SHSe and self-reported indoor SHSe prevalence rates over the study period were 28.26% (95% CI: 24.97%-31.55%) and 4.53% (95% CI: 3.48%-5.57%), respectively. SHS exposure declined from 39.61% (95% CI: 27.88%-51.34%) in 1999/2000 to 15.68% (95% CI: 9.38%-21.98%) in 2011/2012 (Ptrend < 0.001). Age ≥ 60 years was protective against SHSe, while being black, having less than high school education, poverty, and a smoking-related cancer history were associated with higher odds of SHSe.Conclusions: Fortunately, SHSe among nonsmoking cancer survivors in the United States is on the decline, although certain subgroups remain disproportionately burdened.Impact: These findings highlight clinical and public health imperatives to target socioeconomically disadvantaged nonsmoking cancer survivors to reduce their SHSe. Cancer Epidemiol Biomarkers Prev; 26(8); 1296-305. ©2017 AACR.
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Affiliation(s)
| | | | - Prasanta Basak
- Montefiore New Rochelle Hospital, New Rochelle, New York
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15
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Jones MS, Jones PC, Stern SL, Elashoff D, Hoon DSB, Thompson J, Mozzillo N, Nieweg OE, Noyes D, Hoekstra HJ, Zager JS, Roses DF, Testori A, Coventry BJ, Smithers MB, Andtbacka R, Agnese D, Schultz E, Hsueh EC, Kelley M, Schneebaum S, Jacobs L, Bowles T, Kashani-Sabet M, Johnson D, Faries MB. The Impact of Smoking on Sentinel Node Metastasis of Primary Cutaneous Melanoma. Ann Surg Oncol 2017; 24:2089-2094. [PMID: 28224364 PMCID: PMC5553293 DOI: 10.1245/s10434-017-5775-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although a well-established causative relationship exists between smoking and several epithelial cancers, the association of smoking with metastatic progression in melanoma is not well studied. We hypothesized that smokers would be at increased risk for melanoma metastasis as assessed by sentinel lymph node (SLN) biopsy. METHODS Data from the first international Multicenter Selective Lymphadenectomy Trial (MSLT-I) and the screening-phase of the second trial (MSLT-II) were analyzed to determine the association of smoking with clinicopathologic variables and SLN metastasis. RESULTS Current smoking was strongly associated with SLN metastasis (p = 0.004), even after adjusting for other predictors of metastasis. Among 4231 patients (1025 in MSLT-I and 3206 in MSLT-II), current or former smoking was also independently associated with ulceration (p < 0.001 and p < 0.001, respectively). Compared with current smoking, never smoking was independently associated with decreased Breslow thickness in multivariate analysis (p = 0.002) and with a 0.25 mm predicted decrease in thickness. CONCLUSION The direct correlation between current smoking and SLN metastasis of primary cutaneous melanoma was independent of its correlation with tumor thickness and ulceration. Smoking cessation should be strongly encouraged among patients with or at risk for melanoma.
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Affiliation(s)
- Maris S Jones
- Division of Surgical Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Peter C Jones
- Division of Surgical Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
- Department of Molecular Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Stacey L Stern
- Department of Biostatistics, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | | | - Dave S B Hoon
- Department of Molecular Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - John Thompson
- Melanoma Institute Australia, Sydney, NSW, Australia
| | | | - Omgo E Nieweg
- Melanoma Institute Australia, Sydney, NSW, Australia
| | - Dirk Noyes
- IHC Cancer Services, Intermountain Medical Center, Salt Lake City, UT, USA
| | | | | | | | | | - Brendon J Coventry
- Royal Adelaide Hospital Discipline of Surgery, Royal Adelaide HospitalUniversity of Adelaide, Adelaide, SA, Australia
| | - Mark B Smithers
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | | | | | - Erwin Schultz
- Nuremberg General Hospital - Paracelsus Medical University, Nuremberg, Germany
| | | | | | | | - Lisa Jacobs
- Johns Hopkins Medical Institute, Baltimore, USA
| | - Tawnya Bowles
- IHC Cancer Services, Intermountain Medical Center, Salt Lake City, UT, USA
| | | | | | - Mark B Faries
- Department of Melanoma Research, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.
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Chang EHE, Braith A, Hitsman B, Schnoll RA. Treating Nicotine Dependence and Preventing Smoking Relapse in Cancer Patients. EXPERT REVIEW OF QUALITY OF LIFE IN CANCER CARE 2016; 2:23-39. [PMID: 28808692 PMCID: PMC5553981 DOI: 10.1080/23809000.2017.1271981] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Despite the well-documented harmful effects of smoking, many cancer patients continue to smoke. Smoking cessation is critical to address in this population given the associated increase in treatment toxicity, risk of second primary tumors, decrease in treatment response and higher disease-specific and all-cause mortality with continued smoking following a cancer diagnosis. This review seeks to summarize the latest recommendations and guidelines on smoking cessation treatment for patients diagnosed with cancer, and the evidence behind those recommendations. AREAS COVERED We reviewed the latest evidence for smoking cessation treatments for cancer patients and the clinical guidelines and recommendation available for oncologists and health care providers. The unique aspects of nicotine dependence among patients diagnosed with cancer, and key challenges and barriers that cancer survivors and health care providers experience when considering smoking cessation treatments, and available clinical resources, are also discussed. Lastly, the authors summarize future directions in the field of smoking cessation treatment for cancer patients. EXPERT COMMENTARY While there are areas of improvement in research of smoking cessation treatment for cancer patients, critical under-explored areas remain. Nonetheless, providers should adhere to the NCCN guidelines and offer a brief counseling intervention to motivate patients to quit smoking when appropriate resources are not available.
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Affiliation(s)
- Eun Hae Estelle Chang
- Department of Otolaryngology Head and Neck Surgery, University of Nebraska Medical Center, 981225 Nebraska Medical Center, Omaha, NE 68198-1225, Phone 402-559-8007 Fax 402-559-8490
| | - Andrew Braith
- College of Medicine, University of Nebraska Medical Center, 42 Street and Emile Street, Omaha, NE 68198
| | - Brian Hitsman
- Department of Preventive Medicine, Feinberg School of Medicine & Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611, Phone 312-503-2074
| | - Robert A Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, 3535 Market Street, 4 Floor, Philadelphia, PA 19104, Phone 215-746-7143 Fax 215-746-7140
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Peters EN, Warren GW, Sloan JA, Marshall JR. Tobacco assessment in completed lung cancer treatment trials. Cancer 2016; 122:3260-3262. [PMID: 27459400 PMCID: PMC5338464 DOI: 10.1002/cncr.30223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/06/2016] [Accepted: 07/07/2016] [Indexed: 11/08/2022]
Abstract
An effort over 3 years to conduct a data pooling project regarding the association between smoking and lung cancer treatment outcomes has shown that, of 32 completed studies of lung cancer treatments in 1 National Cancer Institute Cooperative Group, only a minority have usable data concerning smoking‐related variables. Clinical trials research is needed to inform patients with cancer and their physicians about the impact of smoking, and how smoking cessation may affect the course of their disease.
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Affiliation(s)
- Erica N. Peters
- Battelle Public Health Center for Tobacco Research, Baltimore, MD
- Department of Cancer Prevention and Population Sciences, Roswell Park Cancer
Institute, Buffalo, NY
- Department of Psychiatry, Yale School of Medicine, New Haven, CT,
| | - Graham W. Warren
- Department of Radiation Oncology, Medical University of South Carolina,
Charleston, SC;
| | | | - James R. Marshall
- Department of Cancer Prevention and Population Sciences, Roswell Park Cancer
Institute, Buffalo, NY,
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18
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Thong AE, Petruzella S, Orlow I, Zabor EC, Ehdaie B, Ostroff JS, Bochner BH, Barnes HF. Accuracy of Self-reported Smoking Exposure Among Bladder Cancer Patients Undergoing Surveillance at a Tertiary Referral Center. Eur Urol Focus 2016; 2:441-444. [PMID: 28164165 DOI: 10.1016/j.euf.2015.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/19/2015] [Accepted: 12/07/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Smoking is a risk factor for developing bladder cancer (BCa). Even though continued exposure after diagnosis may adversely affect prognosis, patients may be reluctant to disclose to their physicians that they are currently smoking, leading to inaccurate reporting of exposure and missed opportunities to deliver smoking-cessation advice and treatment in the context of cancer care. OBJECTIVE We examined the extent of misclassification of recent smoking exposure among patients undergoing BCa surveillance. DESIGN SETTING AND PARTICIPANTS A consecutive sample of 145 patients with a self-reported smoking history and prior initial diagnosis of BCa was recruited from a tertiary referral urology clinic. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patients were asked if they had smoked a cigarette or used nicotine replacement therapy (NRT) within the past week and whether they lived with a smoker. At the same visit, we collected urine under a biospecimen protocol. We used urinary cotinine, the primary metabolite of nicotine, as an objective biomarker of recent smoking exposure. Nine patients whose urine could not be interpreted for cotinine were excluded. We calculated the smoking status misreporting rate by comparing biochemically verified smoking status (≥31.5 ng/ml vs <31.5 ng/ml) against self-reported current smoking status (yes vs no) while considering recent NRT use. RESULTS AND LIMITATIONS Overall, 11% (15 of 136) of patients had cotinine values consistent with current smoking. Of these 15 patients, 7 reported being former smokers, resulting in a 47% misclassification rate. However, three of the seven patients who denied smoking in the past week were currently using NRT. Excluding NRT users, the misclassification rate was 33%. CONCLUSIONS Future studies investigating the impact of postdiagnosis nicotine exposure on BCa outcomes should use biochemical verification combined with self-reported smoking exposure to classify patients accurately. PATIENT SUMMARY Bladder cancer patients may misreport smoking exposure, thereby missing opportunities for smoking cessation.
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Affiliation(s)
- Alan E Thong
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stacey Petruzella
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Irene Orlow
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emily C Zabor
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Behfar Ehdaie
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bernard H Bochner
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Helena Furberg Barnes
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Sarna L, Bialous SA. Implementation of Tobacco Dependence Treatment Programs in Oncology Settings. Semin Oncol Nurs 2016; 32:187-96. [DOI: 10.1016/j.soncn.2016.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Platek AJ, Jayaprakash V, Merzianu M, Platek ME, Cohan DM, Hicks WL, Marimuthu SP, Winslow TB, Gupta V, Arshad H, Kuriakose MA, Dibaj S, Marshall JR, Reid ME, Warren GW, Singh AK. Smoking cessation is associated with improved survival in oropharynx cancer treated by chemoradiation. Laryngoscope 2016; 126:2733-2738. [PMID: 27346612 DOI: 10.1002/lary.26083] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/12/2016] [Accepted: 04/18/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS The effect of smoking and human papillomavirus (HPV) on overall survival (OS) of oropharyngeal squamous cell carcinoma (OPSCC) patients undergoing concurrent chemotherapy (CCRT) remains unclear. STUDY DESIGN Retrospective review. METHODS Clinical characteristics of OPSCC patients treated between 2008 and 2015 with CCRT were abstracted from medical records. OS curves and multivariate cox proportional hazard ratios (HRs) were examined. RESULTS Of 120 evaluable patients, 71% had HPV+ tumors. Median follow-up duration for the entire cohort was 41.5 months (range = 6-88 months). HPV+ current smokers experienced significantly worse 5-year OS (73% alive vs. 36% alive, P = .01) and there was a similar trend in HPV- current smokers (66% alive vs. 31% alive, P = .28) compared to former/never smokers undergoing CCRT. In a multivariate cox proportional hazard model adjusted for age, gender, and overall tumor stage, HPV+ current smokers experienced nearly a fourfold increase in overall mortality in comparison to HPV+ never/former smokers (HR = 3.68, 95% CI = 1.35-10.0). Similarly, current smokers with HPV- tumors (HR = 6.80, 95% CI = 1.11-41.67) had increased mortality compared to never/former smokers. CONCLUSIONS Current smoking is associated with poor prognosis, independent of HPV status, in CCRT-treated OPSCC patients. Current smoking produced an approximately four- to sevenfold increase in risk of mortality for HPV+ and HPV- patients, respectively. Regardless of pack years and HPV status, efforts should be made to achieve smoking cessation before CCRT. LEVEL OF EVIDENCE 4. Laryngoscope, 126:2733-2738, 2016.
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Affiliation(s)
- Alexis J Platek
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Vijayvel Jayaprakash
- Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Mihai Merzianu
- Pathology, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Mary E Platek
- Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - David M Cohan
- Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Wesley L Hicks
- Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Sathiya P Marimuthu
- Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Timothy B Winslow
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Vishal Gupta
- Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Hassan Arshad
- Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Moni A Kuriakose
- Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Shiva Dibaj
- Biostatistics, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - James R Marshall
- Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Mary E Reid
- Medicine, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Graham W Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Anurag K Singh
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
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Land SR, Toll BA, Moinpour CM, Mitchell SA, Ostroff JS, Hatsukami DK, Duffy SA, Gritz ER, Rigotti NA, Brandon TH, Prindiville SA, Sarna LP, Schnoll RA, Herbst RS, Cinciripini PM, Leischow SJ, Dresler CM, Fiore MC, Warren GW. Research Priorities, Measures, and Recommendations for Assessment of Tobacco Use in Clinical Cancer Research. Clin Cancer Res 2016; 22:1907-13. [PMID: 26888828 PMCID: PMC4861174 DOI: 10.1158/1078-0432.ccr-16-0104] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 01/28/2016] [Indexed: 01/12/2023]
Abstract
There is strong evidence that cigarette smoking causes adverse outcomes in people with cancer. However, more research is needed regarding those effects and the effects of alternative tobacco products and of secondhand smoke, the effects of cessation (before diagnosis, during treatment, or during survivorship), the biologic mechanisms, and optimal strategies for tobacco dependence treatment in oncology. Fundamentally, tobacco is an important source of variation in clinical treatment trials. Nevertheless, tobacco use assessment has not been uniform in clinical trials. Progress has been impeded by a lack of consensus regarding tobacco use assessment suitable for cancer patients. The NCI-AACR Cancer Patient Tobacco Use Assessment Task Force identified priority research areas and developed recommendations for assessment items and timing of assessment in cancer research. A cognitive interview study was conducted with 30 cancer patients at the NIH Clinical Center to evaluate and improve the measurement items. The resulting Cancer Patient Tobacco Use Questionnaire (C-TUQ) includes "Core" items for minimal assessment of tobacco use at initial and follow-up time points, and an "Extension" set. Domains include the following: cigarette and other tobacco use status, intensity, and past use; use relative to cancer diagnosis and treatment; cessation approaches and history; and secondhand smoke exposure. The Task Force recommends that assessment occur at study entry and, at a minimum, at the end of protocol therapy in clinical trials. Broad adoption of the recommended measures and timing protocol, and pursuit of the recommended research priorities, will help us to achieve a clearer understanding of the significance of tobacco use and cessation for cancer patients.
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Affiliation(s)
- Stephanie R Land
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland.
| | - Benjamin A Toll
- Hollings Cancer Center, Medical University of South Carolina (MUSC), Charleston, South Carolina
| | - Carol M Moinpour
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Sandra A Mitchell
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | | | - Dorothy K Hatsukami
- Masonic Cancer Center, University of Minnesota (DKH), Minneapolis, Minnesota
| | - Sonia A Duffy
- College of Nursing and VA Center for Clinical Management Research, HSR&D Center of Excellence, The Ohio State University, Columbus, Ohio
| | - Ellen R Gritz
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nancy A Rigotti
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Thomas H Brandon
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, University of South Florida, Tampa, Florida
| | - Sheila A Prindiville
- Coordinating Center for Clinical Trials, National Cancer Institute, Bethesda, Maryland
| | - Linda P Sarna
- School of Nursing, University of California, Los Angeles, California
| | | | - Roy S Herbst
- Yale School of Medicine, Yale Cancer Center, New Haven, Connecticut
| | - Paul M Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Scott J Leischow
- College of Medicine, Mayo Clinic Cancer Center, Mayo Clinic Phoenix, Phoenix, Arizona
| | | | - Michael C Fiore
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Graham W Warren
- Hollings Cancer Center, Medical University of South Carolina (MUSC), Charleston, South Carolina. Department of Radiation Oncology, Medical University of South Carolina (MUSC), Charleston, South Carolina. Department of Cell and Molecular Pharmacology, Medical University of South Carolina (MUSC), Charleston, South Carolina
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22
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Obeidat NA, Ayub HS, Amarin R, Aburajab Altamimi B, Ghonimat I, Abughosh S, Hawari FI. Smoking Cessation Support Among Oncology Practitioners in a Regional Cancer Center in the Middle East-Improving a Critical Service for Cancer Care. Oncologist 2016; 21:503-5. [PMID: 26961922 DOI: 10.1634/theoncologist.2015-0305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/28/2015] [Indexed: 11/17/2022] Open
Affiliation(s)
- Nour A Obeidat
- Cancer Control Office, King Hussein Cancer Center, Amman, Jordan
| | - Hiba S Ayub
- Independent Tobacco Control & Tobacco Dependence Treatment Consultant (private practice), King Hussein Cancer Center, Amman, Jordan
| | - Rula Amarin
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | | | - Iyad Ghonimat
- Respiratory Therapy Services, King Hussein Cancer Center, Amman, Jordan
| | - Susan Abughosh
- College of Pharmacy, University of Houston, Houston, Texas, USA
| | - Feras I Hawari
- Section of Pulmonary and Critical Care, Department of Medicine, King Hussein Cancer Center, Amman, Jordan
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23
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Parker BA, Pierce JP. Importance of Smoking Cessation to Reduce Breast Cancer Mortality. J Clin Oncol 2016; 34:1295-6. [PMID: 26951316 DOI: 10.1200/jco.2015.66.0910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Rojewski AM, Baldassarri S, Cooperman NA, Gritz ER, Leone FT, Piper ME, Toll BA, Warren GW. Exploring Issues of Comorbid Conditions in People Who Smoke. Nicotine Tob Res 2016; 18:1684-96. [PMID: 26783291 DOI: 10.1093/ntr/ntw016] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 01/06/2016] [Indexed: 01/21/2023]
Abstract
UNLABELLED Smoking affects comorbid disease outcomes, and patients with comorbid conditions may have unique characteristics that are important to consider when treating tobacco use. However, addressing tobacco in patients being treated for comorbid conditions is not a consistent practice. Recognizing the need for a "call-to-action" to address tobacco use in people with comorbid conditions, the Tobacco Treatment Network within the Society for Research on Nicotine and Tobacco (SRNT) convened a Comorbidities Workgroup to explore the relationship between smoking and comorbid disease to identify common themes including: the harms associated with continued tobacco use, the frequency of comorbid disease and tobacco use, the potential effect of comorbid disease on the ability to quit tobacco use, the association between tobacco use and suboptimal disease-specific treatment response, and evidence regarding potential approaches to improve addressing tobacco use in patients with comorbid disease. Five candidate conditions (psychiatric, cancer, cardiovascular, pulmonary, and human immunodeficiency virus infected patients) were explored. Across comorbid conditions, smoking adversely affects treatment efficacy and promotes other adverse health conditions. People with comorbid conditions who smoke are motivated to quit and respond to evidence-based smoking cessation treatments. However, tobacco cessation is not regularly incorporated into the clinical care of many individuals with comorbidities. Optimal strategies for addressing tobacco use within each comorbid disease are also not well defined. Further work is needed to disseminate evidence-based care into clinical practice for smokers with comorbid disease and addiction research should consider comorbid conditions as an important construct to explore. IMPLICATIONS This article explores how physical and psychiatric conditions may interact in the treatment of tobacco dependence, and discusses the need for smoking cessation as a critical component of comorbid condition management. Five common comorbid domains-psychiatric, cancer, pulmonary, cardiovascular, and human immunodeficiency virus (HIV)-are highlighted to illustrate how these different conditions might interact with smoking with respect to prevalence and harm, motivation to quit, and cessation treatment utilization and success.
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Affiliation(s)
- Alana M Rojewski
- Department of Psychiatry, Yale School of Medicine, New Haven, CT; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Stephen Baldassarri
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT
| | - Nina A Cooperman
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Ellen R Gritz
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Frank T Leone
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Presbyterian Medical Center, Philadelphia, PA
| | - Megan E Piper
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Benjamin A Toll
- Department of Psychiatry, Yale School of Medicine, New Haven, CT; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC; Department of Cancer Prevention and Control, Yale Cancer Center, New Haven, CT; Tobacco Treatment Service, Smilow Cancer Hospital at Yale-New Haven, New Haven, CT; Tobacco Treatment and Lung Cancer Screening Programs, Hollings Cancer Center, Charleston, SC
| | - Graham W Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC; Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC
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Warren GW, Cummings KM. Tobacco and lung cancer: risks, trends, and outcomes in patients with cancer. Am Soc Clin Oncol Educ Book 2015:359-64. [PMID: 23714547 DOI: 10.14694/edbook_am.2013.33.359] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Tobacco use, primarily associated with cigarette smoking, is the largest preventable cause of cancer mortality, responsible for approximately one-third of all cancer deaths. Approximately 85% of lung cancers result from smoking, with an additional fraction caused by secondhand smoke exposure in nonsmokers. The risk of lung cancer is dose dependent, but can be dramatically reduced with tobacco cessation, especially if the person discontinues smoking early in life. The increase in lung cancer incidence in different countries around in the world parallels changes in cigarette consumption. Lung cancer risks are not reduced by switching to filters or low-tar/low-nicotine cigarettes. In patients with cancer, continued tobacco use after diagnosis is associated with poor therapeutic outcomes including increased treatment-related toxicity, increased risk of second primary cancer, decreased quality of life, and decreased survival. Tobacco cessation in patients with cancer may improve cancer treatment outcomes, but cessation support is often not provided by oncologists. Reducing the health related effects of tobacco requires coordinated efforts to reduce exposure to tobacco, accurately assess tobacco use in clinical settings, and increase access to tobacco cessation support. Lung cancer screening and coordinated international tobacco control efforts offer the promise to dramatically reduce lung cancer mortality in the coming decades.
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Affiliation(s)
- Graham W Warren
- From the Department of Radiation Oncology, Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Department of Psychiatry and Behavioral Sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston SC
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Burris JL, Studts JL, DeRosa AP, Ostroff JS. Systematic Review of Tobacco Use after Lung or Head/Neck Cancer Diagnosis: Results and Recommendations for Future Research. Cancer Epidemiol Biomarkers Prev 2015; 24:1450-61. [PMID: 26282629 PMCID: PMC4592460 DOI: 10.1158/1055-9965.epi-15-0257] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 07/29/2015] [Indexed: 11/16/2022] Open
Abstract
Tobacco use after cancer diagnosis is associated with adverse cancer outcomes, yet reliable prevalence estimates for this behavior are lacking. We conducted a systematic literature review of the prevalence of current tobacco use among individuals with a history of lung or head/neck cancer (CRD #42012002625). An extensive search of electronic databases (MEDLINE, EMBASE, Cochrane Library, CINAHL, PsycINFO, and Web of Science) identified 7,777 potentially relevant articles published between 1980 and 2014 and 131 of these yielded pertinent information. Aggregating results across heterogeneous study designs and diverse patient samples, the overall mean prevalence rate of current tobacco use (mostly cigarette smoking) was 33.0% (median, 31.0%). Among current tobacco users at cancer diagnosis, the mean prevalence rate of current tobacco use (mostly cigarette smoking) was 53.8% (median, 50.3%). In many cases, an operational definition of "current" tobacco use was absent, and biochemical verification of self-reported smoking status was infrequent. These and other observed methodologic limitations in the assessment and reporting of cancer patients' tobacco use underscore the necessity of uniform tobacco use assessment in future clinical research and cancer care.
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Affiliation(s)
- Jessica L Burris
- Lucille P. Markey Cancer Center, Cancer Prevention and Control Program, Lexington, Kentucky. University of Kentucky, Department of Psychology, Lexington, Kentucky.
| | - Jamie L Studts
- Lucille P. Markey Cancer Center, Cancer Prevention and Control Program, Lexington, Kentucky. University of Kentucky, Department of Behavioral Science, Lexington, Kentucky
| | - Antonio P DeRosa
- Memorial Sloan Kettering Cancer Center, Medical Library, New York, New York
| | - Jamie S Ostroff
- Memorial Sloan Kettering Cancer Center, Psychiatry and Behavioral Sciences Service, New York, New York
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Warren GW, Ward KD. Integration of tobacco cessation services into multidisciplinary lung cancer care: rationale, state of the art, and future directions. Transl Lung Cancer Res 2015; 4:339-52. [PMID: 26380175 DOI: 10.3978/j.issn.2218-6751.2015.07.15] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 07/16/2015] [Indexed: 12/31/2022]
Abstract
Tobacco use is the largest risk factor for lung cancer and many lung cancer patients still smoke at the time of diagnosis. Although clinical practice guidelines recommend that all patients receive evidence-based tobacco treatment, implementation of these services in oncology practices is inconsistent and inadequate. Multidisciplinary lung cancer treatment programs offer an ideal environment to optimally deliver effective smoking cessation services. This article reviews best practice recommendations and current status of tobacco treatment for oncology patients, and provides recommendations to optimize delivery of tobacco treatment in multidisciplinary practice.
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Affiliation(s)
- Graham W Warren
- 1 Department of Cell and Molecular Pharmacology and Experimental Therapeutics and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA ; 2 Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Kenneth D Ward
- 1 Department of Cell and Molecular Pharmacology and Experimental Therapeutics and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA ; 2 Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
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Ostroff JS, Goffin JR, Khuri FR, Warren GW. Perspective on the National Comprehensive Cancer Network's Clinical Practice Guidelines for Smoking Cessation. J Oncol Pract 2015; 12:55-8. [PMID: 26374860 DOI: 10.1200/jop.2015.006148] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The new NCCN Smoking Cessation Guidelines represent a critical step in closing research-to-practice gaps, and should help foster successful incorporation of smoking cessation support in cancer care.
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Affiliation(s)
- Jamie S Ostroff
- Memorial Sloan Kettering Cancer Center, New York, NY; Juravinski Cancer Centre, McMaster University, Hamilton, Canada; American University of Beirut, Beirut, Lebanon; and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - John R Goffin
- Memorial Sloan Kettering Cancer Center, New York, NY; Juravinski Cancer Centre, McMaster University, Hamilton, Canada; American University of Beirut, Beirut, Lebanon; and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Fadlo R Khuri
- Memorial Sloan Kettering Cancer Center, New York, NY; Juravinski Cancer Centre, McMaster University, Hamilton, Canada; American University of Beirut, Beirut, Lebanon; and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Graham W Warren
- Memorial Sloan Kettering Cancer Center, New York, NY; Juravinski Cancer Centre, McMaster University, Hamilton, Canada; American University of Beirut, Beirut, Lebanon; and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
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Warren GW. Cigarette smoking and systemic therapy for lung cancer: considering the evidence to improve cancer care. J Thorac Oncol 2015; 9:914-916. [PMID: 24926541 DOI: 10.1097/jto.0000000000000252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Graham W Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC; Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC.
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Gritz ER, Toll BA, Warren GW. Tobacco use in the oncology setting: advancing clinical practice and research. Cancer Epidemiol Biomarkers Prev 2014; 23:3-9. [PMID: 24420982 DOI: 10.1158/1055-9965.epi-13-0896] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although tobacco is a well-established causal agent for many human cancers, less emphasis has been placed on translating this evidence by evaluating the effects of continued tobacco use after a cancer diagnosis. A broad assessment of the effects of continued tobacco use demonstrates that tobacco increases cancer treatment toxicity, recurrence, second primary tumors, and mortality in patients with cancer. Few studies report the potential benefits of cessation after a cancer diagnosis, but data suggest improved treatment outcomes in patients with cancer who quit smoking. Improving tobacco cessation treatment efficacy and access to cessation support has been sparsely researched in the oncology setting compared with the general population; however, patients with cancer are receptive to standard evidence-based tobacco cessation guidelines. Several studies demonstrate moderate tobacco cessation success in patients with cancer using the general principles of evidence-based tobacco cessation support. Several systems-level issues and research efforts are needed to standardize tobacco use definitions, increase access to tobacco cessation support, improve tobacco cessation efficacy, understand the time-dependent effects of tobacco and cessation on cancer biology, and realize the potential benefits of tobacco cessation for patients with cancer.
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Affiliation(s)
- Ellen R Gritz
- Authors' Affiliations: The University of Texas MD Anderson Cancer Center, Houston, Texas; Yale University School of Medicine; Yale Cancer Center; Smilow Cancer Hospital at Yale-New Haven, New Haven, Connecticut; and Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
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Land SR, Liu Q, Wickerham DL, Costantino JP, Ganz PA. Cigarette smoking, physical activity, and alcohol consumption as predictors of cancer incidence among women at high risk of breast cancer in the NSABP P-1 trial. Cancer Epidemiol Biomarkers Prev 2014; 23:823-32. [PMID: 24569437 PMCID: PMC4011972 DOI: 10.1158/1055-9965.epi-13-1105-t] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND NSABP P-1 provides an opportunity to examine the association of behavioral factors with prospectively monitored cancer incidence and interactions with tamoxifen. METHODS From 1992 to 1997, 13,388 women with estimated 5-year breast cancer risk greater than 1.66% or a history of lobular carcinoma in situ (87% younger than age 65; 67% postmenopausal) were randomly assigned to tamoxifen versus placebo. Invasive breast cancer, lung cancer, colon cancer, and endometrial cancer were analyzed with Cox regression. Predictors were baseline cigarette smoking, leisure-time physical activity, alcohol consumption, and established risk factors. RESULTS At median 7 years follow-up, we observed 395, 66, 35, and 74 breast cancer, lung cancer, colon cancer, and endometrial cancer, respectively. Women who had smoked were at increased risk of breast cancer (P = 0.007; HR = 1.3 for 15-35 years smoking, HR = 1.6 for ≥ 35 years), lung cancer (P < 0.001; HR = 3.9 for 15-35 years, HR = 18.4 for ≥ 35 years), and colon cancer (P < 0.001; HR = 5.1 for ≥ 35 years) versus never-smokers. Low activity predicted increased breast cancer risk only among women assigned to placebo (P = 0.021 activity main effect, P = 0.013 activity-treatment interaction; HR = 1.4 for the placebo group) and endometrial cancer among all women (P = 0.026, HR = 1.7). Moderate alcohol (>0-1 drink/day) was associated with decreased risk of colon cancer (P = 0.019; HR = 0.35) versus no alcohol. There were no other significant associations between these behaviors and cancer risk. CONCLUSION Among women with elevated risk of breast cancer, smoking has an even greater impact on breast cancer risk than observed in past studies in the general population. IMPACT Women who smoke or are inactive should be informed of the increased risk of multiple types of cancer.
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Affiliation(s)
- Stephanie R. Land
- National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers, Pittsburgh, PA
- Division of Cancer Control and Population Sciences, Behavioral Research Program, National Cancer Institute, Bethesda, MD
| | - Qing Liu
- National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers, Pittsburgh, PA
- Dept of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - D. Lawrence Wickerham
- National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers, Pittsburgh, PA
- Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Joseph P. Costantino
- National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers, Pittsburgh, PA
- Dept of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Patricia A. Ganz
- National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers, Pittsburgh, PA
- UCLA Schools of Medicine and Public Health, and Division of Cancer Prevention & Control Research, Jonsson Comprehensive Cancer Center, Los Angeles, CA
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Warren GW, Alberg AJ, Kraft AS, Cummings KM. The 2014 Surgeon General's report: "The health consequences of smoking--50 years of progress": a paradigm shift in cancer care. Cancer 2014; 120:1914-6. [PMID: 24687615 DOI: 10.1002/cncr.28695] [Citation(s) in RCA: 205] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 01/30/2014] [Accepted: 02/03/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Graham W Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina; Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, South Carolina; Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
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Balogh EP, Dresler C, Fleury ME, Gritz ER, Kean TJ, Myers ML, Nass SJ, Nevidjon B, Toll BA, Warren GW, Herbst RS. Reducing tobacco-related cancer incidence and mortality: summary of an institute of medicine workshop. Oncologist 2014; 19:21-31. [PMID: 24304712 PMCID: PMC3903060 DOI: 10.1634/theoncologist.2013-0230] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 09/24/2013] [Indexed: 11/17/2022] Open
Abstract
Tobacco use remains a serious and persistent national problem. Recognizing that progress in combating cancer will never be fully achieved without addressing the tobacco problem, the National Cancer Policy Forum of the Institute of Medicine convened a public workshop exploring current issues in tobacco control, tobacco cessation, and implications for cancer patients. Workshop participants discussed potential policy, outreach, and treatment strategies to reduce tobacco-related cancer incidence and mortality, and highlighted a number of potential high-value action items to improve tobacco control policy, research, and advocacy.
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Warren GW, Marshall JR, Cummings KM, Zevon MA, Reed R, Hysert P, Mahoney MC, Hyland AJ, Nwogu C, Demmy T, Dexter E, Kelly M, O'Connor RJ, Houstin T, Jenkins D, Germain P, Singh AK, Epstein J, Dobson Amato KA, Reid ME. Automated tobacco assessment and cessation support for cancer patients. Cancer 2013; 120:562-9. [PMID: 24496870 DOI: 10.1002/cncr.28440] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 05/28/2013] [Accepted: 05/30/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Tobacco assessment and cessation support are not routinely included in cancer care. An automated tobacco assessment and cessation program was developed to increase the delivery of tobacco cessation support for cancer patients. METHODS A structured tobacco assessment was incorporated into the electronic health record at Roswell Park Cancer Institute to identify tobacco use in cancer patients at diagnosis and during follow-up. All patients who reported tobacco use within the past 30 days were automatically referred to a dedicated cessation program that provided cessation counseling. Data were analyzed for referral accuracy and interest in cessation support. RESULTS Between October 2010 and December 2012, 11,868 patients were screened for tobacco use, and 2765 were identified as tobacco users and were referred to the cessation service. In referred patients, 1381 of those patients received only a mailed invitation to contact the cessation service, and 1384 received a mailing as well as telephone contact attempts from the cessation service. In the 1126 (81.4%) patients contacted by telephone, 51 (4.5%) reported no tobacco use within the past 30 days, 35 (3.1%) were medically unable to participate, and 30 (2.7%) declined participation. Of the 1381 patients who received only a mailed invitation, 16 (1.2%) contacted the cessation program for assistance. Three questions at initial consult and follow-up generated over 98% of referrals. Tobacco assessment frequency every 4 weeks delayed referral in < 1% of patients. CONCLUSIONS An automated electronic health record-based tobacco assessment and cessation referral program can identify substantial numbers of smokers who are receptive to enrollment in a cessation support service.
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Affiliation(s)
- Graham W Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina; Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, South Carolina; Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York
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Rajendiran S, Kashyap MV, Vishwanatha JK. Intersection of Smoking, Human immunodeficiency virus/acquired immunodeficiency syndrome and Cancer: Proceedings of the 8(th) Annual Texas Conference on Health Disparities. J Carcinog 2013; 12:18. [PMID: 24227993 PMCID: PMC3814655 DOI: 10.4103/1477-3163.119388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 07/20/2013] [Indexed: 11/04/2022] Open
Abstract
The Texas Center for Health Disparities, a National Institute on Minority Health and Health Disparities Center of Excellence, presents an annual conference to discuss prevention, awareness education and ongoing research about health disparities both in Texas and among the national population. The 2013 Texas Conference on Health Disparities brought together experts, in research, patient care and community outreach, on the "Intersection of Smoking, Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and Cancer". Smoking, HIV/AIDS and cancer are three individual areas of public health concern, each with its own set of disparities and risk factors based on race, ethnicity, gender, geography and socio-economic status. Disparities among patient populations, in which these issues are found to be comorbid, provide valuable information on goals for patient care. The conference consisted of three sessions addressing "Comorbidities and Treatment", "Public Health Perspectives", and "Best Practices". This article summarizes the basic science, clinical correlates and public health data presented by the speakers.
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Affiliation(s)
- Smrithi Rajendiran
- Texas Center for Health Disparities and The Institute for Cancer Research, UNT Health Science Center, Fort Worth, Texas, USA
| | | | - Jamboor K. Vishwanatha
- Texas Center for Health Disparities and The Institute for Cancer Research, UNT Health Science Center, Fort Worth, Texas, USA,Corresponding author
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Hanna N, Mulshine J, Wollins DS, Tyne C, Dresler C. Tobacco Cessation and Control a Decade Later: American Society of Clinical Oncology Policy Statement Update. J Clin Oncol 2013; 31:3147-57. [DOI: 10.1200/jco.2013.48.8932] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nasser Hanna
- Nasser Hanna, Indiana University Health Simon Cancer Center, Indianapolis, IN; James Mulshine, Rush University Medical Center, Chicago, IL; Dana S. Wollins and Courtney Tyne, American Society of Clinical Oncology, Alexandria, VA; and Carolyn Dresler, Arkansas Department of Health, Little Rock, AR
| | - James Mulshine
- Nasser Hanna, Indiana University Health Simon Cancer Center, Indianapolis, IN; James Mulshine, Rush University Medical Center, Chicago, IL; Dana S. Wollins and Courtney Tyne, American Society of Clinical Oncology, Alexandria, VA; and Carolyn Dresler, Arkansas Department of Health, Little Rock, AR
| | - Dana S. Wollins
- Nasser Hanna, Indiana University Health Simon Cancer Center, Indianapolis, IN; James Mulshine, Rush University Medical Center, Chicago, IL; Dana S. Wollins and Courtney Tyne, American Society of Clinical Oncology, Alexandria, VA; and Carolyn Dresler, Arkansas Department of Health, Little Rock, AR
| | - Courtney Tyne
- Nasser Hanna, Indiana University Health Simon Cancer Center, Indianapolis, IN; James Mulshine, Rush University Medical Center, Chicago, IL; Dana S. Wollins and Courtney Tyne, American Society of Clinical Oncology, Alexandria, VA; and Carolyn Dresler, Arkansas Department of Health, Little Rock, AR
| | - Carolyn Dresler
- Nasser Hanna, Indiana University Health Simon Cancer Center, Indianapolis, IN; James Mulshine, Rush University Medical Center, Chicago, IL; Dana S. Wollins and Courtney Tyne, American Society of Clinical Oncology, Alexandria, VA; and Carolyn Dresler, Arkansas Department of Health, Little Rock, AR
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Warren GW, Marshall JR, Cummings KM, Toll BA, Gritz ER, Hutson A, Dibaj S, Herbst R, Mulshine JL, Hanna N, Dresler CA. Addressing tobacco use in patients with cancer: a survey of American Society of Clinical Oncology members. J Oncol Pract 2013; 9:258-62. [PMID: 23943904 DOI: 10.1200/jop.2013.001025] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Assessing tobacco use and providing cessation support is recommended by the American Society for Clinical Oncology (ASCO). The purpose of this study was to evaluate practice patterns and perceptions of tobacco use and barriers to providing cessation support for patients with cancer. METHODS In 2012, an online survey was sent to 18,502 full ASCO members asking about their practice patterns regarding tobacco assessment, cessation support, perceptions of tobacco use, and barriers to providing cessation support for patients with cancer. Responses from 1,197 ASCO members are reported. RESULTS At initial visit, most respondents routinely ask patients about tobacco use (90%), ask patients to quit (80%), and advise patients to stop using tobacco (84%). However, only 44% routinely discuss medication options with patients, and only 39% provide cessation support. Tobacco assessments decrease at follow-up assessments. Most respondents (87%) agree or strongly agree that smoking affects cancer outcomes, and 86% believe cessation should be a standard part of clinical cancer care. However, only 29% report adequate training in tobacco cessation interventions. Inability to get patients to quit (72%) and patient resistance to treatment (74%) are dominant barriers to cessation intervention, but only 8% describe cessation as a waste of time. CONCLUSION Among ASCO members who responded to an online survey about their practice patterns regarding tobacco, most believe that tobacco cessation is important and frequently assess tobacco at initial visit, but few provide cessation support. Interventions are needed to increase access to tobacco cessation support for patients with cancer.
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Affiliation(s)
- Graham W Warren
- Medical University of South Carolina, Charleston, SC; Roswell Park Cancer Institute, Buffalo, NY; Yale School of Medicine, Yale Cancer Center, New Haven, CT; University of Texas MD Anderson Cancer Center, Houston, TX; Rush University, Chicago, IL; Indiana University School of Medicine, Indianapolis, IN; and Arkansas Department of Health, Little Rock, AR
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Health-related quality of life after surgical treatment in patients with non-small cell lung cancer: A systematic review. Lung Cancer 2013; 81:11-26. [DOI: 10.1016/j.lungcan.2013.03.013] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 03/08/2013] [Accepted: 03/11/2013] [Indexed: 11/20/2022]
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Toll BA, Brandon TH, Gritz ER, Warren GW, Herbst RS. Assessing tobacco use by cancer patients and facilitating cessation: an American Association for Cancer Research policy statement. Clin Cancer Res 2013; 19:1941-8. [PMID: 23570694 DOI: 10.1158/1078-0432.ccr-13-0666] [Citation(s) in RCA: 158] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
When diagnosed with cancer, patients can immediately make a meaningful positive impact on their health by stopping their tobacco use. Scientific evidence clearly shows that tobacco use in patients with cancer leads to poorer outcomes. The specific biological processes driving tobacco consumption's interference in cancer therapy are the subject of continuing research, but the evidence is clear that tobacco use in patients with cancer leads to decreased treatment efficacy and safety, decreased survival, decreased quality of life, increased treatment-related toxicity, and increased risk of cancer recurrence and second primary tumors. Data suggest that tobacco cessation can improve outcomes and survival in patients with cancer, yet full execution of evidence-based cessation interventions is infrequent in oncology settings. Therefore, both improved provision of cessation assistance to all patients with cancer who use tobacco or have recently quit and further study of the deleterious effects of tobacco use and benefits of tobacco cessation on cancer progression and treatment are needed and recommended by the American Association for Cancer Research. Progress on both fronts begins with universal assessment and documentation of tobacco use as a standard of quality cancer care regardless of treatment setting and will be further facilitated through the development of reliable, valid, and standard measures of tobacco use, incorporation of evidence-based procedures into quality and accreditation procedures, and the development of appropriate training, clinical infrastructure, and incentives for delivery of tobacco cessation interventions.
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Affiliation(s)
- Benjamin A Toll
- Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
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Improving cancer clinical trial design and clinical practice: the case for tobacco use in cancer patients. ACTA ACUST UNITED AC 2013. [DOI: 10.4155/cli.12.156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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