A snapshot of smokers after lung and colorectal cancer diagnosis

Authors

  • Elyse R. Park PhD, MPH,

    Corresponding author
    1. Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts
    2. Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
    3. Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
    • Massachusetts General Hospital, 50 Staniford Street, Suite 901, Boston, MA 02114

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    • Fax: (617) 724-4738

  • Sandra J. Japuntich PhD,

    1. Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts
    2. Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
    3. Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
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  • Nancy A. Rigotti MD,

    1. Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts
    2. Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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  • Lara Traeger PhD,

    1. Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
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  • Yulei He PhD,

    1. Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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  • Robert B. Wallace MD,

    1. Department of Epidemiology, The University of Iowa, Iowa City, Iowa
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  • Jennifer L. Malin MD,

    1. David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
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  • Jennifer P. Zallen BA,

    1. Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts
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  • Nancy L. Keating MD, MPH

    1. Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
    2. Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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  • See editorial on pages 3012–13, this issue.

Abstract

BACKGROUND:

Continued smoking after a cancer diagnosis may adversely affect treatment effectiveness, subsequent cancer risk, and survival. The prevalence of continued smoking after cancer diagnosis is understudied.

METHODS:

In the multi-regional Cancer Care Outcomes Research and Surveillance cohort (lung cancer [N = 2456], colorectal cancer [N = 3063]), the authors examined smoking rates at diagnosis and 5 months after diagnosis and also study factors associated with continued smoking.

RESULTS:

Overall, 90.2% of patients with lung cancer and 54.8% of patients with colorectal cancer reported ever smoking. At diagnosis, 38.7% of patients with lung cancer and 13.7% of patients with colorectal cancer were smoking; whereas, 5 months after diagnosis, 14.2% of patients with lung cancer and 9.0% of patients with colorectal cancer were smoking. Factors that were associated independently with continued smoking among patients with nonmetastatic lung cancer were coverage by Medicare, other public/unspecified insurance, not receiving chemotherapy, not undergoing surgery, prior cardiovascular disease, lower body mass index, lower emotional support, and higher daily ever-smoking rates (all P < .05). Factors that were associated independently with continued smoking among patients with nonmetastatic colorectal cancer were male sex, high school education, being uninsured, not undergoing surgery, and higher daily ever-smoking rates (all P < .05).

CONCLUSIONS:

After diagnosis, a substantial minority of patients with lung and colorectal cancers continued smoking. Patients with lung cancer had higher rates of smoking at diagnosis and after diagnosis; whereas patients with colorectal cancer were less likely to quit smoking after diagnosis. Factors that were associated with continued smoking differed between lung and colorectal cancer patients. Future smoking-cessation efforts should examine differences by cancer type, particularly when comparing cancers for which smoking is a well established risk factor versus cancers for which it is not. Cancer 2012;118: 3153–64. © 2012 American Cancer Society.

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