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Smoking after cancer diagnosis raises men's risk of death

Monday December 9, 2013
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A study of China residents quantified the higher risk of death men face if they continue to smoke after a cancer diagnosis.

Compared with men who did not smoke after a cancer diagnosis, those who smoked after diagnosis had a 59% increase in risk of death from all causes, after researchers adjusted for factors including age, cancer site and treatment type.

When limited to men who were smokers at diagnosis, those who continued smoking after diagnosis had a 79% increase in risk of death from all causes compared with those who quit smoking after a diagnosis, researchers reported Dec. 6 on the website of the journal Cancer Epidemiology, Biomarkers & Prevention.

“Many cancer patients and their healthcare providers assume that it is not worth the effort to stop smoking at a time when the damage from smoking has already been done, considering these patients have been diagnosed with cancer,” Li Tao, MD, MS, PhD, epidemiologist at the Cancer Prevention Institute of California in Fremont, said in a news release.

“Our study provides evidence of the impact of postdiagnosis smoking on survival after cancer, and assists in addressing the critical issue of tobacco control in cancer survivorship.”

When cancer patients who continued smoking after diagnosis were compared with cancer patients who quit smoking after diagnosis, the risk of death varied with different cancer organ sites: Risk of death increased by 2.95-fold for bladder cancer patients who continued smoking, 2.36-fold for lung cancer patients who continued smoking and 2.31-fold for colorectal cancer patients who continued smoking.

“As far as we know, only a fraction of cancer patients who are smokers at diagnosis receive formal smoking cessation counseling from their physicians or healthcare providers at the time of diagnosis and treatment, and less than half of these patients eventually quit smoking after the diagnosis,” Tao said. “Therefore, there is considerable room for improvement with regard to tobacco control in the postdiagnosis setting for the growing population of cancer survivors.

“Compared with the general population, cancer patients are more likely to receive treatment on an inpatient basis or prolonged outpatient visits. Healthcare providers have an important ‘window of teachable moment’ to engage in tobacco-use counseling during these visits."

Tao and colleagues studied 1,632 incident cancer patients in the Shanghai Cohort Study, a population-based prospective cohort of 18,244 men in Shanghai. Participants were ages 45 to 64 and completed an in-person, interview-based questionnaire about demographics, history of tobacco and alcohol use, diet and medical history. Data were updated on an annual basis for all surviving cohort members.

Of the eligible study participants, 931 died from any cause. In addition, 340 were nonsmokers, 545 quit smoking before a cancer diagnosis and 747 were smokers at diagnosis.

Of the 747 smokers at diagnosis, 214 quit after diagnosis, 197 continued smoking consistently and the remaining 336 smoked intermittently.

The study was funded by the United States Public Health Service Grants. Cancer Epidemiology, Biomarkers & Prevention is a journal of the American Association for Cancer Research.

Study abstract: http://cebp.aacrjournals.org/content/22/12/2404.abstract


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