Self-reported cigarette smoking abstinence rates of more than 40% were observed at 9-month follow-up for people with or without a diagnosis of cancer in a study that evaluated the effectiveness of a comprehensive, intensive smoking cessation program. The findings from this study were published in JAMA Network Open.1

There is evidence showing that continuation of cigarette smoking following a cancer diagnosis is associated with increases in all-cause mortality and cancer-specific mortality, as well as increased risks of experiencing adverse effects from cancer treatment and developing a second primary cancer.1,2  Conversely, cessation of cigarette smoking in patients with a diagnosis of cancer has been associated with benefits “that equal or exceed those of the best cancer treatments available,”1 leading effective smoking treatment cessation plans to be called “the fourth pillar of comprehensive cancer care.”2

This study evaluated smoking cessation rates in a cohort of people with and without cancer participating in a comprehensive tobacco cessation program involving “personalized intensive counseling and proactive pharmacologic management” that was implemented at M.D. Anderson Cancer Center in Houston, Texas.

Specific elements of the smoking cessation program included an initial in-person consultation lasting 60 to 90 minutes followed by 6 to 8 treatment sessions lasting 30 to 45 minutes that were conducted over the phone during an 8- to 12-week period.  Additional psychological or psychiatric counseling was provided for participants with related mental health conditions or other psychosocial concerns. Most participants received 10 to 12 weeks of pharmacotherapy with nicotine replacement therapy, bupropion, and/or varenicline, either alone or in combination. Post-consultation follow-up was conducted at 3, 6, and 9 months. The primary study end point was the percentage of participants who reported no smoking in the previous 7 days at 9-month follow-up assessment.

Of the 2652 participants in the analysis, 2343 currently had cancer, 309 had a history of cancer, and 595 did not have cancer, and included employees of the cancer center and people who underwent cancer screening.

Baseline characteristics of the study population included a mean age of 54 years; 48.9% were men; 76.0%, 9.9%, and 5.3% were of white, black, and Hispanic race/ethnicity, respectively; and 42.9% had 1 or more psychiatric comorbidity. The median number of cigarettes smoked per day was 17 and the mean number of smoking years was 33.

For the overall study cohort, self-reported smoking abstinence rates were 45.1%, 45.8%, and 43.7% at 3, 6, and 9 months, respectively. Interestingly, there were no significant differences in self-reported abstinence rates between people with cancer and those without cancer. Furthermore, study participants with smoking-related and non-smoking related cancers had similar 9-month smoking abstinence rates, with the exception of those with head and neck cancers where smoking abstinence rates were higher.

“Our study results suggest that providing comprehensive tobacco treatment in the oncologic setting may result in sustained high abstinence rates for all patients with cancer and survivors and recommend that this intervention be included as standard of care to ensure the best possible cancer treatment outcomes,” the researchers wrote.

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However, authors of an accompanying commentary cautioned that “the promise of such successful smoking treatment will not be realized unless the treatment is adopted and supported by key oncology and health care stakeholders, and it achieves good reach into the population of patients with cancer who smoke.”

References

1. Cinciripini PM, Karam-Hage M, Kypriotakis G, et al. Association of a comprehensive smoking cessation program with smoking abstinence among patients with cancer. JAMA Netw Open. 2019;2(9):e1912251.

2. Fiore MC, D’Angelo H, Baker T. Effective cessation treatment for patients with cancer who smoke-the fourth pillar of cancer care. JAMA Netw Open. 2019;2(9):e1912264.