Smoking at or following a cancer diagnosis increases both all-cause and cancer-specific mortality, as well as risk for disease progression and tobacco-related second primary cancers. Across various cancer types, continuing to smoke increased the risk of overall mortality by a median rate of 50% and cancer-related mortality by a median rate of 61%. The adverse effects of smoking on cancer treatment outcomes and costs are observed across cancer disease types.
Using a prospective cohort study design, the MD Anderson Cancer Center Tobacco Research and Treatment Program (TRTP) evaluated the survival outcomes associated with smoking cessation among 6593 currently smoking patients who underwent tobacco treatment. The primary analytic sample consisted of 4526 patients patients diagnosed with cancer and receiving tobacco treatment within 6 months, from 6 months to 5 years, and more than 5 years after diagnosis. The TRTP treatment provided personalized interventions, including cognitive behavioral counseling, motivational interviewing, and pharmacotherapy. Medications included nicotine replacement therapy (eg, nicotine patches, gum, and lozenges), bupropion, and varenicline, either as monotherapies or in various combinations. Treatment occurred between January 1, 2006, and March 3, 2022. Patients were excluded if they died before the tobacco treatment ended, received their diagnosis more than 6 months after beginning cessation treatment, or lacked staging information. The data analysis took place from September 2023 to May 2024. The optimal survival outcomes were observed for patients who received tobacco treatment within 6 months of a cancer diagnosis.
Among patients with cancer entering the TRTP within 6 months of diagnosis, survival at the 75th percentile increased from 2.1 years among nonabstainers vs 3.9 years for abstainers. Among patients entering TRTP between 6 months and 5 years from diagnosis, survival at the 75th percentile was 4.8 years for nonabstainers vs 6.0 years for abstainers.
This cohort study provided clear evidence that quitting smoking at or following a cancer diagnosis improves survival across various types of cancer. The largest benefit was noted among patients who entered the TRTP within 6 months of diagnosis, with 1.8 years of added life (75th survival percentile) among patients abstinent at 3 months. Data also demonstrated that smoking cessation, regardless of time of entry, was associated with improved survival: abstinence at 3 months, 6 months, and 9 months after tobacco treatment onset reduced mortality across all cancer types by 26%, 22%, and 16%, respectively.
This study, (1) provides the strongest evidence to date of the importance of receiving evidence-based tobacco treatment as early as possible following a cancer diagnosis. The positive impact of cessation was observed across a broad cancer cohort even after adjustment for age, stage, gender, and diagnosis. A lesser impact was noted among patients receiving tobacco treatment more than 6 months from diagnosis. The results show a clear, consistent, and robust improvement in survival by an earlier entry into tobacco treatment after a cancer diagnosis.
Ensuring that all patients with cancer who smoke have access to smoking cessation treatment can optimize the effectiveness of cancer treatments and contribute to a substantial benefit in survival, in addition to improved non–cancer-related health outcomes. The results of this study suggest that early entry into tobacco treatment is associated with the best survival outcomes and justifies the need to prioritize tobacco cessation as a core element of first-line cancer care.
