Highlights
- •Smoking cessation yields considerable survival benefits in cancer surviving nurses.
- •Cancer-diagnosed nurses (vs cancer-free) hold increased chance of smoking cessation.
- •The time around cancer diagnosis may offer a teachable moment for smoking cessation.
- •Ongoing priority should be given to smoking cessation in oncology care.
Abstract
Purpose
To explore smoking cessation between cancer survivors and cancer-free women, and the
potential survival benefits from smoking cessation in cancer surviving women.
Method
We pooled 46,334 responses from the Danish Nurse Cohort. The cohort consists of female
nurses, who were invited for surveys in 1993, 1999 and 2009. Participants were linked
to nationwide registries on hospitalization, cause of death and migration through
2016. Odds for smoking cessation by cancer diagnosis were computed in propensity score
matched logistic regression models, while survival by postdiagnosis smoking cessation
was estimated in cox proportional hazards models.
Results
Eligible for analysis were 7841 women (mean age = 56.7 years, SD ± 7.2), who were
smokers at baseline and survived to the next follow-up survey. Of these, 545 women
were diagnosed with cancer and matched by propensity score (1:2) with 1090 cancer-free
women. Odds for smoking cessation were significantly higher in cancer-diagnosed women
compared to their cancer-free peers (OR = 1.31, 95% CI: 1.06–1.61). Moreover, mortality
risk was significantly lower among cancer survivors who stopped smoking (HR = 0.64,
95% CI: 0.46–0.91), compared to persistent smokers.
Conclusions
The results suggest considerable survival benefits from smoking cessation in cancer
surviving female nurses, and that the time surrounding cancer diagnosis may serve
as a teachable moment for smoking cessation. However, due to substantial methodological
limitations embedded in the study, careful interpretation of the presented results
is warranted. Future studies are needed to demonstrate the effects of diagnosis on
smoking cessation as well as the effects of smoking cessation on survival in female
cancer populations.
Keywords
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References
- Women and smoking: the effect of gender on the epidemiology, health effects, and cessation of smoking.Curr. Addict. Reports. 2014; 1: 53-60https://doi.org/10.1007/s40429-013-0003-6
- Statistical criteria for selecting the optimal number of untreated subjects matched to each treated subject when using many-to-one matching on the propensity score.Am. J. Epidemiol. 2010; 172: 1092-1097https://doi.org/10.1093/aje/kwq224
- Changes in body mass index and alcohol and tobacco consumption among breast cancer survivors and cancer-free women: A prospective study in the Danish Diet, Cancer and Health Cohort.Acta Oncologica. 2013; 52: 327-335https://doi.org/10.3109/0284186X.2012.746466
- Grasping the “teachable moment”: time since diagnosis, symptom burden and health behaviors in breast, colorectal and prostate cancer survivors.Psycho Oncol. 2015; 24: 1250-1257https://doi.org/10.1002/pon.3857
- Systematic review of tobacco use after lung or head/neck cancer diagnosis: results and recommendations for future research.Cancer Epidemiol. Biomark. Prev. 2015; 24: 1450-1461https://doi.org/10.1158/1055-9965.EPI-15-0257
- Cox Regression Using Different Time-Scales.1995 ([WWW Document])
- Factors associated with continued smoking after treatment of oral cavity cancer: an age and survival time-matched study.J. Adv. Nurs. 2018; 74: 926-934https://doi.org/10.1111/jan.13506
- Addressing a Core gap in cancer care — the NCI moonshot program to help oncology patients stop smoking.N. Engl. J. Med. 2019; 380: 512-515https://doi.org/10.1056/NEJMp1813913
- Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer.J. Clin. Oncol. 2005; 23: 5814-5830https://doi.org/10.1200/JCO.2005.01.230
- Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1659-1724https://doi.org/10.1016/S0140-6736(16)31679-8
- Sex differences in smoking constructs and abstinence: the explanatory role of smoking outcome expectancies.Psychol. Addict. Behav. 2018; 32: 660-669https://doi.org/10.1037/adb0000391
- Joint tobacco smoking and alcohol intake exacerbates cancer risk in women– the Danish nurse cohort.Eur. J. Oncol. Nurs. 2019; 43https://doi.org/10.1016/j.ejon.2019.101675
- MatchIt: Nonparametric Preprocessing for Parametric Causal Inference.JSS Journal of Statistical Software, 2011
- Cohort profile: the Danish nurse cohort.Int. J. Epidemiol. 2012; 41: 1241-1247https://doi.org/10.1093/ije/dyr042
- List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 121.IARC Monogr. Eval. Carcinog. Risks Hum. 2018; 1–121: 1-12
- A Review of Human Carcinogens. Part E: Personal Habits and Indoor Combustions.International Agency for Research on Cancer, 2012
- Tobacco cessation in oncology care.Oncology. 2018; 95: 129-137https://doi.org/10.1159/000489266
- Alcohol and tobacco use prediagnosis and postdiagnosis, and survival in a cohort of patients with early stage cancers of the oral cavity, pharynx, and larynx.Cancer Epidemiol. Biomark. Prev. 2009; 18: 3368-3374https://doi.org/10.1158/1055-9965.EPI-09-0944
- Impact of prediagnostic smoking and smoking cessation on colorectal cancer prognosis: a meta-analysis of individual patient data from cohorts within the CHANCES consortium.Ann. Oncol. 2018; 29: 472-483https://doi.org/10.1093/annonc/mdx761
- Preventive health in cancer survivors: what should we Be recommending?.J. Natl. Compr. Canc. Netw. 2018; 16: 1251-1258https://doi.org/10.6004/jnccn.2018.7083
- Postdiagnosis changes in cigarette smoking and survival following breast cancer.JNCI cancer Spectr. 2017; 1 (pkx001)https://doi.org/10.1093/jncics/pkx001
- Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: systematic review of observational studies with meta-analysis.Br. Med. J. 2010; 340: 55-69https://doi.org/10.1136/bmj.b5569
- Change in alcohol and tobacco consumption after a diagnosis of head and neck cancer: findings from head and neck 5000.Head Neck. 2018; 40: 1389-1399https://doi.org/10.1002/hed.25116
- Tobacco use assessment and treatment in cancer patients: a scoping review of oncology care clinician adherence to clinical practice guidelines in the.U.S. Oncol. 2019; 24: 229-238https://doi.org/10.1634/theoncologist.2018-0246
- 2018. R: A Language and Environment for Statistical Computing.R Foundation for Statistical Computing, Vieanna, Austria2018 ([WWW Document]. URL)
- Smoking, cessation, and cessation counseling in patients with cancer: a population-based analysis.Cancer. 2016; 122: 1247-1253https://doi.org/10.1002/cncr.29851
- Cancer survivorship: rethinking the cancer control continuum.Semin. Oncol. Nurs. 2008; 24: 145-152https://doi.org/10.1016/j.soncn.2008.05.002
- Sex/gender differences in smoking cessation: a review.Prev. Med. 2016; 92: 135-140https://doi.org/10.1016/j.ypmed.2016.07.013
- Toward a health-promoting system for cancer survivors: patient and provider multiple behavior change.Health Psychol. 2019; 38: 840-850https://doi.org/10.1037/hea0000760
- World Cancer Report 2014, ©International Agency for Research on Cancer World Health Organization.WHO Press, 2014
- The impact of psychosocial characteristics in predicting smoking cessation in long-term cancer survivors: a time-to-event analysis.Psycho Oncol. 2018; 27: 2458-2465https://doi.org/10.1002/pon.4851
- Danskernes rygevaner - årsrapport 2018 [WWW document].(Sundhedsstyrelsen) (4.7.20)
- Danskernes rygevaner: udviklingen fra 1994 til 2017 [WWW Document].(Statens Inst. Folk. SDU) (4.7.20)
- Introduction to Danish (nationwide) registers on health and social issues: structure, access, legislation, and archiving.Scand. J. Publ. Health. 2011; 39: 12-16https://doi.org/10.1177/1403494811399956
- Assessing tobacco use by cancer patients and facilitating cessation: an American association for cancer research policy statement AACR tobacco and cancer subcommittee HHS public access.Clin. Canc. Res. 2013; 19: 1941-1948https://doi.org/10.1158/1078-0432.CCR-13-0666
- Disparities in smoking and cessation status among cancer survivors and non-cancer individuals: a population-based study from National Health and Nutrition Examination Survey.J. Canc. Surviv. 2010; 4: 313-321https://doi.org/10.1007/s11764-010-0127-9
- The biological and clinical effects of smoking by patients with cancer and strategies to implement evidence-based tobacco cessation support.Lancet Oncol. 2014; 15: e568-e580https://doi.org/10.1016/S1470-2045(14)70266-9
- Active smoking and mortality among colorectal cancer survivors: the cancer prevention study II nutrition cohort.J. Clin. Oncol. 2015; 33: 885-893https://doi.org/10.1200/JCO.2014.58.3831
Article info
Publication history
Published online: July 15, 2020
Accepted:
June 30,
2020
Received in revised form:
June 29,
2020
Received:
November 22,
2019
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.