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Systematic review of smoking relapse rates among cancer survivors who quit at the time of cancer diagnosis

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Title :Systematic review of smoking relapse rates among cancer survivors who quit at the time of cancer diagnosis
Author: Zachary Feuer a, Jamie Michael b, Elizabeth Morton c, Richard S. Matulewicz d,Paschal Sheeran e,f, Kimberly Shoenbill f,g,h
, Adam Goldstein f,g, Scott Sherman i, MarcA. Bjurlin f,j,
Publication: Cancer Epidemiology
Publisher: Elsevier Inc
Year: 2022
Language: English
Pages: 9
Format: PDF
File size: 1,470 KB
DOI: 10.1016/j.canep.2022.102237
CBID: CBR190

Categories: Researches, Medical Researches Tag: Systematic review of smoking relapse rates among cancer survivors who quit at the time of cancer diagnosis

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Abstract

Background

Tobacco cessation, at the time of cancer diagnosis, has been associated with better oncologic outcomes. Cancer diagnosis has been shown to serves as a “teachable moment,” inspiring tobacco cessation. However, the sustainability of abstinence from smoking is understudied. Similarly, there is a paucity of data regarding the utility of behavioral/pharmacologic intervention to support continued smoking cessation.

Methods

A systematic literature review was conducted in August 2021 with no date limits. Relevant studies that reported tobacco smoking relapse rates for patients who quit at the time of cancer diagnosis were included. Our literature search identified 1620 articles and 29 met inclusion criteria. The primary endpoint of the study was smoking relapse rate. Secondary outcome was a descriptive assessment of behavioral and pharmacologic interventions to promote continued cessation. Exploratory outcomes included a regression analysis to examine associations between study factors and relapse rates.

Results

There were 3021 smokers who quit at the time of cancer diagnosis. Weighted overall relapse rate for the study population was 44 % (range 5–57 %). Interventions to support smoking cessation were employed in 17 of the 29 included studies and protocols were heterogenous, including behavioral, pharmacologic, or mixed intervention strategies. Exploratory analysis demonstrated no association between relapse rates and publication year, gender, or study type. Relapse rates were indirectly associated with age (p = .003), suggesting that younger patients were more likely to relapse.

Conclusion

The sustainability of smoking cessation after a cancer diagnosis is understudied, and existing literature is difficult to interpret due to heterogeneity. Relapse rates remain significant and, although many studies have included the employment of an intervention to promote continued cessation, few studies have measured the effect of a protocolized intervention to support abstinence.

Highlights

• The sustainability of smoking cessation after a cancer diagnosis is understudied.
• Relapse rates remain significant where weighted overall relapse rate for the study population was 44 %
• There was no association between relapse rates and publication year, gender, or study type.
• Relapse rates were indirectly associated with age (p = .003), suggesting that younger patients were more likely to relapse.

1Introduction

Tobacco use is associated with increased risk of many cancers. Smoking cessation after cancer diagnosis has the potential to lower risk of recurrence, progression, surgical complications, and disease-specific mortality . The diagnosis of cancer serves as a ‘teachable moment’ at which time patients are more likely to quit . For patients with a newly diagnosed smoking-related cancer, tobacco cessation rates range from 48 % to 86 % . This is substantially higher than rates reported in the general population, which range from 2 % to 10 % . Furthermore, studies have shown that tobacco cessation can be more successful with interventions such as counseling and nicotine replacement treatment, and for those with substantial social support .

Although cancer diagnosis can provide additional motivation for smoking cessation, tobacco dependence is a chronic illness that often requires repeated cessation attempts and sustained smoking cessation is challenging. As a result, patients frequently relapse . Previous studies have demonstrated that despite initial cessation after initial cancer diagnosis, many patients relapse, implying that this initial event is not a sustainable motivator . However, these studies are often small, single-institution studies with heterogenous methodology, and therefore, difficult to interpret in the context of the general population. Factors such as negative mood, cravings, and withdrawal symptoms have been reported as contributors to relapse in the general population . Patients harboring a new cancer diagnosis may be more prone to smoking relapse secondary to cancer-associated stressors such as depression and anxiety attributed to cancer recurrence .

Prior studies have assessed the utility of interventions to promote smoking cessation amongst cancer survivors . However, a paucity of data exists that quantifies the sustainability of smoking cessation in the initial period after a cancer diagnosis. The primary objective of this review is to investigate current literature to determine the rates of smoking relapse among patients who have quit smoking following a cancer diagnosis. Secondarily, we sought to investigate the use of various interventions to aid patients in the goal of smoking cessation.