Abstract 2421: Smoking, cancer treatment, and design of clinical trials.

Abstract

Abstract Purpose: Smoking has been associated with poor outcomes in cancer patients, but a detailed review of the effects of smoking on cancer treatment outcomes is necessary to effectively implement structured tobacco assessments and cessation into clinical trials design. Methods: We searched Pubmed citations between 1950 and 2011 with the objective of identifying any reports relating smoking with cancer and non-cancer related outcomes in cancer patients. Our search yielded 34,000 pertinent citations of on smoking and cancer. Over 5000 of these citations appeared to include data on smoking as it might be related to cancer treatment outcomes and of these more than 800 were felt to have sufficient information to examine how smoking affects cancer treatment outcomes. Results were cataloged in tables and cross-references according to cancer disease site. Results: The vast majority of pertinent reports provide evidence showing that smoking increases the risk of cancer and non-cancer related mortality as well as treatment related adverse events. The adverse effects of smoking and treatment outcomes are observed in all major cancer disease sites (lung, head/neck, breast, gastrointestinal, gynecologic, leukemia/lymphoma, prostate, and non-prostate genitourinary). A limited number of studies examine how smoking cessation affects treatment outcomes and generally these studies show that cessation of tobacco use is associated with fewer adverse treatment outcomes. Measurement of smoking behavior is a problem due to the reliance on self-reported behavior and lack of standardization in classifying smoking status. In most studies a patients’ cigarette use is categorized into ever smoking or current/former/never smoking; however, there is a broad diversity of definitions used making it less clear exactly how smoking affects treatment outcomes. Despite methodologic issues in published reports, results demonstrate a consistent pattern that smoking increases the risk of adverse outcomes across a broad spectrum of cancer disease sites. Conclusions: This review provides evidence that smoking adversely affects cancer related and non-cancer related outcomes in patients. What is less certain is how past and/or current smoking might differentially modify treatment outcomes for patients. Clinical trials must give strong consideration for prior tobacco history, current tobacco use, and efforts to track tobacco cessation during and following cancer treatment. Citation Format: Graham W. Warren, James R. Marshall, K. Michael Cummings. Smoking, cancer treatment, and design of clinical trials. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2421. doi:10.1158/1538-7445.AM2013-2421