Awareness of Smoking as a Risk Factor in Bladder Cancer: Results from the Prospective FinnBladder 9 Trial

Abstract

BackgroundData regarding patient education and smoking habits among bladder cancer patients are scarce. ObjectiveTo investigate awareness of smoking as a risk factor for bladder cancer among bladder cancer patients. Design, setting, and participantsThis is a substudy of a prospective, randomized, multicenter phase 3 trial (FinnBladder 9, NCT01675219). The data were collected at baseline and after 12 mo of follow-up between 2012 and 2020. InterventionPatients completed a comprehensive nonvalidated questionnaire on smoking in relation to bladder cancer. Outcome measurements and statistical analysisThe outcomes measured were patient-reported awareness of smoking as a risk factor for bladder cancer, and the effect of smoking on bladder cancer–related recurrence, progression, and death. Parametric data were compared using Student’s t test and proportions using Fischer’s exact test. Factors affecting baseline awareness of the effect of smoking cessation on bladder cancer were studied using logistic regression. Results and limitationsOf the 411 patients randomized, 370 completed the baseline questionnaire and were included in the analysis. At baseline, 44% of patients were uncertain if smoking was a risk factor for bladder cancer. Patient awareness of the fact that smoking cessation reduces the risk of bladder cancer recurrence increased from 86% to 92% after 12 mo of follow-up (p = 0.038). Older patients and patients with recurrent bladder cancer had significantly less knowledge about the effect of smoking on bladder cancer recurrence, progression, and mortality. A major limitation is that the response rate was lower at the 12-mo follow-up visit than at baseline. ConclusionsAwareness of smoking as a bladder cancer risk factor is low. Older patients and patients with recurrent bladder cancer may need special attention regarding education. Patient summaryWe looked at outcomes for smoking-related patient education on bladder cancer in a Finnish population. We conclude that older patients and patients with recurrent bladder cancer may need to be educated on this subject.