Abstract
The population of cancer survivors is rapidly growing in the US. Tobacco smoking is associated with many cancers; however, whether cigarette smoking behaviors among cancer survivors vary according to cancer type-that is, smoking-related cancers (SRCs) vs non-smoking-related cancers (NSRCs)-remains unclear. To examine cigarette smoking prevalence and behaviors (ie, continuing or quitting smoking) among cancer survivors and to compare them between survivors of SRCs and NSRCs. This study was a cross-sectional analysis of the 2017 National Health Interview Survey, a household survey of civilian US residents who were aged 18 years or older. The National Health Interview Survey is population based and is representative of the US population. Data analysis was performed from June to October 2019. The primary outcomes were prevalence of current cigarette smoking among cancer survivors and prevalence of continuing smoking and quitting smoking after a cancer diagnosis. Secondary outcomes included factors associated with continued smoking vs quitting smoking after a cancer diagnosis. A total of 26 742 respondents (mean [SD] age, 50.97 [18.61] years; 14 646 women [51.76%]) to the 2017 National Health Interview Survey were included in this study. Of the 3068 individuals (9.42%) in the study population who had cancer, 589 (19.96%) were SRC survivors, 2297 (74.50%) were NSRC survivors, 168 (4.96%) were survivors of both SRC and NSRC, and the remaining 14 (0.58%) had missing information about the type of cancer. Four hundred forty-nine SRC survivors (54.08%) were women, compared with 1412 NSRC survivors (54.30%). Ninety-six SRC survivors (15.69%) and 151 NSRC survivors (7.99%) were younger than 45 years. Overall, 372 cancer survivors (13.16%) were current smokers. Current smoking prevalence was higher among survivors of SRCs (145 survivors [19.78%]) compared with NSRC survivors (251 survivors [10.63%]). Among cancer survivors, 309 current smokers at cancer diagnosis (43.96%) reported having successfully quit smoking and 372 (56.04%) reported continuing smoking. Among the continuing smokers, 176 (56.49%) reported an unsuccessful quit attempt in the last 12 months. After cancer diagnosis, SRC survivors had higher odds of continued smoking compared with NSRC survivors (odds ratio [OR], 2.10; 95% CI, 1.12-3.93; P = .02). Men (OR, 1.93; 95% CI, 1.05-3.57; P = .04), those with angina pectoris (OR, 5.40; 95% CI, 1.33-21.91; P = .02), and those with chronic bronchitis (OR, 2.55; 95% CI, 1.05-6.19; P = .04) had higher odds of continued smoking, whereas Hispanic participants (compared with non-Hispanic white participants: OR, 0.18; 95% CI, 0.05-0.68; P = .01) and married participants (compared with never married participants: OR, 0.33; 95% CI, 0.12-0.96; P = .04) had lower odds of continued smoking. These findings suggest that compared with NSRC survivors, SRC survivors may be at higher risk of being cigarette smokers at cancer diagnosis and of continuing smoking afterward. Although smoking cessation interventions are critically important for all cancer survivors, special efforts should target survivors of SRCs.
Highlights
The cancer survivor population in the US has increased over the past half century to an estimated 18.1 million in 2020 and is projected to increase to more than 20 million by 2026.1,2 This phenomenon is largely due to more cancer diagnoses as a result of an aging population and improvements in early detection and treatment of cancer.[3,4] Healthy lifestyle behaviors may help improve quality of life among cancer survivors and prevent recurrent and subsequent cancers.[4]Smoking remains the leading preventable cause of disease and death in the US
Current smoking prevalence was higher among survivors of smoking-related cancers (SRCs) (145 survivors [19.78%]) compared with non–smokingrelated cancers (NSRCs) survivors (251 survivors [10.63%])
SRC survivors had higher odds of continued smoking compared with NSRC survivors
Summary
The cancer survivor population in the US has increased over the past half century to an estimated 18.1 million in 2020 and is projected to increase to more than 20 million by 2026.1,2 This phenomenon is largely due to more cancer diagnoses as a result of an aging population and improvements in early detection and treatment of cancer.[3,4] Healthy lifestyle behaviors (eg, smoking cessation, physical activity, maintaining healthy weight, and consuming a healthy diet) may help improve quality of life among cancer survivors and prevent recurrent and subsequent cancers.[4]Smoking remains the leading preventable cause of disease and death in the US. The cancer survivor population in the US has increased over the past half century to an estimated 18.1 million in 2020 and is projected to increase to more than 20 million by 2026.1,2 This phenomenon is largely due to more cancer diagnoses as a result of an aging population and improvements in early detection and treatment of cancer.[3,4] Healthy lifestyle behaviors (eg, smoking cessation, physical activity, maintaining healthy weight, and consuming a healthy diet) may help improve quality of life among cancer survivors and prevent recurrent and subsequent cancers.[4]. Numerous antitobacco efforts have made substantial contributions to public health, cigarette smoking continues to claim half a million lives annually as a result of lung cancer and other tobaccorelated diseases.[5,6,7] Compared with individuals who have never smoked, cigarette smokers are at increased risk of having detrimental health conditions such as cancer (eg, leukemia and lung cancer), cardiovascular disorders (eg, atherosclerosis and hypertension), respiratory diseases (eg, chronic obstructive pulmonary disease, pneumonia, chronic bronchitis, and emphysema), diabetes, and oral conditions (eg, periodontal disease, oral leukoplakia, and oral cancer), among others.[8,9,10,11,12] smokers tend to be admitted to the hospital more often than nonsmokers and, have a higher risk of premature death,[13] which carries an associated economic cost to the nation of nearly $300 billion a year.[6,14,15]
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