Abstract
BackgroundWe aimed to estimate the effects of smoking cessation on survival among people diagnosed with cancer.MethodsWe used data from a Comprehensive Community Cancer Program that is part of a large urban safety-net hospital system. Eligible patients were diagnosed with primary invasive solid tumors between 2013 and 2015, and were current smokers at time of diagnosis. Our exposure of interest was initiation of smoking cessation within 6 months of cancer diagnosis. We estimated inverse probability weighted restricted mean survival time (RMST) differences and risk ratio (RR) for all cause 3-year mortality.ResultsOur study population comprised 369 patients, of whom 42% were aged < 55 years, 59% were male, 44% were racial/ethnic minorities, and 59% were uninsured. The 3-year RMST was 1.8 (95% CL: − 1.5, 5.1) months longer for individuals who initiated smoking cessation within 6 months of cancer diagnosis. The point estimate for risk of 3-year mortality was lower for initiation of smoking cessation within 6 months of diagnosis compared with no initiation within 6 months (RR = 0.72, 95% CL: 0.37, 1.4).ConclusionsOur point estimates suggest longer 3-year survival, but the results are compatible with 1.5 month shorter or 5.1 longer 3-year overall survival after smoking cessation within 6 months of cancer diagnosis. Future studies with larger sample sizes that test the comparative effectiveness of different smoking cessation strategies are needed for more detailed evidence to inform decision-making about the effect of smoking cessation on survival among cancer patients.Implications for Cancer survivorsThe benefits of smoking cessation after cancer diagnosis may include longer survival, but the magnitude of benefit is unclear.
Highlights
We aimed to estimate the effects of smoking cessation on survival among people diagnosed with cancer
We aimed to assess the effect of smoking cessation on survival among people diagnosed with cancer using a target trial framework
51% smoked more than one pack of cigarettes per day at the time of diagnosis, 31% initiated smoking cessation within 6 months of diagnosis, and 22% died by the end of 3-year follow-up after cancer diagnosis
Summary
We aimed to estimate the effects of smoking cessation on survival among people diagnosed with cancer. The target trial framework is a recent advancement to facilitate addressing questions using observational data that may be infeasible through RCTs [13]. This framework uses strengths of RCTs to guide the design of observational studies. In the absence of an RCT, this approach could help generate useful evidence about the effects of smoking cessation among people diagnosed with cancer. We aimed to assess the effect of smoking cessation on survival among people diagnosed with cancer using a target trial framework
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