Abstract
Background:The aim was to examine the association between smoking cessation and prognosis in smoking-related cancer as it is unclear that cessation reduces mortality.Methods:In this retrospective cohort study from 1999 to 2013, we assessed the association between cessation during the first year after diagnosis and all-cause and cancer-specific mortality.Results:Of 2882 lung, 757 upper aero-digestive tract (UAT) and 1733 bladder cancer patients 27%, 29% and 21% of lung, UAT and bladder cancer patients quit smoking. In lung cancer patients that quit, all-cause mortality was significantly lower (HR: 0.82 (0.74–0.92), while cancer-specific mortality (HR: 0.89 (0.76–1.04) and death due to index cancer (HR: 0.90 (0.77–1.05) were non-significantly lower. In UAT cancer, all-cause mortality (HR: 0.81 (0.58–1.14), cancer-specific mortality (HR: 0.84 (0.48–1.45), and death due to index cancer (HR: 0.75 (0.42–1.34) were non-significantly lower. There was no evidence of an association between quitting and mortality in bladder cancer. The HRs were 1.02 (0.81–1.30) for all-cause, 1.23 (0.81–1.86) for cancer specific, and 1.25 (0.71–2.20) for death due to index cancer. These showed a non-significantly lower risk in sensitivity analyses.Conclusions:People with lung and possibly UAT cancer who quit smoking have a lower risk of mortality than people who continue smoking.
Highlights
MethodsIn this retrospective cohort study from 1999 to 2013, we assessed the association between cessation during the first year after diagnosis and all-cause and cancer-specific mortality
The aim was to examine the association between smoking cessation and prognosis in smoking-related cancer as it is unclear that cessation reduces mortality
People with lung and possibly upper aero-digestive tract (UAT) cancer who quit smoking have a lower risk of mortality than people who continue smoking
Summary
In this retrospective cohort study from 1999 to 2013, we assessed the association between cessation during the first year after diagnosis and all-cause and cancer-specific mortality. Patients with a first diagnosis of lung, UAT and bladder cancers between 1999 and 2013 who smoked at diagnosis, survived for one year, had been registered with a practice for at least one year and had at least one year of follow-up data were included in the cohort. People with advanced cancer-treated palliatively may be less likely to stop smoking and are more likely to die, confounding the association between smoking cessation and mortality. As many such patients die within a year, restricting the analysis in this way limited confounding. The first version of the protocol was amended to exclude people with thyroid cancer because this is not a smoking-related head and neck cancer
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