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

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Summary

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. 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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