The impact of a bladder cancer diagnosis on smoking behavior: An opportunity to improve care.

Abstract

4570 Background: Cigarette smoking is causal in 30-50% of bladder cancer diagnoses. Smoking after diagnosis results in decreased recurrence and progression-free survival. Little is known about the smoking history, awareness of the risks of continued smoking, and success with quitting among patients with incident bladder cancer. Methods: A random sample of bladder cancer survivors was obtained from the California Cancer Registry. Subjects were surveyed regarding tobacco history, beliefs regarding risk factors, and physician influence on smoking. Four cohorts were created: never smokers, former smokers (quit smoking prior to diagnosis), and active smokers (smoking at time of diagnosis). Active smokers were classified as continued smokers (still smoking at time of survey) and quit smokers. Cohorts were compared using contingency tables and multivariate analysis. Results: Of 153 patients surveyed, 77% of respondents were male. Mean age was 69.2 years. 23% were never smokers, 59% former smokers, and 18% were active smokers at diagnosis. 39% of active smokers continued to smoke after diagnosis. Quit smokers were more likely than former or continued smokers to endorse tobacco use as a risk factor for their bladder cancer (94% vs. 44% vs. 82%, respectively, p<0.001), with 82% indicating that their urologist was the source of this knowledge. 88% of quit smokers indicated that the diagnosis of bladder cancer was responsible for their successful cessation and 71% cited the advice of the urologist. There were no differences between the quit smokers and the continued smokers in age at diagnosis, packs per day, or total pack years. Continued smokers started smoking at a younger age than quit smokers [mean 14.1 vs. 19.4, p=0.003] and had smoked for more years [mean 53.3 vs 37.1, p=0.002]. Conclusions: Most patients with incident bladder cancer are active or former smokers. Patients who continue smoking after diagnosis demonstrate lower smoking health literacy compared with those who quit smoking. Urologists play an important role in educating their patients with bladder cancer. Patient education and smoking cessation efforts aimed at newly diagnosed bladder cancer patients could improve overall and disease-specific survival. No significant financial relationships to disclose.