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Abstract
Simple SummaryThis was a retrospective analysis of breast cancer patients who were self-identified as smokers at diagnosis and who were invited to participate in a comprehensive tobacco treatment program (TP) that provided pharmacotherapy and motivational counseling to quit smoking. Our study shows that quitting smoking is associated with improved survival among breast cancer patients who smoke across all tumor stages. In our survival analysis, tobacco abstainers were more likely than smokers to be alive with no evidence of disease (hazard ratio = 0.616 95%CI (0.402–0.945), p = 0.026). Comprehensive approach to address smoking cessation may prolong survival outcomes when started as early as the time of diagnosis.Background: Smoking negatively affects overall survival after successful breast cancer (BC) treatment. We hypothesized that smoking cessation would improve survival outcomes of BC patients who were smokers at the time of diagnosis. Methods: This was a retrospective analysis of self-identified smokers with BC treated at The University of Texas MD Anderson Cancer Center. Patient demographics, date of diagnosis, tumor stage, tobacco treatment program (TP) participation, and time to death were extracted from our departmental databases and institutional electronic health records. We examined associations between tobacco abstinence status and survival using survival models, with and without interactions, adjusted for personal characteristics and biomarkers of disease. Results: Among all 31,069 BC patients treated at MD Anderson between 2006 and 2017, we identified 2126 smokers (6.8%). From those 2126 self-identified smokers, 665 participated in the TP, reporting a conservative estimate of 31% abstinence (intent-to-treat) 9 months into the program. Patients without reported follow-up abstinence status (including TP and non-TP participants) were handled in the analyses as smokers. Survival analysis controlled for multiple factors, including disease characteristics and participation in the TP, indicated that abstainers were more likely to be alive with no evidence of disease compared to non-abstainers (HR, 0.593; 95% CI, 0.386–0.911; p = 0.017). Conclusion: Our results suggest that quitting smoking is associated with improved survival among BC patients who were smokers at time of diagnosis across all tumor stages. Comprehensive approaches for smoking cessation in patients diagnosed with BC may prolong survival when started as early as the time of diagnosis.
Highlights
Smoking is associated with increased long-term all-cause lung- and breast-cancerspecific mortality, and negatively influences overall survival after breast cancer diagnosis [1,2]
The abstinent group was composed of patients identified as abstinent from their participation in the treatment program (TP), and the non-abstinent group included both patients in the TP who identified themselves as smokers at the program’s last follow-up and patients not in the TP program who were identified as smokers at baseline, and their smoking status was imputed as smoking
To calculate breast cancer-specific survival, we excluded patients that were alive with disease, dead without the disease, and dead due to any other cause
Summary
Smoking is associated with increased long-term all-cause lung- and breast-cancerspecific mortality, and negatively influences overall survival after breast cancer diagnosis [1,2]. Smokers who continue to smoke have a higher risk of lung cancer following breast cancer radiotherapy [3], while nonsmokers have minimal added risk of late radiation-induced lung cancer and cardiac mortality. Multivariable-adjusted models with smoking status as a time-dependent variable have shown that breast cancer incidence was significantly higher among current and former smokers compared with never-smokers [5]. Continued smoking impairs wound healing, causes poor surgical outcomes, and increases the risk of postoperative complications among patients undergoing breast reconstruction surgery [7]. We hypothesized that smoking cessation would improve survival outcomes of BC patients who were smokers at the time of diagnosis. We examined associations between tobacco abstinence status and survival using survival models, with and without interactions, adjusted for personal characteristics and biomarkers of disease
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