Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Cancer. 2012 Jun 15;118(12):3153-64. doi: 10.1002/cncr.26545. Epub 2012 Jan 23.
Continued smoking after a cancer diagnosis may adversely affect treatment effectiveness, subsequent cancer risk, and survival. The prevalence of continued smoking after cancer diagnosis is understudied.
In the multi-regional Cancer Care Outcomes Research and Surveillance cohort (lung cancer [N = 2456], colorectal cancer [N = 3063]), the authors examined smoking rates at diagnosis and 5 months after diagnosis and also study factors associated with continued smoking.
Overall, 90.2% of patients with lung cancer and 54.8% of patients with colorectal cancer reported ever smoking. At diagnosis, 38.7% of patients with lung cancer and 13.7% of patients with colorectal cancer were smoking; whereas, 5 months after diagnosis, 14.2% of patients with lung cancer and 9.0% of patients with colorectal cancer were smoking. Factors that were associated independently with continued smoking among patients with nonmetastatic lung cancer were coverage by Medicare, other public/unspecified insurance, not receiving chemotherapy, not undergoing surgery, prior cardiovascular disease, lower body mass index, lower emotional support, and higher daily ever-smoking rates (all P < .05). Factors that were associated independently with continued smoking among patients with nonmetastatic colorectal cancer were male sex, high school education, being uninsured, not undergoing surgery, and higher daily ever-smoking rates (all P < .05).
After diagnosis, a substantial minority of patients with lung and colorectal cancers continued smoking. Patients with lung cancer had higher rates of smoking at diagnosis and after diagnosis; whereas patients with colorectal cancer were less likely to quit smoking after diagnosis. Factors that were associated with continued smoking differed between lung and colorectal cancer patients. Future smoking-cessation efforts should examine differences by cancer type, particularly when comparing cancers for which smoking is a well established risk factor versus cancers for which it is not.
癌症诊断后继续吸烟可能会对治疗效果、后续癌症风险和生存产生不利影响。癌症诊断后继续吸烟的流行情况研究较少。
在多区域癌症护理结果研究和监测队列中（肺癌 [N=2456]，结直肠癌 [N=3063]），作者检查了诊断时和诊断后 5 个月的吸烟率，并研究了与继续吸烟相关的因素。
总体而言，2456 例肺癌患者和 3063 例结直肠癌患者中，90.2%和 54.8%报告有吸烟史。诊断时，38.7%的肺癌患者和 13.7%的结直肠癌患者正在吸烟；而诊断后 5 个月，14.2%的肺癌患者和 9.0%的结直肠癌患者正在吸烟。与非转移性肺癌患者继续吸烟相关的独立因素包括：医疗保险、其他公共/未指明的保险覆盖、未接受化疗、未接受手术、既往心血管疾病、较低的体重指数、较低的情感支持和较高的每日吸烟率（均 P<0.05）。与非转移性结直肠癌患者继续吸烟相关的独立因素包括：男性、高中学历、无保险、未接受手术和较高的每日吸烟率（均 P<0.05）。
诊断后，相当一部分肺癌和结直肠癌患者继续吸烟。肺癌患者诊断时和诊断后吸烟率较高；而结直肠癌患者诊断后戒烟的可能性较低。与继续吸烟相关的因素在肺癌和结直肠癌患者之间存在差异。未来的戒烟努力应根据癌症类型进行检查，特别是在比较已确定吸烟为明确危险因素的癌症与尚未确定吸烟为危险因素的癌症时。
