J. Lee Westmaas, Behavioral Research Center, American Cancer Society; Christina C. Newton, Victoria L. Stevens, Susan M. Gapstur, and Eric J. Jacobs, American Cancer Society; and W. Dana Flanders, Rollins School of Public Health, Emory University, Atlanta, GA.
J Clin Oncol. 2015 May 20;33(15):1647-52. doi: 10.1200/JCO.2014.58.3088. Epub 2015 Apr 20.
Quitting smoking provides important health benefits to patients with cancer. A cancer diagnosis may motivate quitting-potentially providing a teachable moment in which oncologists can encourage and assist patients to quit-but little is known about whether a recent cancer diagnosis (including diagnosis of a cancer that is less strongly linked to smoking) is associated with increased quitting.
Cancer Prevention Study-II Nutrition Cohort participants reported smoking status at enrollment in 1992 to 1993 and approximately biennially through 2009. Quit rates of smokers diagnosed with cancer during 2- and 4-year intervals were compared with those of smokers not diagnosed with cancer (12,182 and 12,538 smokers in 2- and 4-year analyses, respectively). Cancers likely to cause physical limitations or symptoms that could influence smoking (cancers of the lung, head and neck, esophagus, or any metastatic cancer) were excluded. Logistic regressions calculated quit rates controlling for age, sex, survey year, cardiovascular disease, and chronic obstructive pulmonary disease.
The 2-year quit rate was higher among the 772 smokers who were diagnosed with cancer (31.3%; 95% CI, 28.0% to 34.5%) than among smokers not diagnosed with cancer (19.5%; 95% CI, 19.0% to 19.9%). A similar difference was observed for 4-year quit rates (43.0% v 33.8%). Results were similar by cancer site and stage.
A diagnosis of cancer, even a cancer not strongly related to smoking and with a relatively good prognosis, may be associated with increased quitting that is sustained well after diagnosis. Results support the hypothesis that a cancer diagnosis presents a teachable moment that can be capitalized on to promote cessation.
戒烟可使癌症患者获得显著健康获益。癌症诊断可能会激发戒烟动机——这可能是一个教育契机，让肿瘤医生鼓励并帮助患者戒烟——但人们对近期癌症诊断（包括与吸烟关联较弱的癌症诊断）是否与戒烟率增加有关知之甚少。
癌症预防研究-II 营养队列参与者于 1992 至 1993 年首次入组时报告吸烟情况，并在之后的大约每两年通过 2009 年进行报告。将在 2 年和 4 年时间间隔内被诊断患有癌症的吸烟者的戒烟率与未被诊断患有癌症的吸烟者（2 年和 4 年分析中分别有 12182 名和 12538 名吸烟者）进行比较。排除可能导致身体限制或影响吸烟的症状的癌症（肺癌、头颈部癌、食管癌或任何转移性癌症）。使用逻辑回归在控制年龄、性别、调查年份、心血管疾病和慢性阻塞性肺疾病的情况下计算戒烟率。
772 名被诊断患有癌症的吸烟者中有 31.3%（95%CI，28.0%至 34.5%）在 2 年内戒烟，高于未被诊断患有癌症的吸烟者（19.5%，95%CI，19.0%至 19.9%）。4 年内的戒烟率也有类似差异（43.0%比 33.8%）。结果与癌症部位和分期相似。
即使是与吸烟关联较弱且预后相对较好的癌症诊断，也可能与增加的戒烟率相关，且这种戒烟率在诊断后很长一段时间内持续保持。结果支持这样一种假说，即癌症诊断提供了一个教育契机，可以加以利用来促进戒烟。
