Cinciripini Paul M, Kypriotakis George, Blalock Janice A, Karam-Hage Maher, Beneventi Diane M, Robinson Jason D, Minnix Jennifer A, Warren Graham W
Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston.
Department of Radiation Oncology, Medical University of South Carolina, Charleston.
JAMA Oncol. 2024 Dec 1;10(12):1689-1696. doi: 10.1001/jamaoncol.2024.4890.
Smoking after a cancer diagnosis increases mortality and risk for a second cancer.
To determine the association between time of entry into a smoking cessation intervention following a cancer diagnosis and survival outcomes.
DESIGN, SETTING, AND PARTICIPANTS: Using a prospective cohort study design, patients with cancer who smoked and received cessation treatment were assessed at 3 months, 6 months, and 9 months following tobacco treatment onset. Survival outcomes of tobacco treatment were measured and compared among patients at the MD Anderson Cancer Center Tobacco Research and Treatment Program. Treatment occurred between January 1, 2006, and March 3, 2022. Patients were excluded if they died before the tobacco treatment ended, received their diagnosis more than 6 months after beginning cessation treatment, or lacked staging information. The data analysis took place from September 2023 to May 2024.
Cessation treatment consisted of 6 to 8 personalized counseling visits and 10 to 12 weeks of pharmacotherapy. More than 95% of visits were provided via telemedicine.
The primary outcomes were survival as recorded in the MD Anderson Cancer Center tumor registry and 7-day point prevalence abstinence at each follow-up.
The main analytical sample consisted of 4526 currently smoking patients diagnosed with cancer and receiving cessation treatment (2254 [49.8%] female; median [IQR] age, 55 [47-62] years). Survival over 15 years increased for those quitting smoking at 3 months (adjusted hazard ratio [aHR], 0.75 [95% CI, 0.67-0.83]), 6 months (aHR, 0.79 [95% CI, 0.71-0.88]), and 9 months (aHR, 0.85 [95% CI, 0.76-0.95]) of follow-up. The optimal survival outcomes were observed for patients who received tobacco treatment within 6 months of a cancer diagnosis. At the 75th percentile, their survival increased from 2.1 years (95% CI, 1.8-2.4 years) among continuing smokers (nonabstainers) vs 3.9 years (95% CI, 3.2-4.6 years) for patients who quit (abstainers). Similar but less pronounced outcomes were noted when tobacco treatment began within 6 months to 5 years following diagnosis, with survival at the 75th percentile of 4.8 years (95% CI, 4.3-5.3 years) for nonabstainers vs 6.0 years (95% CI, 5.1-7.2 years) for abstainers.
The results of this prospective cohort study suggest that evidence-based smoking cessation treatment within 6 months following a cancer diagnosis maximizes survival benefit. This study supports smoking cessation as an important early clinical intervention for patients after being diagnosed with cancer.
癌症诊断后吸烟会增加死亡率和患第二种癌症的风险。
确定癌症诊断后开始戒烟干预的时间与生存结果之间的关联。
设计、设置和参与者：采用前瞻性队列研究设计，对吸烟且接受戒烟治疗的癌症患者在烟草治疗开始后的3个月、6个月和9个月进行评估。在MD安德森癌症中心烟草研究与治疗项目中，对患者的烟草治疗生存结果进行测量和比较。治疗发生在2006年1月1日至2022年3月3日之间。如果患者在烟草治疗结束前死亡、在开始戒烟治疗6个月后才确诊或缺乏分期信息，则将其排除。数据分析于2023年9月至2024年5月进行。
戒烟治疗包括6至8次个性化咨询门诊和10至12周的药物治疗。超过95%的门诊通过远程医疗提供。
主要结局是MD安德森癌症中心肿瘤登记处记录的生存情况以及每次随访时的7天点患病率戒烟情况。
主要分析样本包括4526名目前吸烟且被诊断患有癌症并接受戒烟治疗的患者（2254名[49.8%]为女性；年龄中位数[四分位间距]为55[47 - 62]岁）。随访3个月（调整后风险比[aHR]，0.75[95%置信区间，0.67 - 0.83]）、6个月（aHR，0.79[95%置信区间，0.71 - 0.88]）和9个月（aHR，0.85[95%置信区间，0.76 - 0.95]）时戒烟者的15年生存率有所提高。癌症诊断后6个月内接受烟草治疗的患者观察到最佳生存结果。在第75百分位数时，持续吸烟者（非戒烟者）的生存期为2.1年（95%置信区间，1.8 - 2.4年），而戒烟者为3.9年（95%置信区间，3.2 - 4.6年）。当在诊断后6个月至5年内开始烟草治疗时，观察到类似但不太明显的结果，非戒烟者在第75百分位数时的生存期为4.8年（95%置信区间，4.3 - 5.3年），戒烟者为6.0年（95%置信区间，5.1 - 7.2年）。
这项前瞻性队列研究的结果表明，癌症诊断后6个月内进行基于证据的戒烟治疗可使生存获益最大化。本研究支持戒烟作为癌症患者重要的早期临床干预措施。
