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Predictors of Smoking Cessation and Relapse in Cancer Patients and Effect on Psychological Variables: an 18-Month Observational Study

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Although cancer patients are generally strongly advised to quit smoking in order to improve treatment efficacy and survival, up to 68 % of patients who were smokers at the time of cancer diagnosis continue smoking. Psychological factors such as depression and anxiety are likely to be associated with smoking behavior following a cancer diagnosis, but the empirical evidence is scarce.

Purpose

This observational study aimed at estimating smoking cessation rates and assessing the effect of smoking cessation on psychological symptoms, as well as the predictive role of the same psychological variables on smoking cessation and smoking relapse following cancer surgery.

Methods

As part of a larger prospective, epidemiological study, smokers (n = 175) with a first diagnosis of nonmetastatic cancer completed the Hospital Anxiety and Depression Scale, the Insomnia Severity Index, and the Fear of Cancer Recurrence Inventory. Quitters (n = 55) and pair-matched nonquitters (n = 55) were compared on each symptom at pre-quitting, post-quitting, and at a 4-month follow-up. Predictors of smoking cessation and smoking relapse, including psychological variables, were also investigated.

Results

Fifty-five patients (31.4 %) stopped smoking at least on one occasion during the study. Of the 55 quitters, 27 (49.1 %) experienced a relapse. At pre-quitting, quitters had significantly higher levels of anxiety (p = .03) and fear of cancer recurrence (p = .01) than nonquitters, symptoms that significantly diminished at post-quitting and 4 months later in this subgroup of patients. Having breast cancer significantly predicted smoking cessation (relative risk [RR] = 3.08), while depressive symptoms were a significant predictor of smoking relapse (RR = 1.07).

Conclusions

This study highlights the importance of psychological symptoms in predicting tobacco cessation and relapse among individuals with cancer. Our findings suggest that breast cancer patients are more inclined to stop smoking than patients with other cancers, but future studies should attempt to delineate the effect on smoking cessation of gender and other demographics that characterize this subgroup. This study also suggests that a particular attention should be paid to the early management of depressive symptoms in order to prevent smoking relapse.

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References

  1. Canadian Cancer Society. Tobacco and your health. http://www.cancer.ca/en/cancer-information/cancer-101/what-is-a-risk-factor/tobacco/?region=on. 2016. Accessed February 07, 2016.

  2. Sitas F, Weber MF, Egger S, Yap S, Chiew M, O’Connell D. Smoking cessation after cancer. J Clin Oncol. 2014; 32(32):3593–3595.

    Article  PubMed  Google Scholar 

  3. Aveyard P, Adab P, Cheng KK. Does smoking status influence the prognosis of bladder cancer? A systematic review. BJU International. 2002; 90(3):228–239.

    Article  CAS  PubMed  Google Scholar 

  4. Chen CH, Shun CT, Huang KH, et al. Stopping smoking might reduce tumour recurrence in nonmuscle-invasive bladder cancer. BJU International. 2007; 100(2):281–286.

    Article  PubMed  Google Scholar 

  5. Parsons A, Daley A, Begh R, Aveyard P. Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: Systematic review of observational studies with meta-analysis. Br Med J. 2010; 340:b5569-b5569.

    Article  CAS  Google Scholar 

  6. Pytynia KB, Grant JR. Matched-pair analysis of survival of never smokers and ever smokers with squamous cell carcinoma of the head and neck. J Clin Oncol. 2004; 22(19):3981–3988.

    Article  PubMed  Google Scholar 

  7. Fleshner N, Garland JA, Moadel A, Herr H. Influence of smoking status on the disease-related outcomes of patients with tobacco-associated superficial transitional cell carcinoma of the bladder. Cancer. 1999; 86(11):2337–2345.

    Article  CAS  PubMed  Google Scholar 

  8. Do KA, Johnson MM, Lee JJ, Wu XF. Study of smoking patterns in relation to the development of smoking-related secondary primary tumors in patients with upper aerodigestive tract malignancies. Cancer. 2004; 101(12):2837–2842.

    Article  PubMed  Google Scholar 

  9. Peppone LJ, Reid ME, Moysich KB, et al. The effect of secondhand smoke exposure on the association between active cigarette smoking and colorectal cancer. Cancer Cause Control. 2010; 21:1247–1255.

    Article  Google Scholar 

  10. Walker MS, Larsen RJ, Zona DM. Smoking urges and relapse among lung cancer patients: Findings from a preliminary retrospective study. Prev Med. 2004; 39(3):449–457.

    Article  PubMed  Google Scholar 

  11. Bell RJ, Lijovic M, Fradkin P, Schwarz M, Davis SR. Changes in patterns of use of cigarettes and alcohol in women after a first diagnosis of invasive breast cancer: A cohort study of women from Victoria, Australia. Support Care Cancer. 2012; 20(4):783–789.

    Article  PubMed  Google Scholar 

  12. Westmaas JL, Newton CC, Stevens VL, Flanders WD, Gapstur SM, Jacobs EJ. Does a recent cancer diagnosis predict smoking cessation? An analysis from a large prospective US cohort. J Clin Oncol. 2015.

  13. Balbani APS, Montovani JC. Methods for smoking cessation and treatment of nicotine dependence. Braz J Otorhinolaryngol. 2005; 71(6):820–827.

    Article  PubMed  Google Scholar 

  14. Fagerström K. The epidemiology of smoking: Health consequences and benefits of cessation. Drugs. 2002; 62 Suppl 2:1–9.

    Article  PubMed  Google Scholar 

  15. Hughes JR. Effects of abstinence from tobacco: Valid symptoms and time course. Nicotine Tob Res. 2007; 9(3):315–327.

    Article  PubMed  Google Scholar 

  16. Karnath B. Smoking cessation. Am J Med. 2002; 112(5):399–405.

    Article  PubMed  Google Scholar 

  17. Underner M, Paquereau J, Meurice JC. Tabagisme et troubles du sommeil. Rev Mal Respir. 2006; 23:67–77.

    Article  Google Scholar 

  18. Hughes JR, Higgins ST, Bickel WK. Nicotine withdrawal versus other drug withdrawal syndromes: Similarities and dissimilarities. Addiction. 1994; 89(11):1461–1470.

    Article  CAS  PubMed  Google Scholar 

  19. Augustson EM, Wanke KL, Rogers S, et al. Predictors of sustained smoking cessation: A prospective analysis of chronic smokers from the alpha-tocopherol Beta-Carotene Cancer Prevention Study. Am J Public Health. 2008; 98(3):549–555.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Cinciripini PM, Wetter DW, Fouladi RT, et al. The effects of depressed mood on smoking cessation: Mediation by postcessation self-efficacy. J Consult Clinical Psych. 2003; 71(2):292–301.

    Article  Google Scholar 

  21. Cooley ME, Sarna L, Brown JK, et al. Tobacco use in women with lung cancer. Ann Behav Med. 2007; 33(3):242–250.

    Article  PubMed  Google Scholar 

  22. Bloom EL, Oliver JA, Sutton SK, Brandon TH, Jacobsen PB, Simmons VN. Post-operative smoking status in lung and head and neck cancer patients: Association with depressive symptomatology, pain, and fatigue. Psycho-Oncol. 2014; 24(9):1012–1019.

    Article  Google Scholar 

  23. Pomerleau OF, Pomerleau CS, Marks JL. Abstinence effects and reactivity to nicotine during 11 days of smoking deprivation. Nicotine Tob Res. 2000; 2(2):149–157.

    Article  CAS  PubMed  Google Scholar 

  24. Colrain I, Trinder J, Swan G. The impact of smoking cessation on objective and subjective markers of sleep: Review, synthesis, and recommendations. Nicotine Tob Res. 2004; 6(6):913–925.

    Article  PubMed  Google Scholar 

  25. Swan GE, Ward MM, Jack LM. Abstinence affects as predictors of 28-day relapse in smokers. Addict Behav. 1996; 21(4):481–490.

    Article  CAS  PubMed  Google Scholar 

  26. Niaura R, Britt DM, Shadel WG, Goldstein M, Abrams D, Brown R. Symptoms of depression and survival experience among three samples of smokers trying to quit. Psychol Addict Behav. 2001; 15(1):13–17.

    Article  CAS  PubMed  Google Scholar 

  27. Shiffman S, Waters AJ. Negative affect and smoking lapses: A prospective analysis. J Consult Clinical Psych. 2004; 72(2):192–201.

    Article  Google Scholar 

  28. Weinberger AH, Mazure CM, Morlett A, McKee SA. Two decades of smoking cessation treatment research on smokers with depression: 1990–2010. Nicotine Tob Res. 2013; 15(6):1014–1031.

    Article  CAS  PubMed  Google Scholar 

  29. Kinnunen T, Korhonen T, Garvey AJ. Role of nicotine gum and pretreatment depressive symptoms in smoking cessation: Twelve-month results of a randomized placebo controlled trial. Int J Psychiat Med. 2008; 38(3):373–389.

    Article  Google Scholar 

  30. Haas AL, Muñoz RF, Humfleet GL, Reus VI, Hall SM. Influences of mood, depression history, and treatment modality on outcomes in smoking cessation. J Consult Clinical Psych. 2004; 72:563–570.

    Article  Google Scholar 

  31. Piper ME, Schlam TR, Cook JW, et al. Tobacco withdrawal components and their relations with cessation success. Psychopharmacology. 2011; 216(4):569–578.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Covey LS, Glassman, AH, Stetner F. Major depression following smoking cessation. Am J Psychiat. 1997; 154(2):263–265.

    Article  CAS  PubMed  Google Scholar 

  33. Gritz ER, Schacherer C, Koehly L. Smoking withdrawal and relapse in head and neck cancer patients. Head Neck. 1999; 21(5):420–427.

    Article  CAS  PubMed  Google Scholar 

  34. Cox LS, Africano NL, Tercyak KP, Taylor KL. Nicotine dependence treatment for patients with cancer. Cancer. 2003; 98(3):632–644.

    Article  PubMed  Google Scholar 

  35. Martinez E, Tatum KL, Weber DM. Issues related to implementing a smoking cessation clinical trial for cancer patients. Cancer Cause Control. 2009; 20(1):97–104.

    Article  Google Scholar 

  36. Schnoll R, Martinez E, Tatum KL. A bupropion smoking cessation clinical trial for cancer patients. Cancer Cause Control. 2010; 21(6):811–820.

    Article  Google Scholar 

  37. Blalock JA, Lam C, Minnix JA, et al. The effect of mood, anxiety, and alcohol use disorders on smoking cessation in cancer patients. J Cogn Psychother. 2011;25(1):82–96.

    Article  Google Scholar 

  38. Simmons VN, Litvin EB, Jacobsen PB, et al. Predictors of smoking relapse in patients with thoracic cancer or head and neck cancer. Cancer. 2013;119(7):1420–1427.

    Article  PubMed  Google Scholar 

  39. Savard J, Ivers H, Villa J, Caplette-Gingras A, Morin CM. Natural course of insomnia comorbid with cancer: An 18-month longitudinal study. J Clin Oncol. 2011;29:3580–3586.

    Article  PubMed  Google Scholar 

  40. Savard J, Villa J, Ivers H, Simard S, Morin CM. Prevalence, natural course, and risk factors of insomnia comorbid with cancer over a 2-month period. J Clin Oncol. 2009;27:5233–5239.

    Article  PubMed  Google Scholar 

  41. Morin CM, Barlow DH. Insomnia: Psychological Assessment and Management Guilford Press New York; 1993.

    Google Scholar 

  42. Savard MH, Savard J, Simard S, Ivers H. Empirical validation of the insomnia severity index in cancer patients. Psycho-Oncol. 2005;14:429–441.

    Article  Google Scholar 

  43. Savard J, Laberge B, Gauthier JG, Ivers H, Bergeron MG. Evaluating anxiety and depression in HIV-infected patients. J Pers Assess. 1998;71:349–367.

    Article  CAS  PubMed  Google Scholar 

  44. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiat Scand. 1983;67:361–370.

    Article  CAS  PubMed  Google Scholar 

  45. Simard S, Savard J. Fear of cancer recurrence inventory: Development and initial validation of a multidimensional measure of fear of cancer recurrence. Support Care Cancer. 2009;17:241–251.

    Article  PubMed  Google Scholar 

  46. Zou G. A Modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702–706.

    Article  PubMed  Google Scholar 

  47. Walker MS, Vidrine DJ, Gritz ER. Smoking relapse during the first year after treatment for early-stage non–small-cell lung cancer. Cancer Epidemiol Biomarkers Prev. 2006;15(12):2370–2377.

    Article  CAS  PubMed  Google Scholar 

  48. Wetter DW, Carmack CL, Anderson CB, et al. Tobacco withdrawal signs and symptoms among women with and without a history of depression. Exp Clin Psychopharmacol. 2000;8(1):88.

  49. Jaehne A, Unbehaun T, Feige B, Cohrs S, Rodenbeck A, Riemann D. Sleep changes in smokers before, during and 3 months after nicotine withdrawal. Addict Biol. 2014.

  50. Gilbert DG, McClernon FJ, Rabinovich NE, et al. Mood disturbance fails to resolve across 31 days of cigarette abstinence in women. 2002;70:142–152.

  51. Ward MM, Swan GE, Jack LM. Self-reported abstinence effects in the first month after smoking cessation. Addict Behav. 2001;26(3):311–327.

    Article  CAS  PubMed  Google Scholar 

  52. Schnoll R, Rothman RL, Newman H, et al. Characteristics of cancer patients entering a smoking cessation program and correlates of quit motivation: Implications for the development of tobacco control programs for cancer patients Psycho-Oncol. 2004;13(5):346–358.

    Article  Google Scholar 

  53. Schnoll R, Calvin J, Malstrom M. Longitudinal predictors of continued tobacco use among patients diagnosed with cancer. Ann Behav Med. 2003;25(3):214–222.

    Article  PubMed  Google Scholar 

  54. Trudel-Fitzgerald C, Savard J, Ivers H. Evolution of cancer-related symptoms over an 18-month period. J Pain Symptom Manage. 2013;45:1007–1018.

    Article  PubMed  Google Scholar 

  55. Hughes JR. Tobacco withdrawal in self-quitters. J Consult Clinical Psych. 1992;60(5):689–697.

    Article  CAS  Google Scholar 

  56. Tate JC, Stanton AL, Green SB, Schmitz JM. Assessing the validity of nicotine abstinence effects by self-and observer ratings under “blinded” conditions. Exp Clin Psychopharmacol. 1996;4(3):330.

    Article  Google Scholar 

  57. Brown RA, Kahler CW, Niaura R, et al. Cognitive–behavioral treatment for depression in smoking cessation. J Consult Clinical Psych. 2001;69(3):471–480.

    Article  CAS  Google Scholar 

  58. Burgess ES, Brown RA, Kahler CW, et al. Patterns of change in depressive symptoms during smoking cessation: Who’s at risk for relapse? J Consult Clinical Psych. 2002;70:356–361.

    Article  Google Scholar 

  59. Gritz ER, Carr CR, Rapkin D. Predictors of long-term smoking cessation in head and neck cancer patients. Cancer Epidemiol Biomarkers Prev. 1993;2:261–270.

    CAS  PubMed  Google Scholar 

  60. Ostroff JS, Jacobsen PB, Moadel AB. Prevalence and predictors of continued tobacco use after treatment of patients with head and neck cancer. Cancer. 1995;2(75):569–576.

    Article  Google Scholar 

  61. Reid JL, Hammond D, Boudreau C, Fong GT, Siahpush M. Socioeconomic disparities in quit intentions, quit attempts, and smoking abstinence among smokers in four western countries: Findings from the International Tobacco Control Four Country Survey. Nicotine Tob Res. 2010;12 Suppl(October):S20–33.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Smit ES, Hoving C, Schelleman-Offermans K, West R, de Vries H. Predictors of successful and unsuccessful quit attempts among smokers motivated to quit. Addict Behav. 2014;39(9):1318–1324.

    Article  PubMed  Google Scholar 

  63. MacPherson L, Tull MT, Matusiewicz AK, et al. Randomized controlled trial of behavioral activation smoking cessation treatment for smokers with elevated depressive symptoms. J Consult Clinical Psych. 2010;78(1):55.

    Article  Google Scholar 

  64. Savard J, Morin CM. Insomnia in the context of cancer: A review of a neglected problem. J Clin Oncol. 2001;19:895–908.

    CAS  PubMed  Google Scholar 

  65. Savard J, Savard M-H. Insomnia and cancer: Prevalence, nature, and nonpharmacologic treatment. Sleep Med Clin. 2013;8(3):373–387.

    Article  Google Scholar 

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Acknowledgments

This study was supported by master and doctoral research training scholarships from the Fonds pour la recherche en santé du Québec and a scholarship from the Psychosocial Oncology Research Training program of the Canadian Institutes of Health Research held by the first author, a scholarship from the Fonds pour la recherche en santé du Québec held by the second author, and a grant from the Canadian Institutes of Health Research (MOP-69073).

Author information

Authors and Affiliations

  1. School of Psychology, Université Laval, Québec, QC, Canada

    Anne-Josée Guimond MA, Virginie A. Croteau BA, Paquito Bernard PhD, Hans Ivers PhD & Josée Savard PhD

  2. CHU de Québec-Université Laval Research Center, Québec, QC, Canada

    Anne-Josée Guimond MA, Virginie A. Croteau BA, Marie-Hélène Savard PhD, Paquito Bernard PhD, Hans Ivers PhD & Josée Savard PhD

  3. Université Laval Cancer Research Center, Québec, QC, Canada

    Anne-Josée Guimond MA, Virginie A. Croteau BA, Marie-Hélène Savard PhD, Paquito Bernard PhD, Hans Ivers PhD & Josée Savard PhD

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  1. Anne-Josée Guimond MA
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Correspondence to Josée Savard PhD.

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Authors Anne-Josée Guimond, Virginie A. Croteau, Marie-Hélène Savard, Paquito Bernard, Hans Ivers, and Josée Savard declare that they have no conflict of interest. Participants gave their informed consent prior to participation. The investigators complied with APA ethical standards in the treatment of the study sample.

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Guimond, AJ., Croteau, V.A., Savard, MH. et al. Predictors of Smoking Cessation and Relapse in Cancer Patients and Effect on Psychological Variables: an 18-Month Observational Study. ann. behav. med. 51, 117–127 (2017). https://doi.org/10.1007/s12160-016-9834-4

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