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Health care access and smoking cessation among cancer survivors: implications for the Affordable Care Act and survivorship care

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Abstract

Purpose

The study objectives are to examine prevalence of current smoking, and to assess the association of both health insurance (HI) and access to care with smoking cessation among cancer survivors.

Methods

We performed an analysis from a cross-sectional study of cancer survivors aged 18–64 years using nationally representative data from the 2009 Behavioral Risk Factor Surveillance System survey. We assessed the prevalence of current smoking among cancer survivors. Also, in a subset excluding never smokers, we assessed cessation status of cancer survivors operationalized as comparing current to former smokers.

Results

The study population (N = 18,896) was predominantly 45–64 years of age, female, and white. The prevalence of current smoking was substantially greater among cancer survivors without HI (40.9 %) than for those with HI (19.5 %). Cancer survivors with no HI had 2-fold greater adjusted odds of not quitting cigarette smoking compared to those with HI. Among those with insurance, cancer survivors who did not have regular health care provider or could not see doctor due to cost or had their last routine checkup ≥1 year ago had 60–80 % fold greater adjusted odds of not quitting cigarette smoking compared to cancer survivors who had better access to health care.

Conclusions

Cancer survivors without HI have substantially greater current smoking rates compared with those with HI. Among cancer survivors with HI, those who experienced health care access-related problems had lower cessation rates than their counterparts.

Implications for Cancer Survivors

Smoking cessation needs to be recognized as a crucial component of preventive care for cancer survivors. Continuous patient engagement and cancer-patient-centered strategies are urgently needed to achieve optimal results for quit rates particularly for young cancer survivors who are most susceptible to current smoking.

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Acknowledgments

The study was supported by the Baltimore VA GRECC (Geriatric Research, Education, and Clinical Center), Claude D. Pepper Older Americans Independence Center (NIA P30 AG028747 08), and the Mid Atlantic Nutrition Obesity Research Center (NIDDK 5P30DK072488-09). The authors do not have any financial conflict of interest to disclose regarding the content of this study.

Conflict of interest

The authors do not have any financial conflict of interest to disclose regarding the content of this study.

Role of the sponsors

No role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author contributions

Study concept and design: all authors

Acquisition, analysis, or interpretation of data: all authors

Drafting of the manuscript: Burcu

Critical revision of the manuscript for important intellectual content: all authors

Statistical analysis: Burcu, Sorkin

Obtained funding: Sorkin

Administrative, technical, or material support: all authors

Study supervision: Steinberger, Sorkin

Author information

Authors and Affiliations

  1. Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, 220 Arch Street, 12th floor, Baltimore, MD, 21201, USA

    Mehmet Burcu

  2. Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA

    Eileen K. Steinberger & John D. Sorkin

  3. Biostatistics and Informatics, Baltimore VA Medical Center, Baltimore, MD, USA

    John D. Sorkin

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  1. Mehmet Burcu
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  2. Eileen K. Steinberger
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  3. John D. Sorkin
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Correspondence to Mehmet Burcu.

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Burcu, M., Steinberger, E.K. & Sorkin, J.D. Health care access and smoking cessation among cancer survivors: implications for the Affordable Care Act and survivorship care. J Cancer Surviv 10, 1–10 (2016). https://doi.org/10.1007/s11764-015-0446-y

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