Smoking cessation attitudes and practices among cancer survivors – United States, 2015
The prevalence of smoking among cancer survivors is similar to the general population. However, there is little evidence on the prevalence of specific smoking cessation behaviors among adult cancer survivors.
The 2015 National Health Interview Survey (NHIS) data were analyzed to examine the prevalence of smoking cessation behaviors and use of treatments among cancer survivors. Weighted self-reported prevalence estimates and 95% confidence intervals were calculated using a sample of 2527 cancer survivors.
Among this sample of US cancer survivors, 12% were current smokers, 37% were former smokers, and 51% were never smokers. Compared with former and never smokers, current smokers were younger (< 65 years), less educated, and less likely to report being insured or Medicaid health insurance (p < 0.01). More males were former smokers than current or never smokers. Current smokers reported wanting to quit (57%), a past year quit attempt (49%), or a health professional advised them to quit (66%). Current smokers reported the use of smoking cessation counseling (8%) or medication (38%).
Even after a cancer diagnosis, about one in eight cancer survivors continued to smoke. All could have received advice to quit smoking by a health professional, but a third did not.
Implications for Cancer Survivors
Health professionals could consistently advise cancer survivors about the increased risks associated with continued smoking, provide them with cessation counseling and medications, refer them to other free cessation resources, and inform them of cessation treatments covered by their health insurance.
KeywordsSmoking Smoking cessation Cancer survivor Medication National survey
Gallaway: conceptualization, methodology, formal analysis, investigation, writing original-draft, writing-review and editing, and project administration. Glover-Kudon: conceptualization, methodology, writing original-draft, writing-review and editing, resources, and project administration. Momin, Puckett, Buchanan Lunsford, Ragan, and Rohan: conceptualization, methodology, writing original-draft, writing-review, and editing. Babb: conceptualization, methodology, writing original-draft, writing-review and editing, resources, and project administration.
All funding was provided by the Centers for Disease Control and Prevention.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not include any studies with human participants or animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
- 1.U.S. Department of Health and Human Services. The health consequences of smoking: 50 years of progress: a report of the surgeon general. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014.Google Scholar
- 3.US Cancer Statistics Working Group. United States cancer statistics: 1999–2013 incidence and mortality web-based report. Atlanta: U.S. Department of Health and Human Services, CDC, National Cancer Institute; 2016.Google Scholar
- 11.Park B, Kong SY, Kim J, Kim Y, Park IH, Jung SY, et al. Health behaviors of cancer survivors in nationwide cross-sectional survey in Korea: higher alcohol drinking, lower smoking, and physical inactivity pattern in survivors with higher household income. Medicine (Baltimore). 2015;94(31):e1214. https://doi.org/10.1097/MD.0000000000001214.CrossRefGoogle Scholar
- 12.Tseng TS, Lin HY, Martin MY, Chen T, Partridge EE. Disparities in smoking and cessation status among cancer survivors and non-cancer individuals: a population-based study from National Health and Nutrition Examination Survey. J Cancer Surviv. 2010;4(4):313–21. https://doi.org/10.1007/s11764-010-0127-9.CrossRefPubMedGoogle Scholar
- 14.Westmaas JL, Alcaraz KI, Berg CJ, Stein KD. Prevalence and correlates of smoking and cessation-related behavior among survivors of ten cancers: findings from a nationwide survey nine years after diagnosis. Cancer Epidemiol Biomark Prev. 2014;23(9):1783–92. https://doi.org/10.1158/1055-9965.EPI-14-0046.CrossRefGoogle Scholar
- 16.Division of Cancer Prevention and Control Centers for Disease Control and Prevention. National Comprehensive Cancer Control Program (NCCCP). 2017. https://www.cdc.gov/cancer/ncccp/. Accessed 3 April 2017.
- 24.Blum A. Cancer prevention: preventing tobacco-related cancers. In: Devita VTHS, Rosenberg SA, editors. Cancer: principles and practice of oncology. Philadelphia: Lippincott-Raven Publishers; 1997. p. 545–57.Google Scholar
- 29.Shiels MS, Gibson T, Sampson J, Alabanes D, Andreotti G, Freeman LB, et al. Cigarette smoking prior to first cancer and risk of second smoking-associated cancers among survivors of bladder, kidney, head and neck, and stage I lung cancers. J Clin Oncol. 2014;32(35):3989–95. https://doi.org/10.1200/JCO.2014.56.8220.CrossRefPubMedPubMedCentralGoogle Scholar
- 31.Al-Mamgani A, van Rooij PH, Mehilal R, Verduijn GM, Tans L, Kwa SL. Radiotherapy for T1a glottic cancer: the influence of smoking cessation and fractionation schedule of radiotherapy. Eur Arch Otorhinolaryngol. 2014;271(1):125–32. https://doi.org/10.1007/s00405-013-2608-8.CrossRefPubMedGoogle Scholar
- 36.Passarelli MN, Newcomb PA, Hampton JM, Trentham-Dietz A, Titus LJ, Egan KM, et al. Cigarette smoking before and after breast cancer diagnosis: mortality from breast cancer and smoking-related diseases. J Clin Oncol. 2016;34(12):1315–22. https://doi.org/10.1200/JCO.2015.63.9328.CrossRefPubMedPubMedCentralGoogle Scholar
- 37.Roach MC, Rehman S, DeWees TA, Abraham CD, Bradley JD, Robinson CG. It’s never too late: smoking cessation after stereotactic body radiation therapy for non-small cell lung carcinoma improves overall survival. Pract Radiat Oncol. 2016;6(1):12–8. https://doi.org/10.1016/j.prro.2015.09.005.CrossRefPubMedGoogle Scholar
- 38.Sandoval M, Font R, Manos M, Dicenta M, Quintana MJ, Bosch FX, et al. The role of vegetable and fruit consumption and other habits on survival following the diagnosis of oral cancer: a prospective study in Spain. Int J Oral Maxillofac Surg. 2009;38(1):31–9. https://doi.org/10.1016/j.ijom.2008.09.004.CrossRefPubMedPubMedCentralGoogle Scholar
- 42.Fiore MC, Jaen CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ et al. Treating tobacco use and dependence: 2008 update. Clinical practice guideline. Rockville: US Department of Health and Human Services, Public Health Service; 2008.Google Scholar
- 43.Cahill K, Stead L, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews, the Cochrane Library. 1996(1).Google Scholar
- 44.Lancaster T, Stead L. Individual behavioural counselling for smoking cessation. Cochrane Database Syst Rev Cochrane Lib. 1996;(2).Google Scholar
- 48.National Center for Health Statistics. National Health Interview Survey 2015. National Center for Health Statistics. http://www.cdc.gov/nchs/nhis/quest_data_related_1997_forward.htm.2016. Accessed 1 March 2017.
- 49.Centers for Disease Control and Prevention. Current cigarette smoking among adults in the United States. Atlanta, Georgia; 2016. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm. Accessed 17 Oct 2017.
- 56.Pommeranke A, Alberg A, Brandon T, Croghan I, Cummings KM, Dresler C, et al. Physician preferences in tobacco cessation support for cancer patients: a survey of National Cancer Institute Designated Cancer Centers. San Diego: American Association for Cancer Research; 2014.Google Scholar
- 57.Warren GW, Marshall JR, Cummings KM, Toll B, Gritz ER, Hutson A, et al. Practice patterns and perceptions of thoracic oncology providers on tobacco use and cessation in cancer patients. J Thorac Oncol. 2013;8(5):543–8. https://doi.org/10.1097/JTO.0b013e318288dc96.CrossRefPubMedPubMedCentralGoogle Scholar
- 63.Fiore M. Treating tobacco use and dependence: 2008 guidelines. United States Tobacco Use and Dependence Guideline Panel; 2008.Google Scholar
- 66.Malarcher A. Quitting smoking among adults—United States, 2001-2010. JAMA. 2011;306(23):2554.Google Scholar
- 67.Blair NA, Husten CG, Mariolis P, Pechacek TF, Starr G, Centers for Disease Control and Prevention (U.S.) et al. Best practices for comprehensive tobacco control programs. [Atlanta, GA]: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health; 2007.Google Scholar
- 68.National Cancer Institute. Cancer Center Cessation Initiative. 2018. https://cancercontrol.cancer.gov/brp/tcrb/cessation-initiative.html. Accessed 21 Oct 2018.
- 70.Comprehensive Cancer Control National Partnership. Increase availability of tobacco cessation services for cancer survivors. 2016. http://www.cccnationalpartners.org/increase-availability-tobacco-cessation-services-cancer-survivors. Accessed 3 Aug 2017.