Journal of Cancer Survivorship

, Volume 13, Issue 5, pp 687–694 | Cite as

Continued smoking after a cancer diagnosis: a longitudinal study of intentions and attempts to quit

  • Christine L. PaulEmail author
  • Flora Tzelepis
  • Allison W. Boyes
  • Catherine D’Este
  • Emma Sherwood
  • Afaf Girgis



Continued smoking after a cancer diagnosis is associated with poor treatment outcomes and reduced life expectancy. We aimed to identify the stability of smoking status after diagnosis including quit attempts and quit intentions.


Participants with a first primary cancer diagnosis were recruited via two state-based registries in Australia. Questionnaires were mailed at approximately 6 months (T1), 1 year (T2), 2 years (T3), and 3.5 years (T4) post-diagnosis. Smoking status and quitting intentions were assessed at each time point.


A cohort of 1444 people was recruited. People who indicated that they were more than 9 months post-diagnosis are excluded from analysis, leaving 1407 eligible study participants. Sixty-six (37%) of the 178 self-reported smokers at diagnosis had quit in the 6-month post-diagnosis (T1), the remaining 112 (63%) reported being a current smoker. Of the smokers at T1, 40% intended to quit: with 8% having quit smoking by T2; 11% quit by T3; 12% quit by T4. Of those who reported at T1 that they intended to quit in the next 6 months, 10% or fewer reported having quit at any subsequent time point. Quitting attempts decreased in frequency over time post-diagnosis. Less than 15% of respondents who had quit at or shortly before diagnosis reported relapse to smoking at each time point.


The majority of smokers diagnosed with cancer continue to smoke beyond diagnosis, even in the context of an intention to quit and attempts to do so. Cancer survivors who smoke remain motivated to quit well beyond the initial diagnosis.

Implications for Cancer Survivors

There are clear positive clinical effects of smoking cessation for those who have undergone treatment for cancer, both for short-term treatment outcomes, and for long-term survivorship. Given the substantial rates of continued smoking among those who report smoking at diagnosis and their continued attempts to quit during survivorship, there is a need for improved cessation support initiatives for people diagnosed with cancer. These initiatives need to continue to be offered to smokers long after the initial diagnosis and treatment.


Cancer Smoking cessation Smoking Survivorship 



This research was conducted as part of the Cancer Survival Study. The assistance of the following people is gratefully acknowledged: Associate Professor Raoul Walsh for advising on outcome measurement; staff of the Victorian Cancer Registry (The Cancer Council Victoria) and NSW Central Cancer Registry (NSW Department of Health and Cancer Institute NSW) for assistance with case recruitment; Ms. Alison Zucca and Dr. Alix Hall for data collection; Ms. Sandra Dowley for data entry; Ms. Emma Byrnes with paper preparation and Dr. Chris Oldmeadow and Dr. Lucy Leigh with statistical support. AG, AB, CDE, FT, and CP were responsible for study conception (including development of measurement). AB and AG were responsible for data collection. CP, FT, AB, and ES were responsible for data analysis and interpretation. ES, CP, and FT were responsible for manuscript preparation. All authors were responsible for manuscript review and approval.


Funding for this study was provided by the National Health & Medical Research Council (ID 252418), Cancer Council NSW, Hunter Medical Research Institute, Honda Foundation and University of Newcastle.

Professor Paul was supported by a National Health and Medical Research Council Career Development Fellowship (grant number 106335). Associate Professor Tzelepis was supported by a Cancer Institute New South Wales (CINSW) Early Career Fellowship (grant number 15/ECF/1–44) followed by a National Health & Medical Research Council Career Development Fellowship (grant number 1143269). Dr. Allison Boyes is supported by a National Health & Medical Research Council Early Career Fellowship (grant number 1073317) and CINSW Early Career Fellowship (grant number 13/ECF/1–37). Professor Girgis is supported by CINSW grants.

Compliance with ethical standards

Conflict of interests

The authors declare that they have no conflict of interest.


  1. 1.
    Johnson CB, Davis MK, Law A, Sulpher J. Shared risk factors for cardiovascular disease and cancer: implications for preventive health and clinical care in oncology patients. Can J Cardiol. 2016;32(7):900–7.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Clark JR, McCluskey SA, Hall F, Lipa J, Neligan P, Brown D, et al. Predictors of morbidity following free flap reconstruction for cancer of the head and neck. Head Neck. 2007;29(12):1090–101.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Ligibel J. Lifestyle factors in cancer survivorship. J Clin Oncol. 2012;30(30):3697–704.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Cowen D, Gross E, Rouannet P, Teissier E, Ellis S, Resbeut M, et al. Immediate post-mastectomy breast reconstruction followed by radiotherapy: risk factors for complications. Breast Cancer Res Treat. 2010;121(3):627–34.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Mason DP, Subramanian S, Nowicki ER, Grab JD, Murthy SC, Rice TW, et al. Impact of smoking cessation before resection of lung cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database study. Ann Thorac Surg. 2009;88(2):362–71.PubMedCrossRefGoogle Scholar
  6. 6.
    Baser S, Shannon VR, Eapen GA, Jimenez CA, Onn A, Lin E, et al. Smoking cessation after diagnosis of lung cancer is associated with a beneficial effect on performance status. CHEST J. 2006;130(6):1784–90.CrossRefGoogle Scholar
  7. 7.
    Kelly KJ, Greenblatt DY, Wan Y, Rettammel RJ, Winslow E, Cho CS, et al. Risk stratification for distal pancreatectomy utilizing ACS-NSQIP: preoperative factors predict morbidity and mortality. J Gastrointest Surg. 2011;15(2):250–61.PubMedCrossRefGoogle Scholar
  8. 8.
    Zingg U, Smithers BM, Gotley DC, Smith G, Aly A, Clough A, et al. Factors associated with postoperative pulmonary morbidity after esophagectomy for cancer. Ann Surg Oncol. 2011;18(5):1460–8.PubMedCrossRefGoogle Scholar
  9. 9.
    US Department of Health and Human Services. The health consequences of smoking - 50 years of progress: A report of the surgeon general. Atlanta: USDHHS, CDCP, NCCDPHP; 2014.Google Scholar
  10. 10.
    Schnoll RA, Rothman RL, Newman H, Lerman C, Miller SM, Movsas B, 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-Oncology. 2004;13(5):346–58.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Munro A, Bentley A, Ackland C, Boyle P. Smoking compromises cause-specific survival in patients with operable colorectal cancer. Clin Oncol. 2006;18(6):436–40.CrossRefGoogle Scholar
  12. 12.
    Cataldo JK, Dubey S, Prochaska JJ. Smoking cessation: an integral part of lung cancer treatment. Oncology. 2010;78(5–6):289–301.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Mayer DK, Carlson J. Smoking patterns in cancer survivors. Nicotine Tob Res. 2010;13(1):34–40.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Blanchard CM, Courneya KS, Stein K. Cancer survivors’ adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society’s SCS-II. J Clin Oncol Off J Am Soc Clin Oncol. 2008;26(13):2198–204. Scholar
  15. 15.
    Hawkins NA, Smith T, Zhao L, Rodriguez J, Berkowitz Z, Stein KD. Health-related behavior change after cancer: results of the American cancer society’s studies of cancer survivors (SCS). J Cancer Surviv. 2010;4(1):20–32. Scholar
  16. 16.
    Eakin EG, Youlden DR, Baade PD, Lawler SP, Reeves MM, Heyworth JS, et al. Health behaviors of cancer survivors: data from an Australian population-based survey. Cancer Causes Control. 2007;18(8):881–94.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Gritz ER, Toll BA, Warren GW. Tobacco use in the oncology setting: advancing clinical practice and research. Cancer Epidemiol Biomark Prev. 2014;23(1):3–9.CrossRefGoogle Scholar
  18. 18.
    Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM. Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol. 2005;23(24):5814–30.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    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;33(15):1647–52.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Duffy SA, Louzon SA, Gritz ER. Why do cancer patients smoke and what can providers do about it? Commun Oncol. 2012;9(11):344.CrossRefGoogle Scholar
  21. 21.
    Park ER, Japuntich SJ, Rigotti NA, Traeger L, He Y, Wallace RB, et al. A snapshot of smokers after lung and colorectal cancer diagnosis. Cancer. 2012;118(12):3153–64.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Berg CJ, Thomas AN, Mertens AC, Schauer GL, Pinsker EA, Ahluwalia JS, et al. Correlates of continued smoking versus cessation among survivors of smoking-related cancers. Psycho-Oncology. 2013;22(4):799–806.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Gritz ER, Fingeret MC, Vidrine DJ, Lazev AB, Mehta NV, Reece GP. Successes and failures of the teachable moment. Cancer. 2006;106(1):17–27.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Cooley ME, Sarna L, Kotlerman J, Lukanich JM, Jaklitsch M, Green SB, et al. Smoking cessation is challenging even for patients recovering from lung cancer surgery with curative intent. Lung Cancer. 2009;66(2):218–25.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Walker MS, Vidrine DJ, Gritz ER, Larsen RJ, Yan Y, Govindan R, et al. Smoking relapse during the first year after treatment for early-stage non–small-cell lung cancer. Cancer Epidemiol Prev Biomark. 2006;15(12):2370–7.CrossRefGoogle Scholar
  26. 26.
    Schnoll RA, Malstrom M, James C, Rothman RL, Miller SM, Ridge JA, et al. Correlates of tobacco use among smokers and recent quitters diagnosed with cancer. Patient Educ Couns. 2002;46(2):137–45.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Nayan S, Gupta MK, Strychowsky JE, Sommer DD. Smoking cessation interventions and cessation rates in the oncology population: an updated systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2013;149(2):200–11.PubMedCrossRefGoogle Scholar
  28. 28.
    Lucchiari C, Masiero M, Botturi A, Pravettoni G. Helping patients to reduce tobacco consumption in oncology: a narrative review. SpringerPlus. 2016;5(1):1136.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Warren GW, Marshall JR, Cummings KM, Toll BA, Gritz ER, Hutson A, et al. Addressing tobacco use in patients with cancer: a survey of American Society of Clinical Oncology members. J Oncol Pract. 2013;9(5):258–62.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Schnoll RA, Calvin J, Malstrom M, Rothman RL, Wang H, Babb J, et al. Longitudinal predictors of continued tobacco use among patients diagnosed with cancer. Ann Behav Med. 2003;25(3):214–21.PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    Bryant J, Boyes AW, Hall A, Girgis A, D’Este C, Sitas F. Prevalence and factors related to smoking and smoking cessation 6 months following a cancer diagnosis: a population-based study. J Cancer Surviv. 2016;10(4):645–53.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Simmons VN, Litvin EB, Jacobsen PB, Patel RD, McCaffrey JC, Oliver JA, et al. Predictors of smoking relapse in patients with thoracic cancer or head and neck cancer. Cancer. 2013;119(7):1420–7.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Cooley ME, Wang Q, Johnson BE, Catalano P, Haddad RI, Bueno R, et al. Factors associated with smoking abstinence among smokers and recent-quitters with lung and head and neck cancer. Lung Cancer. 2012;76(2):144–9.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Berg CJ, Carpenter MJ, Jardin B, Ostroff JS. Harm reduction and cessation efforts and interest in cessation resources among survivors of smoking-related cancers. J Cancer Surviv. 2013;7(1):44–54.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Burris JL, Studts JL, DeRosa AP, Ostroff JS. Systematic review of tobacco use after lung or head/neck cancer diagnosis: results and recommendations for future research. Cancer Epidemiol Prev Biomark. 2015;24(10):1450–61.CrossRefGoogle Scholar
  36. 36.
    Boyes AW, Girgis A, D’Este C, Zucca AC. Flourishing or floundering? Prevalence and correlates of anxiety and depression among a population-based sample of adult cancer survivors 6 months after diagnosis. J Affect Disord. 2011;135(1):184–92.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Australian Institute of Health and Welfare. Australian Institute of Health and Welfare and Australasian Association of Cancer Registries 2012. Cancer in Australia: an overview, 2012. Cancer Series No. 74. Cat. No. CAN 70. Canberra: AIHW; 2012.Google Scholar
  38. 38.
    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 Prev Biomark. 2014;23(9):1783–92.CrossRefGoogle Scholar
  39. 39.
    Underwood JM, Townsend JS, Tai E, White A, Davis SP, Fairley TL. Persistent cigarette smoking and other tobacco use after a tobacco-related cancer diagnosis. J Cancer Surviv. 2012;6(3):333–44.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6(1):42.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Ajzen I. From Intentions to Actions: A Theory of Planned Behavior. In: Kuhl J., Beckmann J. (eds) Action Control. SSSP Springer Series in Social Psychology. Springer, Berlin, Heidelberg. p. 11–39.Google Scholar
  42. 42.
    Hawkins ML, Buys SS, Gren LH, Simonsen SE, Kirchhoff AC, Hashibe M. Do cancer survivors develop healthier lifestyle behaviors than the cancer-free population in the PLCO study? J Cancer Surviv. 2017;11(2):233–45.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Dresler CM, Bailey M, Roper CR, Patterson GA, Cooper JD. Smoking cessation and lung cancer resection. Chest. 1996;110(5):1199–202.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Gritz ER, Nisenbaum R, Elashoff RE, Holmes EC. Smoking behavior following diagnosis in patients with stage I non-small cell lung cancer. Cancer Causes Control. 1991;2(2):105–12.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Chang EHE, Braith A, Hitsman B, Schnoll RA. Treating nicotine dependence and preventing smoking relapse in cancer patients. Expert Rev Qual Life Cancer Care 2017;2(1):23–39.Google Scholar
  46. 46.
    Eng L, Qiu X, Su J, Pringle D, Niu C, Mahler M, et al. The role of second-hand smoke exposure on smoking cessation in non-tobacco-related cancers. Cancer. 2015;121(15):2655–63. Scholar
  47. 47.
    Morales NA, Romano MA, Cummings KM, Marshall JR, Hyland AJ, Hutson A, et al. Accuracy of self-reported tobacco use in newly diagnosed cancer patients. Cancer Causes Control. 2013;24(6):1223–30.PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Sandhu S, Humphris G, Whitley S, Cardozo A, Sandhu A. Smoking habits in patient’s who have been treated for an oral cancer: validation of self-report using saliva cotinine. Oral Oncol. 2004;40(6):576–8.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Studts JL, Ghate SR, Gill JL, Studts CR, Barnes CN, LaJoie AS, et al. Validity of self-reported smoking status among participants in a lung cancer screening trial. Cancer Epidemiol Prev Biomark. 2006;15(10):1825–8.CrossRefGoogle Scholar
  50. 50.
    Brigham J, Lessov-Schlaggar CN, Javitz HS, Krasnow RE, Tildesley E, Andrews J, et al. Validity of recall of tobacco use in two prospective cohorts. Am J Epidemiol. 2010;172(7):828–35.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of Medicine and Public HealthThe University of NewcastleCallaghanAustralia
  2. 2.The Hunter Medical Research InstituteNew Lambton HeightsAustralia
  3. 3.Hunter New England Population HealthHunter New England Local Health DistrictWallsendAustralia
  4. 4.National Centre for Epidemiology and Population Health, Research School of Population HealthAustralian National UniversityCanberraAustralia
  5. 5.Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical SchoolUniversity of New South WalesSydneyAustralia

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