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Correlates of smoking status in cancer survivors

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Abstract

Purpose

To determine the characteristics associated with cancer survivors which indicate continued cigarette smoking at or around the time of cancer diagnosis.

Methods

A total of 631 survivors were recruited in four cancer centers in Memphis, TN, between March 2015 and June 2016. To increase the probability of accurate reporting, surveys were conducted anonymously. A total of 112 respondents reported they were current smokers and 202 reported they were former smokers (n = 314), who comprised the sample.

Results

We found that the rate of daily e-cigarette use among cancer survivors who smoked was 15.2% versus 3.9% in cancer survivors who no longer smoked. The national rate of adult e-cigarette use is 3.5%. Multivariate models correlated the characteristics of current versus former smokers and revealed that increasing age (aOR = 0.97, p < .0001), decreasing education (aOR = 2.39, p < .02), and current use of e-cigarettes (aOR = 3.74, p < .00045) were frequently associated with current cigarette smoking.

Conclusions

While age and gender were associated with continued smoking, current use of e-cigarettes was associated with almost four times higher odds of being a current smoker. Further research is needed to determine if use of e-cigarettes deters or promotes the smoking cessation process, at least in cancer survivors.

Implications for Cancer Survivors

Among cancer survivors who continue to smoke after a cancer diagnosis, use of e-cigarettes is highly prevalent; research is needed to determine whether use of e-cigarettes promotes, has no effect, or hinders smoking cessation efforts among this vulnerable population.

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References

  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 

  2. Centers for Disease Control and Prevention (CDC). Fact sheet: Current cigarette smoking among adults in the United States. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm. Updated 2016. Accessed 09/04, 2017.

  3. 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. BMJ. 2010;340:b5569. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2809841/. https://doi.org/10.1136/bmj.b5569.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Adhikari B, Kahende J, Malarcher A, Pechacek T, Tong V. Smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 2000-2004. MMWR Morb Mortal Wkly Rep. 2008;57(45):1226–8 http://www.proxy.its.virginia.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=105715504&site=ehost-live&scope=site.

  5. NCI dictionary of cancer terms. https://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=450125. Accessed 14 Aug 2017.

  6. American Cancer Society. Cancer treatment & survivorship facts & figures 2016–2017. Atlanta: American Cancer Society; 2016. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-treatment-and-survivorship-facts-and-figures/cancer-treatment-and-survivorship-facts-and-figures-2016-2017.pdf. Accessed 20 Nov 2017

    Google Scholar 

  7. Cox LS, Africano NL, Tercyak KP, Taylor KL. Nicotine dependence treatment for patients with cancer. Cancer. 2003;98(3):632–44. https://doi.org/10.1002/cncr.11538.

    Article  PubMed  Google Scholar 

  8. de Moor JS, Mariotto AB, Parry C, Alfano CM, Padgett L, Kent EE, et al. Cancer survivors in the United States: prevalence across the survivorship trajectory and implications for care. Cancer Epidemiol Biomark Prev. 2013;22(4):561. http://cebp.aacrjournals.org/content/22/4/561.abstract–70.

    Article  Google Scholar 

  9. Browman GP, Wong G, Hodson I, Sathya J, Russell R, McAlpine L, et al. Influence of cigarette smoking on the efficacy of radiation therapy in head and neck cancer. N Engl J Med. 1993;328(3):159–63. https://doi.org/10.1056/NEJM199301213280302.

    Article  CAS  PubMed  Google Scholar 

  10. Kumar B, Cordell KG, Lee JS, Worden FP, Prince ME, Tran HH, et al. EGFR, p16, HPV titer, bcl-xL and p53, sex, and smoking as indicators of response to therapy and survival in oropharyngeal cancer. J Clin Oncol. 2008;26(19):3128–37. https://doi.org/10.1200/JCO2007.12.7662.

    Article  PubMed  Google Scholar 

  11. Florou AN, Gkiozos IC, Tsagouli SK, Souliotis KN, Syrigos KN. Clinical significance of smoking cessation in subjects with cancer: A 30-year review. Respir Care. 2014;59(12):1924–36. https://doi.org/10.4187/respcare.02559.

    Article  PubMed  Google Scholar 

  12. Nayan S, Gupta MK, Strychowsky JE, Sommer DD. Smoking cessation interventions and cessation rates in the oncology population. Otolaryngol Head Neck Surg. 2013;149(2):200–11. https://doi.org/10.1177/0194599813490886.

    Article  PubMed  Google Scholar 

  13. 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. https://doi.org/10.1207/S15324796ABM2503_07.

    Article  PubMed  Google Scholar 

  14. Eng L, Su J, Qiu X, et al. Second-hand smoke as a predictor of smoking cessation among lung cancer survivors. J Clin Oncol. 2014;32(6):564–70. https://doi.org/10.1200/JCO.2013.50.9695.

    Article  PubMed  Google Scholar 

  15. Ostroff JS, Jacobsen PB, Moadel AB, Spiro RH, Shah JP, Strong EW, et al. Prevalence and predictors of continued tobacco use after treatment of patients with head and neck cancer. Cancer. 1995;75(2):569–76.

    Article  CAS  PubMed  Google Scholar 

  16. Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO. The fagerstrom test for nicotine dependence: a revision of the fagerstrom tolerance questionnaire. Br J Addict. 1991;86(9):1119–27.

    Article  CAS  PubMed  Google Scholar 

  17. Jamal A, King BA, Neff LJ, Whitmill J, Babb SD, Graffunder CM. Current cigarette smoking among adults—United States, 2005–2015. MMWR Morb Mortal Wkly Rep. 2016;65(44):1205–11. http://www.proxy.its.virginia.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=119452652&site=ehost-live&scope=site. https://doi.org/10.15585/mmwr.mm6544a2.

    Article  PubMed  Google Scholar 

  18. Garrett BE, Dube SR, Trosclair A, Caraballo RS, Pechacek TF. Centers for Disease Control and Prevention (CDC). Cigarette smoking—United States, 1965-2008. MMWR Suppl. 2011;60(1):109–13.

    PubMed  Google Scholar 

  19. Singh T, Arrazola RA, Corey CG, et al. Tobacco use among middle and high school students—United States, 2011–2015. MMWR Morb Mortal Wkly Rep. 2016;65(14):361–7. https://doi.org/10.15585/mmwr.mm6514a1.

    Article  PubMed  Google Scholar 

  20. Tam J, Warner KE, Gillespie BW, Gillespie JA. Impact of changing U.S. demographics on the decline in smoking prevalence, 1980–2010. Nicotine Tob Res. 2014;16(6):864–6. https://doi.org/10.1093/ntr/ntt223.

    Article  PubMed  Google Scholar 

  21. Escobedo LG, Peddicord JP. Smoking prevalence in US birth cohorts: the influence of gender and education. Am J Public Health. 1996;86(2):231–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Zhu BP, Giovino GA, Mowery PD, Eriksen MP. The relationship between cigarette smoking and education revisited: implications for categorizing persons’ educational status. Am J Public Health. 1996;86(11):1582–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Lillard DR, Plassmann V, Kenkel D, Mathios A. Who kicks the habit and how they do it: socioeconomic differences across methods of quitting smoking in the USA. Soc Sci Med. 2007;64(12):2504–19. https://doi.org/10.1016/j.socscimed.2007.02.036.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Wagenknecht LE, Perkins LL, Cutter GR, Sidney S, Burke GL, Manolio TA, et al. Cigarette smoking behavior is strongly related to educational status: the cardia study. Prev Med. 1990;19(2):158–69. https://doi.org/10.1016/0091-7435(90)90017-E.

    Article  CAS  PubMed  Google Scholar 

  25. Stringhini S, Sabia S, Shipley M, et al. Association of socioeconomic position with health behaviors and mortality. JAMA. 2010;303(12):1159–66. https://doi.org/10.1001/jama.2010.297.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. QuickStats: Cigarette smoking status* among current adult E-cigarette users,dagger by age group—national health interview survey, section sign United States, 2015. MMWR Morb Mortal Wkly Rep. 2016;65(42):1177. https://doi.org/10.15585/mmwr.mm6542a7.

  27. Grana RA, Popova L, Ling PM. A longitudinal analysis of electronic cigarette use and smoking cessation. JAMA Intern Med. 2014;174(5):812–3. https://doi.org/10.1001/jamainternmed.2014.187.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Pericot-Valverde I, Gaalema DE, Priest JS, Higgins ST. E-cigarette awareness, perceived harmfulness, and ever use among U.S. adults. Prev Med. 2017;104:92–9. https://doi.org/10.1016/j.ypmed.2017.07.014.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Giovenco DP, Delnevo CD. Prevalence of population smoking cessation by electronic cigarette use status in a national sample of recent smokers. Addict Behav. 2018;76:129–34. https://doi.org/10.1016/j.addbeh.2017.08.002.

    Article  PubMed  Google Scholar 

  30. Little MA, Bursac Z, Derefinko KJ, et al. Types of dual and poly-tobacco users in the US military. Am J Epidemiol. 2016;184(3):211–8. https://doi.org/10.1093/aje/kwv321.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Tobacco Advisory Group of the Royal College of Physicians. Nicotine without smoke: Tobacco harm reduction. https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0. Updated 2016. Accessed 09/04, 2017.

  32. Smokefree.gov. What we know about E-cigarettes. https://smokefree.gov/quitting-smoking/e-cigs-menthol-dip-more/what-we-know-about-e-cigarettes. Accessed 4 Sept 2017.

  33. Hartmann-Boyce J, McRobbie H, Bullen C, Begh R, Stead LF, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev. 2016;9:CD010212. https://doi.org/10.1002/14651858.CD010216.pub3.

    Article  Google Scholar 

  34. McNeill A, Brose L, Calder R, Hitchman S, Hajek P, McRobbie H. E-cigarettes: An evidence update. Public Health England 2015;3. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/733022/Ecigarettes_an_evidence_update_A_report_commissioned_by_Public_Health_En. Accessed 30 April 2018.

  35. Biener L, Hargraves JL. A longitudinal study of electronic cigarette use among a population-based sample of adult smokers: Association with smoking cessation and motivation to quit. Nicotine Tob Res. 2015;17(2):127–33. https://doi.org/10.1093/ntr/ntu200.

    Article  PubMed  Google Scholar 

  36. Kalkhoran S, Glantz SA. E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis. Lancet Respir Med. 2016;4(2):116–28. https://doi.org/10.1016/S2213-2600(15)00521-4.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Fidler JA, Shahab L, West O, et al. ‘The smoking toolkit study’: a national study of smoking and smoking cessation in England. BMC Public Health. 2011;11:479–2458–11-479. https://doi.org/10.1186/1471-2458-11-479.

    Article  PubMed  PubMed Central  Google Scholar 

  38. West R, Beard E, Brown J. Trends in electronic cigarette use in England. Smoking Toolkit Study: Latest Statistics. 2017(July 7). https://smokinginengland.info/latest-statistics/. Accessed 30 April 2018

  39. Bullen C, Howe C, Laugesen M, McRobbie H, Parag V, Williman J, et al. Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet. 2013;382(9905):1629–37. https://doi.org/10.1016/S0140-6736(13)61842-5.

    Article  PubMed  Google Scholar 

  40. Brandon TH, Goniewicz ML, Hanna NH, et al. Electronic nicotine delivery systems: A policy statement from the american association for cancer research and the american society of clinical oncology. J Clin Oncol. 2015;33(8):952–63. https://doi.org/10.1200/JCO.2014.59.4465.

    Article  PubMed  Google Scholar 

  41. Jamal A, Phillips E, Gentzke AS, et al. Current cigarette smoking among adults—United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67(2):53–9. https://doi.org/10.15585/mmwr.mm6702a1.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors gratefully acknowledge Methodist Health Systems and the West Cancer Center for their assistance in providing access to their facilities and patients.

Funding

This study was supported by a grant from the National Cancer Institute (R01CA127964) awarded to the Dr. Klesges, as well as funding from the University of Virginia Center for Addiction Prevention Research.

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Correspondence to Melissa A. Little.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Little, M.A., Klesges, R.C., Bursac, Z. et al. Correlates of smoking status in cancer survivors. J Cancer Surviv 12, 828–834 (2018). https://doi.org/10.1007/s11764-018-0720-x

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  • DOI: https://doi.org/10.1007/s11764-018-0720-x

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