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Awareness of the Harms of Continued Smoking Among Cancer Survivors

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Abstract

Background

Smoking cessation is an integral part of cancer survivorship. To help improve survivorship education, clinicians need an understanding of patient awareness of the harms of continued smoking.

Methods

Cancer survivors from Princess Margaret Cancer Centre (Toronto, ON) were surveyed on their awareness of the harms of continued smoking on cancer-related outcomes. Multivariable logistic regression models assessed factors associated with awareness and whether awareness was associated with subsequent cessation among smokers at diagnosis.

Results

Among 1118 patients, 23% were current smokers pre-diagnosis and 54% subsequently quit; 25% had lung and 30% head and neck cancers. Many patients reported being unaware that continued smoking results in greater cancer surgical complications (53%), increased radiation side effects (62%), decreased quality of life during chemotherapy (51%), decreased chemotherapy or radiation efficacy (57%), increased risk of death (40%), and increased development of second primaries (38%). Being a current smoker was associated with greater lack of awareness of some of these smoking harms (aORs = 1.53–2.20, P < 0.001–0.02), as was exposure to any second-hand smoke (aORs = 1.45–1.53, P = 0.006–0.04) and being diagnosed with early stage cancer (aORs = 1.38–2.31, P < 0.001–0.06). Among current smokers, those with fewer pack-years, being treated for cure, or had a non-tobacco-related cancer were more likely unaware. Awareness that continued tobacco use worsen quality of life after chemotherapy was associated with subsequent cessation (aOR = 2.26, P = 0.006).

Conclusions

Many cancer survivors are unaware that continued smoking can negatively impact cancer-related outcomes. The impact of educating patients about the potential harms of continued smoking when discussing treatment plans should be further evaluated.

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Funding

This research was supported in part by the Alan B Brown Chair in Molecular Genomics, the CCO Chair in Experimental Therapeutics and Population studies, and the Posluns Family Foundation.

Author information

Author notes

  1. Meredith Elana Giuliani and Geoffrey Liu are co-senior authors.

Authors and Affiliations

  1. Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre/University Health Network and University of Toronto, Toronto, Ontario, Canada

    Lawson Eng, Devon Alton, Katie Mattina, Christopher Harper, Sophia Liu & Geoffrey Liu

  2. Ontario Cancer Institute, Toronto, Ontario, Canada

    Lawson Eng, Devon Alton, Yuyao Song, Jie Su, Delaram Farzanfar, Rahul Mohan, Olivia Krys, Katie Mattina, Christopher Harper, Sophia Liu, Robin Milne, M. Catherine Brown, Ashlee Vennettilli, Doris Howell, Jennifer M Jones, Wei Xu, Meredith Elana Giuliani & Geoffrey Liu

  3. Department of Medicine, University Health Network, Toronto, Ontario, Canada

    Lawson Eng, Devon Alton, Wei Xu & Geoffrey Liu

  4. Department of Radiation Oncology, Princess Margaret Cancer Centre, 610 University Ave, Rm 7-125, Toronto, Ontario, M5G 2M9, Canada

    Devon Alton, Robin Milne, Nazek Abdelmutti, Andrew J. Hope & Meredith Elana Giuliani

  5. Department of Biostatistics, Princess Margaret Cancer Centre/University Health Network and University of Toronto, Toronto, Ontario, Canada

    Yuyao Song, Jie Su, Qihuang Zhang & Jiahua Che

  6. Department of Otolaryngology-Head and Neck Surgery, University of Toronto, University Health Network, Toronto, Ontario, Canada

    Tom Yoannidis & David Paul Goldstein

  7. Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada

    Peter Selby

  8. Departments of Family and Community Medicine & Psychiatry, University of Toronto, Toronto, Canada

    Peter Selby

  9. Division of Medical Oncology, Department of Oncology, McMaster University, Hamilton, Ontario, Canada

    William K Evans

  10. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

    Wei Xu & Geoffrey Liu

Authors
  1. Lawson Eng
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  2. Devon Alton
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  3. Yuyao Song
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  4. Jie Su
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  5. Qihuang Zhang
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  6. Jiahua Che
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  7. Delaram Farzanfar
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  8. Rahul Mohan
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  9. Olivia Krys
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  10. Katie Mattina
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  11. Christopher Harper
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  12. Sophia Liu
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  13. Tom Yoannidis
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  14. Robin Milne
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  15. Nazek Abdelmutti
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  16. M. Catherine Brown
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  17. Ashlee Vennettilli
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  18. Andrew J. Hope
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  19. Doris Howell
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  20. Jennifer M Jones
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  21. Peter Selby
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  22. William K Evans
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  23. Wei Xu
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  24. David Paul Goldstein
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  25. Meredith Elana Giuliani
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  26. Geoffrey Liu
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Corresponding authors

Correspondence to Meredith Elana Giuliani or Geoffrey Liu.

Ethics declarations

The institutional (University Health Network) research ethics board approved the study. Informed consent was obtained from all individual participants included in the study. We have full control of all primary data and we agree to allow the journal to review our data if requested.

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The authors declare that they have no conflict of interest.

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Eng, L., Alton, D., Song, Y. et al. Awareness of the Harms of Continued Smoking Among Cancer Survivors. Support Care Cancer 28, 3409–3419 (2020). https://doi.org/10.1007/s00520-019-05175-4

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