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

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

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

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.

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Authors and Affiliations

  1. School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia

    Christine L. Paul, Flora Tzelepis, Allison W. Boyes, Catherine D’Este & Emma Sherwood

  2. The Hunter Medical Research Institute, New Lambton Heights, NSW, Australia

    Christine L. Paul, Flora Tzelepis, Allison W. Boyes & Emma Sherwood

  3. Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia

    Flora Tzelepis

  4. National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia

    Catherine D’Este

  5. Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia

    Afaf Girgis

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  1. Christine L. Paul
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Correspondence to Christine L. Paul.

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Paul, C.L., Tzelepis, F., Boyes, A.W. et al. Continued smoking after a cancer diagnosis: a longitudinal study of intentions and attempts to quit. J Cancer Surviv 13, 687–694 (2019). https://doi.org/10.1007/s11764-019-00787-5

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  • DOI: https://doi.org/10.1007/s11764-019-00787-5

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