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Nearly Half Of Lung Cancer Surgery Patients Continue Smoking
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Key Point
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| Nearly half of lung cancer surgery patients with a recent history of smoking may return to smoking, and 60% of those who do may resume within the first two months after surgery. |
ST. LOUIS —Lung cancer surgery may not be a strong enough motivator for patients with a recent history of smoking to quit, according to recent findings.1
Mark S. Walker, PhD, Assistant Professor at Washington University School of Medicine in St. Louis, and colleagues assessed 12-month smoking status and duration of continuous abstinence after surgery in 154 early-stage non–small cell lung cancer patients who had smoked within three months before surgery. Results showed that 66 of the initial cohort of patients (42.9%) smoked at some point after surgery, and at 12 months, 31 of 84 patients (36.9%) who underwent follow-up were smoking. Among all patients who smoked after surgery, 60% lapsed or relapsed during the first two months after surgery.
Predictors of Postsurgery Smoking
Smoking at follow-up was predicted by shorter quit duration before surgery, more intense appetitive cravings, lower income, and a higher level of education. These same predictors, with the exception of a higher level of education, also predicted a short time to first smoking lapse. The researchers also found that greater delay to smoking lapse was associated with abstinence from smoking at 12 months after surgery.
Opportunities
for Intervention
Dr. Walker and colleagues pointed out that the higher likelihood of relapse among patients who had quit smoking for a shorter period before surgery, the higher likelihood of smoking at 12 months among patients who had lapsed sooner after surgery, and the greater predictive power of appetitive rather than aversive cravings all “have strong implications for interventions” focusing on recent smokers who have undergone lung cancer surgery. This combination of factors “strongly suggests the importance of interventions to prevent relapse as opposed to interventions to help those who have relapsed regain abstinence,” the researchers stated. “Such interventions might target efforts at getting patients to quit earlier relative to their surgery, should be promoted especially among those who have quit for only a brief period before surgery, and should provide more intensive intervention during the first two months after surgery.”
Dr. Walker’s team also suggested that interventions should “target the cognitions that underlie appetitive cravings to smoke,” including perceptions that smoking “would taste good and be pleasant, and that the urge to smoke is outside the patient’s control.” Such an approach would be based on the present study’s finding that delayed smoking lapse may have an effect on later smoking status, although the researchers noted that the efficacy of such interventions requires further research.
“Health care providers should emphasize the importance of quitting not only for the perioperative period but well in advance of surgery if possible,” Dr. Walker and colleagues asserted. “They should not assume that getting lung cancer will by itself be a ‘wakeup call’ sufficient to enable patients to quit and stay quit. Rather, they should identify resources to help patients stay quit during the first weeks and months after surgery.... Repeated counseling, over time, by multiple providers, with instruction on coping with cravings to smoke, general support for patient’s quitting efforts, and consideration of pharmacotherapy, provides an effective approach to helping patients quit smoking.”
—John Merriman
Reference
Walker MS, Vidrine DJ, Gritz ER, et al. Smoking relapse during the first year after treatment for early-stage non–small-cell lung cancer. Cancer Epidemiol Biomarkers Prev. 2006;15:2370-2377.
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