Summary
New research shows that individuals who quit smoking at any time—even less than 2 years prior to a lung cancer diagnosis—improve their odds of survival, according to data presented during the 2020 ASCO Annual Meeting (Abstract 1512).
“After a lifetime of smoking, patients often feel it's too late to quit and that the damage has already been done,” noted lead author Aline Fusco Fares, MD, who is a clinical research fellow at Princess Margaret Cancer Centre in Toronto.
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Original Article
Smoking Cessation Prior to Lung Cancer Diagnosis Can Improve Survival
Oncology Times
By Catlin Nalley
New research shows that individuals who quit smoking at any time—even less than 2 years prior to a lung cancer diagnosis—improve their odds of survival, according to data presented during the 2020 ASCO Annual Meeting (Abstract 1512).
“After a lifetime of smoking, patients often feel it's too late to quit and that the damage has already been done,” noted lead author Aline Fusco Fares, MD, who is a clinical research fellow at Princess Margaret Cancer Centre in Toronto.
These new findings emphasize the importance of smoking cessation. And, lung cancer screening offers a possible teachable moment. “[It is a time] when health professionals can reach a receptive patient with a heavier smoking history,” Fusco Fares said
Study Details
While it is well-established that smoking significantly impacts lung cancer risk, data is limited on the extent smoking cessation impacts lung cancer survival.
“We aimed to examine the survival benefits of quitting smoking, using time since smoking compared to current smoking at the time of lung cancer diagnosis,” Fusco Fares explained during a press briefing.
The researchers used individual data to analyze 17 International Lung Cancer Consortium studies with available time since smoking cessation (TSCC) to estimate survival using univariable analysis and models of stage-adjusted and cumulative smoking-adjusted multivariable analysis, according to the study authors. They created adjusted hazard ratios from Cox models, cubic spline smooth curves, and Kaplan-Meier curves.
“We also performed two preplanned sensitivity analyses to estimate lung cancer specific survival, and also to mimic a high-risk population with cumulative smoking history greater than 30 pack-years that would be eligible for lung cancer screening,” Fusco Fares said.
The study included 35,428 patients with lung cancer: 47.5 percent were current smokers, 30 percent were former smokers, and 22.5 percent had never smoked at the time of diagnosis.
The researchers confirmed that ex-smokers and never smokers had improved overall survival compared to current smokers. Compared to current smokers, they found that individuals who quit less than 2 years before, between 2 and 5 years before, and for more than 5 years before a lung cancer diagnosis had a 12 percent,16 percent, and 20 percent reduced risk of death from all causes, respectively. Additionally, the study authors reported that those who had smoked at least 20 cigarettes per day for more than 30 years had a slightly greater benefit from quitting.
“This research shows that if you’re a smoker and you quit, no matter when you quit, you will be more likely to survive after being diagnosed with lung cancer, compared to someone who continues smoking,” concluded Fusco Fares, in a statement. “The study’s message is simple: quit smoking now.”
Expert Commentary
Maher Karam-Hage, MD, Director of the Tobacco Treatment Program at MD Anderson Cancer Center, discussed the implications of this research with Oncology Times, noting that this study provides definitive data on the value of smoking cessation.
“This study provides specific numbers and evidence on the impact of quitting smoking—no matter how long an individual has been a smoker—that wasn’t available before,” he said, adding that this research is a powerful tool in shared decision-making. “We can now go to our patients and share data that shows them that the sooner they quit, the more likely their risk of death, from all causes, will be reduced.”
“We’ve been encouraging people to quit smoking for a long time. These results add more weight to this public health message and provide additional incentive for smokers—particularly those who have smoked for many years—to quit,” emphasized ASCO President Howard A. Burris III, MD, FACP, FASCO, in a statement. “The improvements in survival seen even with quitting a short time before lung cancer diagnosis show that it’s never too late to stop smoking.”
Catlin Nalley is a contributing writer.