PCP Visits Associated with Smoking Cessation after Lung Cancer Diagnosis and Before Surgery

Among nearly 7500 patients in the Veterans Affairs (VA) health system who were identified as current or former smokers prior to undergoing lung cancer surgery, more than 4 in 10 (43%) continued to smoke—or had resumed smoking—one year later, according to findings presented at CHEST 2021, the American College of Chest Physicians' annual meeting held online October 17-20, 2021.

Moreover, those whose smoking persisted or had resumed at the 1-year follow-up, study authors report, were approximately 30% more likely to die in the succeeding years.

The study also found that for those who did stop smoking after a diagnosis and before lung resection, seeing a primary care physician was a factor in being able to quit

As context for their research, investigators led by Brendan Heiden, MD, of Washington University in St Louis, observe that a significant proportion of patients diagnosed with lung cancer are smoking at the time of surgery but that cancer registries do not collect post-surgical data on the prevalence of persistent smoking. The result, they write in the study abstract, is a gap in knowledge about the relationship between continued smoking and outcomes in early-stage lung cancer.

The retrospective cohort study Heiden and colleagues pursued enrolled 7536 veterans with clinical stage 1 non-small-cell lung cancer undergoing surgery between 2006 and 2016. Mean patient age at surgery was 67 years, nearly all were men and 82% were white. For purposes of analysis researchers defined persistent cigarette smoking as individuals who continued to smoke 1 year after surgery. Sociodemographic and treatment-related factors associated with persistent smoking were assessed in multivariable modeling and the relationship between persistent smoking and all-cause mortality also was assessed.

At the time of lung cancer diagnosis, 68% (5142) of participants reported current smoking. Of those, 11.3% (580) reported they had stopped smoking between diagnosis date and surgical intervention. The researchers found that the interventions during the pre-operative period that were associated with smoking cessation were being prescribed cessation medication (odds ratio [OR] 1.466, 95% CI 1.213-1.771), more frequent medical encounters (OR 1.007, 95% CI 1.002-1.012), and seeing a primary care physician (OR 1.408, 95% CI 1.139-1.740).

When they assessed persistent smoking at 1 year post-surgery, Heiden et al found more than half (56%) of participants who reported smoking when they were diagnosed continued to smoke with the strongest associations found for age (with older individuals less likely to smoke, OR 0.960, 95% CI 0.949-0.970), elevated Charlson comorbidity score (OR 1.049, 95% CI 1.011-1.089), and higher area deprivation index score (OR 1.007, 95% CI 1.002-1.011).

Patients who stopped smoking after diagnosis and before surgery were significantly less likely to be smoking 1-year post-surgery (OR 0.512, 95% CI 0.418-0.627). Median overall survival was significantly worse among participants who continued to smoke (73.1 months vs. 84.7 months, p<.001).

The authors urge health care providers, including surgeons, to “aggressively counsel patients regarding smoking cessation in the perioperative period,” suggesting that successful interventions can have a significant positive impact on early-stage lung cancer outcomes.

Reference: Heiden B, Eaton D, Chang SH, et al. Association between persistent cigarette smoking and oncologic outcomes in stage 1 non-small cell lung cancer following surgery. Chest. 2021;160(supplement):A1610.