Smoking cessation close to the time of a lung cancer diagnosis improves overall survival compared to those who don’t stop
Smoking cessation around the time of a lung cancer diagnosis is associated with an improved survival from both non-small and small cell lung cancer, compared to those who continue to smoke. This was the finding from a systematic review by a team from the Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy
World Health Organisation data shows that globally, in 2020, there were 2.21 million cases of lung cancer and which resulted in 1.8 million deaths. Moreover, lung cancer has a poor prognosis with Cancer Research UK suggesting that only around 15% of those diagnosed with the cancer survive for 5 years or more. Cigarette smoking seen as a major factor in the development of lung cancer with one analysis of the burden of respiratory tract cancers, indicating that smoking contributed to an estimated 64·2% of all deaths from tracheal, bronchus, and lung cancer and 63·4% of all deaths from larynx cancer in 2019.
One study with 517 smokers, found that smoking cessation at the time of a lung cancer diagnose can reduce the risk of future lung cancer, although for the present study, the Italian team sought to provide a more robust estimate of the overall prognostic value of smoking cessation at or around the time of a lung cancer diagnosis. They searched for articles which included those who continued to smoke and those who quit in relation to their cancer diagnosis and the associated changes in survival. The team calculated relative risks for the association between smoking cessation and the survival from lung cancer.
Findings
A total of 21 studies were included in the systematic review with patients diagnosed with non-small cell lung cancer (10 studies, 5,315 patients) and small cell lung cancer (5 studies, 1,133 patients), together with a further six studies of both cancer subtypes or where the subtype was not specified. The mean age of lung cancer diagnosis across the studies ranged from 60 to 70 years and the proportion of men ranged from 40.2% to 91.8%. The duration of follow-up also ranged from 12 months to 27.7 years.
Smoking cessation at or around the time of diagnosis was associated with a better overall survival regardless of lung cancer type. For smoking cessation at any time, compared to those who continued smoking (used as the reference group), the relative risk for non-small cell lung cancer was 0.77 (relative risk, RR = 0.77, 95% CI 0.66 – 0.90) and this reduction was broadly similar compared to those stopping strictly at or after their diagnosis or up to 12 months before the diagnosis. For small cell lung cancer, overall survival was also broadly similar (RR = 0.75, 95% CI 0.57 – 0.99). Even in studies where the cancer subtype was not specified, there were survival benefits among quitters (RR = 0.81, 95% CI 0.68 – 0.96).
The authors calculated an overall benefit for those who undertook smoking cessation at or around the time of their lung cancer diagnosis, finding that such individuals had a 29% improvement in their overall survival compared to those who continued to smoke (RR = 0.71, 95% CI 0.64 – 80).
The authors concluded that advice to quit smoking at or around the time of a lung cancer diagnosis, should arguably become a non-optional part of the management of these patients.
Citation
Caini S et al. Quitting smoking at or around diagnosis improves the overall survival of lung cancer patients: a systematic review and meta-analysis J Thorac Oncol 2022
