Faculy Mentor: Ursula Martinez-Pradeda (Family & Preventative Medicine, University of Utah)

In addition to lung cancer, smoking causes cancer of the larynx, oral cavity and pharynx, esophagus, pancreas, bladder, stomach, colon and rectum, and liver. Continued smoking after a cancer diagnosis has been associated with multiple negative health consequences, regardless of the cancer type. For example, cancer patients who smoke have an increased risk of cancer recurrence, development of a second cancer, treatments not being as effective, and lower survival. Studies have shown that patients with cancers that are widely known to be caused by smoking (i.e., lung, head and neck) are more motivated to quit smoking than those with cancers not typically perceived as smoking related (e.g., melanoma) (1). The difference in smoking cessation motivation is due to varying reasons among different types of cancer (2). Patients with a cancer that is not obviously caused by smoking may not understand the risks smoking has for their cancer treatment and prognosis (3). About one third of cancer patients continued to smoke after their cancer diagnosis (3). Therefore, it is important to motivate and encourage cancer patients to quit smoking, especially those with cancers that are not typically associated with smoking.

In this study, we conducted a secondary analysis using data from an NCI R03 award that aimed to develop an intervention to increase the motivation to quit smoking among patients with cancers that are not typically perceived as smoking related (i.e., breast, bladder, colorectal, GYN, melanoma). The goal of the study was to compare the use of smoking cessation products and the knowledge of risk of continued smoking after diagnosis among patients with a smoking-related cancer (i.e., bladder and colorectal) and patients with a non-smoking related cancer (i.e., melanoma, breast, and gynecological).

Participants were current smokers (individuals who reported smoking at least one cigarette in the past 30 days), who had received a diagnosis of bladder, melanoma, breast, gynecological, or colorectal cancer within the past six months. Other inclusion criteria were ability to read/write in English, able to give informed consent, not currently enrolled in a smoking cessation program, and not having a prior cancer diagnosis except for non-melanoma skin cancer.

Patients completed surveys assessing the following variables: demographic and cancer-related variables (e.g., sex, race, ethnicity, marital status, cancer type, stage). We used the Cancer Patient Tobacco Use Questionnaire (4, 5) to assess smoking behavior after the cancer diagnosis and the Fagerstrom Test for Nicotine Dependence (FTND) (6) to assess nicotine dependence. The Perception of Risk (POR) questionnaire (7) assessed the patients’ perceived risk of continued smoking after their diagnosis. We used the Fears of Cancer Relapse/Recurrence (FAC) (8) scale to assess fears of cancer recurrence. To assess motivation to quit smoking, we used the Contemplation Ladder (9).

More than half of the patients were female (66%) and non-Hispanic white (94%), 64% had a cancer that was not smoking related (i.e., melanoma, breast, gynecological) and 65% were in the early stages of their cancer (Stage 0-II). Patients smoked for about 35 years, and about 17 cigarettes per day. About 80% of patients did not use any evidence based smoking cessation treatments (e.g., nicotine replacement therapy, counseling) and there were no significant differences between patients with a smoking-related cancer vs. a non-smoking related cancer. Patients with a smoking related cancer were more likely to identify risk factors such as alcohol or diet as the cause of their cancer (p<.001). Patients with a smoking-related cancer were more likely to perceive the risks of continued smoking after diagnosis (p<.05) and had a greater fear of cancer recurrence (p<.05). Specifically, patients with a smoking related cancer were more likely to agree or completely agree that if they continued to smoke after a diagnosis, they would develop a second cancer (p<.05).

In conclusion, it is urgent that we develop strategies to increase the use of evidence based smoking cessation treatments among cancer patients. Additionally, we need to educate patients with cancers that are not caused by smoking of the negative consequences smoking may have on their cancer treatment and prognosis.

Given this was my first research experience, I was unsure of what to expect I enjoyed the challenges of developing a research question, and although there were some setbacks, once I formulated my question and delved into the research, I was excited to see how everything came together. I learned that trial and error are part of the process and that sometimes it is necessary to return to square one to keep making progress. I am very appreciative of this opportunity, and I believe it has contributed to my professional and personal growth.

Footnotes

1. Wakefield, M.et al., Motivational interviewing as a smoking cessation intervention for patients with cancer: randomized controlled trial. Nurse Res, 2004. 53(6): p. 396-405

2. Martinez U et al. 2018. Associations between the smoking-relatedness of a cancer type, cessation attributes and beliefs, and future abstinence among recent quitters. Psychooncology 27:21042110

3. Brandon, Thomas, Simmons, Vani., Motivating a Spectrum of Cancer Patients to Quit Smoking: Intervention Development ad Feasibility. 2023

4. Land, S.R. et al., Cognitive testing of tobacco use items for administration to patients with cancer and cancer survivors in clinical research. Cancer, 2016. 122(11): p. 1728-34

5. Land, S.R. et al. Research Priorities, Measures, and Recommendations for Assessment of Tobacco Use in Clinical Cancer Research. Clinical research Cancer Res, 2016. 22(8): p. 1907-13

6. Heatherton, T.F. et al., The Fagerstorm Test for Nicotine Dependence: a revision of the Fagerstorm Tolerance Questionnaire. Br J Addict, 1991. 86(9): p. 1119-27

7. Schnoll, R.A.et al., Longitudinal predictors of continued tobacco use among patients diagnosed with cancer. Ann Behav Med, 2003. 25(3): p. 214-22.

8. Greenberg, D.B. et al., Quality of life for adult leukemia survivors treated on clinical trials of Cancer and Leukemia Group B during the period 1971-1988: predictors for later psychologic distress. Cancer, 1997. 80(10): p. 1936-44

9. Biener, L. and D.B. Abrams, The Contemplation Ladder: validation of a measure of readiness to consider smoking cessation. Health Psychol, 1991. 10(5): p. 360-5