Smoking cessation is challenging even for patients recovering from lung cancer surgery with curative intent
Dana Farber Cancer Institute, Phyllis F. Cantor Center, Research in Nursing and Patient Care, Boston, MA, USA. mary Lung cancer (Amsterdam, Netherlands)
(Impact Factor: 3.96).
04/2009; 66(2):218-25. DOI: 10.1016/j.lungcan.2009.01.021
Although it is recommended that smokers undergoing surgery for lung cancer quit smoking to reduce post-operative complications, few studies have examined patterns of smoking in the peri-operative period. The goals of this study were to determine: (1) patterns of smoking during post-operative recovery, (2) types of cessation strategies used to quit smoking, and (3) factors related to smoking after lung cancer surgery.
Data were collected from 94 patients through chart review, tobacco, health status, and symptom questionnaires at 1, 2, and 4 months after surgery. Smoking status was assessed through self-report and urinary cotinine measurement.
Eighty-four patients (89%) were ever-smokers and 35 (37%) reported smoking at diagnosis. Thirty-nine (46%) ever-smokers remained abstinent, 13 (16%) continued smoking at all time-points, and 32 (38%) relapsed. Ten (46%) of those who relapsed were former-smokers and had not smoked for at least 1 year. Sixteen (46%) of those who were smoking at diagnosis received cessation assistance with pharmacotherapy being the most common strategy. Factors associated with smoking during recovery were younger age and quitting smoking < or =6 months before the diagnosis of lung cancer. Factors that were marginally significant were lower educational level, male gender, lower number of comorbidities, and the presence of pain.
Only half of those who were smoking received assistance to quit prior to surgery. Some patients were unable to quit and relapse rates post-surgery were high even among those who quit more than 1 year prior. Innovative programs incorporating symptom management and relapse prevention may enhance smoking abstinence during post-operative care.
Available from: W. Jay Christian
- "Others have indicated that socioeconomic factors, such as low income, low education, or reliance on government-subsidized health insurance , are associated with continued smoking   . Despite these insights, many of these studies only examined a single time point after resection    , or followed patients for a short amount of time   , or did not examine factors associated with continued smoking  . "
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ABSTRACT: Smoking cessation after a diagnosis of lung cancer is associated with improved outcomes, including quality of life and survival. The research presented here is based on data obtained from sequential interviews with early stage lung cancer patients in Kentucky, on their smoking patterns at four time points: (1) six months before enrollment in the study, before diagnosis, (2) at enrollment (shortly after surgical resection), (3) three months post-enrollment, and (4) six months post-enrollment. A number of covariates were considered to examine the factors associated with smoking abstinence and rebound trajectories. The results indicate that, while about 75% of patients who were smoking at six months before enrollment had quit by the first post-surgery interview, almost 50% of them had returned to smoking six months later. Multivariate analysis to evaluate the relative contribution of covariates indicated that low household income, exposure to environmental tobacco smoke at home and evidence of depression were positively associated with returning to smoking. Furthermore, even after controlling for these factors, patients from the Appalachian region of Kentucky, an area with substantially high smoking prevalence and very high lung cancer incidence rates, were less likely to abstain from smoking throughout the study than subjects in the rest of the state. Future research is suggested to investigate in more detail the tobacco-related behaviors and cessation attempts of patients and their families, which can lead to more targeted, successful smoking cessation interventions for lung cancer patients.
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ABSTRACT: Persons living with HIV/AIDS who are current smokers are more likely to develop disease-related adverse health outcomes compared to nonsmokers with HIV/AIDS. However, the impact of smoking cessation on health outcomes such as symptom status and health-related quality of life (HRQOL) has not yet been assessed within this population. This study examined the effects of changes in smoking status on HIV-related symptom burden and health-related quality of life outcomes in a multiethnic, low-income population of persons living with HIV/AIDS. Patients (n = 95) from a large, inner city HIV/AIDS clinic were enrolled in a smoking cessation trial providing nicotine replacement therapy, counseling, and self-help written materials. Biochemically verified smoking status, length of smoking abstinence, HIV-related symptom burden, and HRQOL were assessed approximately 3-months posttrial enrollment. A series of multiple linear regression models was performed to assess the associations between the smoking status variables and the health outcomes at follow-up while controlling for baseline levels. Length of smoking abstinence was significantly associated (p = 0.02) with HIV-related symptom burden. Specifically, increasing number of consecutive days of smoking abstinence during the 3-month follow-up period was associated with lower levels of HIV-related symptom burden at the time of follow-up. However, 24-hour smoking prevalence was not significantly (p > 0.05) associated with changes in either HIV-related symptom burden or HRQOL. These findings suggest that smoking cessation can significantly improve symptom burden for individuals living with HIV/AIDS. Moreover, these benefits are observable as early as 3 months after quitting and are positively correlated with the length of abstinence.
Available from: Julia Rowland
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