ImportanceSmoking after a cancer diagnosis increases mortality and risk for a second cancer.ObjectiveTo determine the association between time of entry into a smoking cessation intervention following a cancer diagnosis and survival outcomes.Design, Setting, and ParticipantsUsing a prospective cohort study design, patients with cancer who smoked and received cessation treatment were assessed at 3 months, 6 months, and 9 months following tobacco treatment onset. Survival outcomes of tobacco treatment were measured and compared among patients at the MD Anderson Cancer Center Tobacco Research and Treatment Program. Treatment occurred between January 1, 2006, and March 3, 2022. Patients were excluded if they died before the tobacco treatment ended, received their diagnosis more than 6 months after beginning cessation treatment, or lacked staging information. The data analysis took place from September 2023 to May 2024.InterventionsCessation treatment consisted of 6 to 8 personalized counseling visits and 10 to 12 weeks of pharmacotherapy. More than 95% of visits were provided via telemedicine.Main Outcomes and MeasuresThe primary outcomes were survival as recorded in the MD Anderson Cancer Center tumor registry and 7-day point prevalence abstinence at each follow-up.ResultsThe main analytical sample consisted of 4526 currently smoking patients diagnosed with cancer and receiving cessation treatment (2254 [49.8%] female; median [IQR] age, 55 [47-62] years). Survival over 15 years increased for those quitting smoking at 3 months (adjusted hazard ratio [aHR], 0.75 [95% CI, 0.67-0.83]), 6 months (aHR, 0.79 [95% CI, 0.71-0.88]), and 9 months (aHR, 0.85 [95% CI, 0.76-0.95]) of follow-up. The optimal survival outcomes were observed for patients who received tobacco treatment within 6 months of a cancer diagnosis. At the 75th percentile, their survival increased from 2.1 years (95% CI, 1.8-2.4 years) among continuing smokers (nonabstainers) vs 3.9 years (95% CI, 3.2-4.6 years) for patients who quit (abstainers). Similar but less pronounced outcomes were noted when tobacco treatment began within 6 months to 5 years following diagnosis, with survival at the 75th percentile of 4.8 years (95% CI, 4.3-5.3 years) for nonabstainers vs 6.0 years (95% CI, 5.1-7.2 years) for abstainers.Conclusions and RelevanceThe results of this prospective cohort study suggest that evidence-based smoking cessation treatment within 6 months following a cancer diagnosis maximizes survival benefit. This study supports smoking cessation as an important early clinical intervention for patients after being diagnosed with cancer.

中文翻译：

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癌症诊断后早期干预戒烟治疗的生存结果


重要性癌症诊断后吸烟会增加死亡率和患第二种癌症的风险。目的确定癌症诊断后开始戒烟干预的时间与生存结局之间的关联。设计、环境和参与者使用前瞻性队列研究设计，在烟草治疗开始后 3 个月、 6 个月和 9 个月评估吸烟和接受戒烟治疗的癌症患者。在 MD 安德森癌症中心烟草研究和治疗计划的患者之间测量和比较烟草治疗的生存结果。治疗发生在 2006 年 1 月 1 日至 2022 年 3 月 3 日期间。如果患者在烟草治疗结束前死亡、在开始戒烟治疗后 6 个月以上才得到诊断或缺乏分期信息，则被排除在外。数据分析于 2023 年 9 月至 2024 年 5 月进行，干预措施戒烟治疗包括 6 至 8 次个性化咨询访问和 10 至 12 周的药物治疗。超过 95% 的就诊是通过远程医疗提供的。主要结局和指标主要结局是 MD 安德森癌症中心肿瘤登记处记录的生存率和每次随访的 7 天点患病率戒断。结果主要分析样本包括 4526 名被诊断患有癌症并接受戒烟治疗的当前吸烟患者 （2254 [49.8%] 女性;中位 [IQR] 年龄，55 [47-62] 岁）。戒烟者在 3 个月 （调整后风险比 [aHR]，0.75 [95% CI，0.67-0.83]）、6 个月 （aHR，0.79 [95% CI，0.71-0.88]）和 9 个月 （aHR，0.85 [95% CI，0.76-0.95]） 随访时，戒烟者的生存率增加。 在癌症诊断后 6 个月内接受烟草治疗的患者观察到最佳生存结果。在第 75 个百分位，他们的生存期从持续吸烟者（非戒烟者）的 2.1 年 （95% CI，1.8-2.4 年） 增加到戒烟患者 （戒酒者） 的 3.9 年 （95% CI，3.2-4.6 年）。当在诊断后 6 个月至 5 年内开始烟草治疗时，观察到相似但不太明显的结局，未戒酒者的生存率为第 75 个百分位 4.8 年 （95% CI，4.3-5.3 年），而戒酒者为 6.0 年 （95% CI，5.1-7.2 年）。结论和相关性这项前瞻性队列研究的结果表明，癌症诊断后 6 个月内的循证戒烟治疗可最大限度地提高生存获益。本研究支持戒烟作为患者被诊断出患有癌症后的重要早期临床干预措施。