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Predictive Risk Factors for Continued Smoking after the Diagnosis of a Genitourinary Malignancy

      Objective

      To determine risk factors for continued smoking following a diagnosis of a genitourinary (GU) malignancy. Smoking is a well established risk factor in the development of cancers involving the GU tract. Unfortunately, a large percentage of patients continue to smoke or relapse after cancer diagnosis; by doing so, there is an increased risk of recurrence, poor survival rates, treatment complications, secondary primary cancers, and other chronic smoking related illnesses.

      Materials and Methods

      Two hundred and five patients who presented to a Urologic Oncology clinic at a single tertiary treatment center were given smoking cessation counseling and pharmacotherapy, as well as a questionnaire which was used to identify smoking status, demographics, and behavioral/psychosocial characteristics. Patients were followed for a minimum of 1 year with a median length of follow up for 13 months.

      Results

      91% of patients enrolled in the study continued smoking at survey completion. After accounting for age, ethnicity, education and cigarettes consumed/day, 5 variables were independently associated with an increased risk of continued smoking: smoking 20 or more cigarettes per day, less than 2 prior quit attempts, anxiety and/or depression, fear of cancer recurrence, and home secondhand smoke exposure.

      Conclusion

      The role of the urologist is imperative for encouraging smoking cessation. While every patient should receive adequate counseling regarding smoking at the time of a GU malignancy diagnosis, identifying patients with the risk factors noted in this study and augmenting smoking cessation efforts may result in stronger efforts to quit and prevention of long-term complications.
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      References

        • Centers for Disease Control and Prevention (CDC)
        Smoking-attributable mortality, years of potential life lost, and productivity losses–United States, 2000-2004.
        MMWR. Morbidity and Mortality Weekly Report. 2008; 57: 1226-1228
        • Pommer W.
        • Bronder E.
        • Klimpel A.
        • Helmert U.
        • Greiser E.
        • Molzahn M.
        Urothelial cancer at different tumour sites: role of smoking and habitual intake of analgesics and laxatives. Results of the Berlin Urothelial Cancer Study.
        Nephrology, Dialysis, Transplantation. 1999; 14: 2892-2897
        • van Osch F.H.
        • Jochems S.H.
        • van Schooten F.-J.
        • Bryan R.T.
        • Zeegers M.P.
        Quantified relations between exposure to tobacco smoking and bladder cancer risk: a meta-analysis of 89 observational studies.
        Int J Epidemiol. 2016; 45: 857-870
        • Hunt J.D.
        • van der Hel O.L.
        • McMillan G.P.
        • Boffetta P.
        • Brennan P.
        Renal cell carcinoma in relation to cigarette smoking: meta-analysis of 24 studies.
        Int J Cancer. 2005; 114: 101-108
        • Silverman DT
        • Morrison AS
        • Devesa SS
        Bladder cancer.
        in: Schottenfeld D Fraumeni Jr, JF Cancer Epidemiology and Prevention. 2nd ed. Oxford University Press, New York1996: 1156-1179
        • Foerster B.
        • Pozo C.
        • Abufaraj M.
        • et al.
        Association of smoking status with recurrence, metastasis, and mortality among patients with localized prostate cancer undergoing prostatectomy or radiotherapy: a systematic review and meta-analysis.
        JAMA Oncology. 2018; 4: 953-961
        • Cox L.S.
        • Africano N.L.
        • Tercyak K.P.
        • Taylor K.L.
        Nicotine dependence treatment for patients with cancer.
        Cancer. 2003; 98: 632-644
        • Simmons V.N.
        • Litvin E.B.
        • Jacobsen P.B.
        • et al.
        Predictors of smoking relapse in patients with thoracic cancer or head and neck cancer.
        Cancer. 2013; 119: 1420-1427
        • Tao L
        • Wang R
        • Gao YT
        • et al.
        Impact of postdiagnosis smoking on long-term survival of cancer patients: the Shanghai cohort study.
        Cancer Epidemiol Biomarkers Prev. 2013; 22: 2404-2411
        • Cinciripini PM
        • Hecht SS
        • Henningfield JE
        • et al.
        Tobacco addiction: implications for treatment and cancer prevention.
        J Natl Cancer Inst. 1997; 89: 1852-1867
        • Bjurlin MA
        • Cohn MR
        • Kim DY
        • Freeman VL
        • Lombardo L
        • Hurley SD
        • et al.
        Brief smoking cessation intervention: a prospective trial in the urology setting.
        J Urol. 2013; 189: 1843-1849
        • Bjurlin M.A.
        • Goble S.M.
        • Hollowell C.M.P.
        Smoking cessation assistance for patients with bladder cancer: a national survey of American urologists.
        J Urol. 2010; 184: 1901-1906
        • Glynn Thomas J
        • Marc W Manley
        • National Cancer Institute (U.S.)
        How to Help Your Patients Stop Smoking: a National Cancer Institute Manual for Physicians.
        The Institute, [Bethesda, MD]1997
        • Stead LF
        • Bergson G
        • Lancaster T
        Physician advice for smoking cessation.
        Cochrane Database Syst Rev. 2008; 2CD000165
        • Tomko R.L.
        • Saladin M.E.
        • McClure E.A.
        • et al.
        Alcohol consumption as a predictor of reactivity to smoking and stress cues presented in the natural environment of smokers.
        Psychopharmacology. 2017; 234: 427-435
        • Broadhead W.E.
        • Gehlbach S.H.
        • de Gruy F.V.
        • Kaplan B.H.
        The Duke-UNC Functional Social Support Questionnaire. Measurement of social support in family medicine patients.
        Medical Care. 1988; 26: 709-723
        • Custers J.A.E.
        • van den Berg S.W.
        • van Laarhoven H.W.M.
        • Bleiker E.M.A.
        • Gielissen M.F.M.
        • Prins J.B.
        The cancer worry scale: detecting fear of recurrence in breast cancer survivors.
        Cancer Nursing. 2014; 37: E44-E50
        • Zigmond A.S.
        • Snaith R.P.
        The hospital anxiety and depression scale.
        Acta Psychiatrica Scandinavica. 1983; 67: 361-370
        • Westmaas J.Lee
        • Thewes B
        • Seguin Leclair C
        • Lebel S
        Smoking versus Quitting and Fear of Cancer Recurrence 9 Years after Diagnosis in the American Cancer Society's Longitudinal Study of Cancer Survivors‐I (SCS‐I).
        Cancer. 2019; 125: 4260-4268
        • Macleod L.C.
        • Dai J.C.
        • Holt S.K.
        • Bassett J.C.
        • Wright J.L.
        • Gore J.L.
        Underuse and underreporting of smoking cessation for smokers with a new urologic cancer diagnosis.
        Urologic Oncology. 2015; 33 (504.e1–7)
        • Toll B.A.
        • Brandon T.H.
        • Gritz E.R.
        • Warren G.W.
        • Herbst R.S.
        • AACR Subcommittee on Tobacco and Cancer
        Assessing tobacco use by cancer patients and facilitating cessation: an American Association for Cancer Research policy statement.
        Clin Cancer Res. 2013; 19: 1941-1948
        • Yan H.
        • Ying Y.
        • Xie H.
        • et al.
        Secondhand smoking increases bladder cancer risk in nonsmoking population: A meta-analysis.
        Cancer Manag. Res. 2018; 10: 3781-3791
        • Schnoll R.A.
        • Malstrom M.
        • James C.
        • et al.
        Correlates of tobacco use among smokers and recent quitters diagnosed with cancer.
        Patient Education and Counseling. 2002; 46: 137-145
        • Fujisawa D.
        • Umezawa S.
        • Basaki-Tange A.
        • Fujimori M.
        • Miyashita M.
        Smoking status, service use and associated factors among Japanese cancer survivors–a web-based survey.
        Supportive Care in Cancer. 2014; 22: 3125-3134