Smoking Again After Lung Cancer Surgery

In a retrospective written report reported at Breast 2021, the American College of Chest Physicians annual meeting , of the most seven,500 patients in the VA health system who were listed every bit current or former smokers just before undergoing surgery for stage I lung cancer, roughly 45% were notwithstanding smoking -- or smoking once again -- a year subsequently.

In this sectional MedPage Today video, study author Brendan Heiden, Dr., of Washington University School of Medicine in St. Louis, presents the written report details.

Following is a transcript of his remarks :

Non-minor cell lung cancer is the leading cause of cancer-related bloodshed in the United States, with 80% to 90% of cases caused past cigarette smoking. The aureate-standard treatment for early-stage lung cancer remains surgery. Previous studies have demonstrated that smoking at the fourth dimension of surgery is associated with significantly higher risk of perioperative morbidity and poor long-term outcomes. For this reason, several organizations, including the World Health Organization, recommend smoking cessation at least four weeks prior to surgery.

While smoking habits are well documented in lung cancer patients at the fourth dimension of diagnosis, information technology is unclear what proportion of these patients continued to smoke following surgery and how this affects long-term outcomes.

Nosotros performed this retrospective cohort report using a uniquely compiled dataset from the Veterans Health Administration of adults with clinical phase I not-pocket-size cell lung cancer undergoing surgery from 2006 to 2016. This dataset was assembled and groomed through chart review by a big team of defended researchers at the VA.

Our main exposure of interest was smoking condition, which we assessed 1 twelvemonth after surgery and defined as persistent smoking. We then assessed the human relationship between persistent smoking and illness-free survival and overall survival.

Contour diagram for our report is shown on the left. Our initial cohort included over 10,000 veterans. Nosotros had several exclusion criteria, including never-smokers, patients with pathologic phase 4 disease, patients who died within 30 days of surgery, and patients who did non follow upwardly inside the VA. This left a final report cohort of roughly vii,500 patients.

Various demographics from our study population are shown on the right side of this slide. And it's a relatively representative cohort of veterans. The mean age is 67 years former. The majority of the cohort is male. Threescore percent of patients were actively smoking at the time of surgery, and the median Charlson Comorbidity score was seven, which is essentially college than what would exist expected in the general U.S. population.

The left side of this slide shows important treatment characteristics. Equally y'all tin can see, the median fourth dimension between diagnosis and surgery was 62 days, with thirty% of veterans experiencing a handling delay beyond 12 weeks. The majority of veterans underwent lobectomy, as would be expected in this population. And the nearly common surgical approach was open thoracotomy.

At present, focusing on the correct side of the slide, y'all'll run into that a majority of patients had pathologic stage I disease. The most common postoperative complication was pneumonia. And finally, the 30-day readmission charge per unit was 7%.

This slide shows the relative smoking rates at the time of surgery and 1 year afterward surgery. On the left side, you can see that roughly 60% of the population was smoking at the time of surgery. In the middle, 1 year after surgery, 58% of these individuals continued to smoke. Additionally, of the 39% of patients who were sometime smokers at the fourth dimension of surgery, xx% relapsed and started smoking again ane twelvemonth afterward surgery. Overall, roughly 45% of the entire population was establish to persistently smoke at 1 year afterwards surgery.

The median follow-up in our accomplice was half dozen.6 years. Equally you can see on the left side of this slide, persistent smoking was associated with significantly shorter overall survival, with an adjusted hazard ratio of all-cause bloodshed of 1.29. The median survival was 82.ii months in those who were not smoking compared to 73.7 months in persistent smokers. A cumulative incidence function for recurrence is shown on the right. Recurrence was detected in roughly 25% of patients. We did not find an association betwixt persistent smoking and disease recurrence, even so.

So, in conclusion, nosotros found that a majority of veterans smoke at the time of lung cancer diagnosis. One year following surgery a meaning proportion of this population persistently smokes. Persistent smoking is associated with significantly worse overall survival, simply is not associated with disease recurrence. Cancer survivorship programs should continue to focus on smoking abeyance, given the disproportionate impact of persistent smoking on early on-stage lung cancer surgery following curative-intent treatment.

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  Greg Laub is the Senior Director of Video and currently leads the video and podcast production teams.

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Source: https://www.medpagetoday.com/meetingcoverage/chestvideopearls/95522

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