Smoking Behaviors in Survivors of Smoking-Related and Non–Smoking-Related Cancers | Lifestyle Behaviors | JAMA Network Open | JAMA Network
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    1 Comment for this article
    Smoking behaviors in cancer survivors
    Tomoyuki Kawada, MD | Nippon Medical School
    Gritz et al. examined smoking behaviors among cancer survivors with special reference to smoking-related cancers (SRCs) (1). Prevalence of current smoking prevalence in survivors of SRCs was 19.8%, which was higher than survivors of non-SRCs (10.63%). The authors recommended effective smoking cessation interventions for cancer survivors, especially for survivors of SRCs. I have a query about their study with special reference to effective interventions.

    Sheeran et al. conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate factors for smoking cessation among cancer survivors (2). Interventions by nurses exhibited larger effects than those from other subjects. They also recognized
    that current smoking cessation interventions were not effective for keeping health among cancer survivors. I suppose that keeping quality of life in cancer survivors is important and adequate explanations for smoking cessation is needed by hearing desires on their life.

    Sheeran et al. conducted a meta-analysis of RCTs to promote the change of health behavior by self-determination theory (SDT) (3). SDT intervention had significant effects for physical activity, sedentary behavior, diet, alcohol consumption, and smoking cessation, but the magnitude in effects on health behavior change were small. This means that there is a difficulty in resenting effective interventions for smoking cessation. Anyway, further trials are needed to improve intervention procedures.

    1. Gritz ER, Talluri R, Fokom Domgue J, et al. Smoking behaviors in survivors of smoking-related and non-smoking-related cancers. JAMA Netw Open. 2020;3(7):e209072.
    2. Sheeran P, Jones K, Avishai A, et al. What works in smoking cessation interventions for cancer survivors? A meta-analysis. Health Psychol. 2019;38(10):855-865.
    3. Sheeran P, Wright CE, Avishai A, et al. Self-determination theory interventions for health behavior change: Meta-analysis and meta-analytic structural equation modeling of randomized controlled trials. J Consult Clin Psychol. 2020;88(8):726-737.
    Original Investigation
    Public Health
    July 2, 2020

    Smoking Behaviors in Survivors of Smoking-Related and Non–Smoking-Related Cancers

    Author Affiliations
    • 1Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston
    • 2Department of Data Science, The University of Mississippi Medical Center, Jackson
    • 3Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston
    • 4Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
    • 5Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston
    • 6Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
    • 7Division of Cancer Prevention and Population Science, The University of Texas MD Anderson Cancer Center, Houston
    JAMA Netw Open. 2020;3(7):e209072. doi:10.1001/jamanetworkopen.2020.9072
    Key Points español 中文 (chinese)

    Question  Among adult cancer survivors, do cigarette smoking behaviors vary according to whether the cancer was smoking related or not smoking related?

    Findings  This cross-sectional study found that, in the 2017 US National Health Interview Survey, which included 26 742 respondents aged 18 years or older, current smoking prevalence was higher among smoking-related cancer survivors compared with non–smoking-related cancer survivors (19.78% vs 10.63%). After cancer diagnosis, the odds of continued cigarette smoking were twice as high among those with smoking-related cancers compared with those with non–smoking-related cancers.

    Meaning  Compared with non–smoking-related cancer survivors, smoking-related cancer survivors have a higher risk of being cigarette smokers and of continuing smoking.


    Importance  The population of cancer survivors is rapidly growing in the US. Tobacco smoking is associated with many cancers; however, whether cigarette smoking behaviors among cancer survivors vary according to cancer type—that is, smoking-related cancers (SRCs) vs non–smoking-related cancers (NSRCs)—remains unclear.

    Objectives  To examine cigarette smoking prevalence and behaviors (ie, continuing or quitting smoking) among cancer survivors and to compare them between survivors of SRCs and NSRCs.

    Design, Setting, and Participants  This study was a cross-sectional analysis of the 2017 National Health Interview Survey, a household survey of civilian US residents who were aged 18 years or older. The National Health Interview Survey is population based and is representative of the US population. Data analysis was performed from June to October 2019.

    Main Outcomes and Measures  The primary outcomes were prevalence of current cigarette smoking among cancer survivors and prevalence of continuing smoking and quitting smoking after a cancer diagnosis. Secondary outcomes included factors associated with continued smoking vs quitting smoking after a cancer diagnosis.

    Results  A total of 26 742 respondents (mean [SD] age, 50.97 [18.61] years; 14 646 women [51.76%]) to the 2017 National Health Interview Survey were included in this study. Of the 3068 individuals (9.42%) in the study population who had cancer, 589 (19.96%) were SRC survivors, 2297 (74.50%) were NSRC survivors, 168 (4.96%) were survivors of both SRC and NSRC, and the remaining 14 (0.58%) had missing information about the type of cancer. Four hundred forty-nine SRC survivors (54.08%) were women, compared with 1412 NSRC survivors (54.30%). Ninety-six SRC survivors (15.69%) and 151 NSRC survivors (7.99%) were younger than 45 years. Overall, 372 cancer survivors (13.16%) were current smokers. Current smoking prevalence was higher among survivors of SRCs (145 survivors [19.78%]) compared with NSRC survivors (251 survivors [10.63%]). Among cancer survivors, 309 current smokers at cancer diagnosis (43.96%) reported having successfully quit smoking and 372 (56.04%) reported continuing smoking. Among the continuing smokers, 176 (56.49%) reported an unsuccessful quit attempt in the last 12 months. After cancer diagnosis, SRC survivors had higher odds of continued smoking compared with NSRC survivors (odds ratio [OR], 2.10; 95% CI, 1.12-3.93; P = .02). Men (OR, 1.93; 95% CI, 1.05-3.57; P = .04), those with angina pectoris (OR, 5.40; 95% CI, 1.33-21.91; P = .02), and those with chronic bronchitis (OR, 2.55; 95% CI, 1.05-6.19; P = .04) had higher odds of continued smoking, whereas Hispanic participants (compared with non-Hispanic white participants: OR, 0.18; 95% CI, 0.05-0.68; P = .01) and married participants (compared with never married participants: OR, 0.33; 95% CI, 0.12-0.96; P = .04) had lower odds of continued smoking.

    Conclusions and Relevance  These findings suggest that compared with NSRC survivors, SRC survivors may be at higher risk of being cigarette smokers at cancer diagnosis and of continuing smoking afterward. Although smoking cessation interventions are critically important for all cancer survivors, special efforts should target survivors of SRCs.