Smoking status and the association between patient-level factors and survival among lung cancer patients

Author:

Carroll Nikki M1ORCID,Burnett-Hartman Andrea N12ORCID,Rendle Katharine A3ORCID,Neslund-Dudas Christine M4ORCID,Greenlee Robert T5,Honda Stacey A6ORCID,Vachani Anil3ORCID,Ritzwoller Debra P1ORCID

Affiliation:

1. Institute for Health Research, Kaiser Permanente Colorado , Denver, CO, USA

2. Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine , Pasadena, CA, USA

3. Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA

4. Henry Ford Health and Henry Ford Cancer Institute , Detroit, MI, USA

5. Marshfield Clinic Research Institute , Marshfield, WI, USA

6. Hawaii Permanente Medical Group, Center for Integrated Healthcare Research, Kaiser Permanente Hawaii , Honolulu, HI, USA

Abstract

Abstract Background Declines in the prevalence of cigarette smoking, advances in targeted therapies, and implementation of lung cancer screening have changed the clinical landscape for lung cancer. The proportion of lung cancer deaths is increasing in those who have never smoked cigarettes. To better understand contemporary patterns in survival among patients with lung cancer, a comprehensive evaluation of factors associated with survival, including differential associations by smoking status, is needed. Methods Patients diagnosed with lung cancer between January 1, 2010, and September 30, 2019, were identified. We estimated all-cause and lung cancer-specific median, 5-year, and multivariable restricted mean survival time (RMST) to identify demographic, socioeconomic, and clinical factors associated with survival, overall and stratified by smoking status (never, former, and current). Results Analyses included 6813 patients with lung cancer: 13.9% never smoked, 54.2% formerly smoked, and 31.9% currently smoked. All-cause RMST through 5 years for those who never, formerly, and currently smoked was 32.1, 25.9, and 23.3 months, respectively. Lung cancer–specific RMST was 36.3 months, 30.3 months, and 26.0 months, respectively. Across most models, female sex, younger age, higher socioeconomic measures, first-course surgery, histology, and body mass index were positively associated, and higher stage was inversely associated with survival. Relative to White patients, Black patients had increased survival among those who formerly smoked. Conclusions We identify actionable factors associated with survival between those who never, formerly, and currently smoked cigarettes. These findings illuminate opportunities to address underlying mechanisms driving lung cancer progression, including use of first-course treatment, and enhanced implementation of tailored smoking cessation interventions for individuals diagnosed with cancer.

Funder

National Cancer Institute

National Institutes of Health

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Oncology

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