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Am Fam Physician. 2007;76(6):872

Background: Approximately 50 percent of U.S. patients with tobacco-induced lung cancer are active smokers at the time of diagnosis. The impact of active smoking on morbidity and mortality in patients with lung cancer is controversial. Some studies have suggested a benefit of smoking cessation in patients with early-stage lung cancer. However, the benefit of smoking cessation in patients with non–small cell lung cancer specifically is unknown. Performance status, a measure of patients' functional status, has been shown to be an independent prognostic indicator for patients with non–small cell lung cancer. No studies have observed the effect of smoking cessation on performance status in this population. Baser and colleagues evaluated whether smoking cessation in patients with non–small cell lung cancer would improve their performance status and survival.

The Study: A review was conducted of the records of patients who were diagnosed with non–small cell lung cancer from January through November 2001 and were referred to a pulmonary function laboratory. Smoking status at the time of diagnosis was established based on the patient's self-report. Follow-up smoking status information and comorbidity data were obtained from the records. Performance status was classified using the Eastern Cooperative Oncology Group criteria, which includes information on patients' functional status and ability for self-care. Patients' performance statuses at baseline, six months, and 12 months after the initial diagnosis were compared.

Results: There were 206 patients included in the review. Forty-five percent (93) were current smokers, 48 percent (98) were former smokers, and 7 percent (15) were never smokers. Forty-six of the current smokers quit after the diagnosis of lung cancer. Those who quit smoking after the diagnosis had similar disease stages, demographics, treatment modalities, and comorbidities to those who continued to smoke. There was no difference between the survival rates of current smokers who quit and of those who continued to smoke. However, those who stopped smoking maintained better performance status at six and 12 months compared with those who continued to smoke after adjusting for disease stage, patient demographics, treatment modalities, and comorbidities.

Conclusions: Smoking cessation after the diagnosis of non–small cell lung cancer was associated with better maintenance of performance status. This was true regardless of disease stage, age, race, sex, therapy modalities, and comorbidities. The authors note that the results show the importance of smoking cessation in patients with lung cancer.

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Copyright © 2007 by the American Academy of Family Physicians.

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