title: Smoking cessation is challenging even for patients recovering from lung cancer surgery with curative intent.
abstract: BACKGROUND
  Although it is recommended that smokers undergoing surgery for lung cancer quit smoking to reduce post-operative complications, few studies have examined patterns of smoking in the peri-operative period. The goals of this study were to determine: (1) patterns of smoking during post-operative recovery, (2) types of cessation strategies used to quit smoking, and (3) factors related to smoking after lung cancer surgery.
  
  
  METHODS
  Data were collected from 94 patients through chart review, tobacco, health status, and symptom questionnaires at 1, 2, and 4 months after surgery. Smoking status was assessed through self-report and urinary cotinine measurement.
  
  
  RESULTS
  Eighty-four patients (89%) were ever-smokers and 35 (37%) reported smoking at diagnosis. Thirty-nine (46%) ever-smokers remained abstinent, 13 (16%) continued smoking at all time-points, and 32 (38%) relapsed. Ten (46%) of those who relapsed were former-smokers and had not smoked for at least 1 year. Sixteen (46%) of those who were smoking at diagnosis received cessation assistance with pharmacotherapy being the most common strategy. Factors associated with smoking during recovery were younger age and quitting smoking < or =6 months before the diagnosis of lung cancer. Factors that were marginally significant were lower educational level, male gender, lower number of comorbidities, and the presence of pain.
  
  
  CONCLUSIONS
  Only half of those who were smoking received assistance to quit prior to surgery. Some patients were unable to quit and relapse rates post-surgery were high even among those who quit more than 1 year prior. Innovative programs incorporating symptom management and relapse prevention may enhance smoking abstinence during post-operative care.
authors.affiliation: Dana Farber Cancer Institute, Phyllis F. Cantor Center, Research in Nursing and Patient Care, Boston, MA, USA. mary cooley@dfci.harvard.edu
authors.forename: Mary E
authors.initials: ME
authors.lastname: Cooley
authors.forename: Linda
authors.initials: L
authors.lastname: Sarna
authors.forename: Jenny
authors.initials: J
authors.lastname: Kotlerman
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Lukanich
authors.forename: Michael
authors.initials: M
authors.lastname: Jaklitsch
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Green
authors.forename: Raphael
authors.initials: R
authors.lastname: Bueno