title: Factors associated with smoking abstinence among smokers and recent-quitters with lung and head and neck cancer.
abstract: BACKGROUND
  Smoking cessation among cancer patients is critical for improving outcomes. Understanding factors associated with smoking abstinence after the diagnosis of cancer can provide direction to develop and test interventions to enhance cessation rates. The purpose of this study was to identify determinants of smoking outcomes among cancer patients.
  
  
  METHODS
  Standardized questionnaires were used to collect data from 163 smokers or recent-quitters (quit≤6 months) at study entry of which 132 and 121 had data collected at 3 and 6 months. Biochemical verification was conducted with urinary cotinine and carbon monoxide. Descriptive statistics, Cronbach alpha coefficients, Pearson correlations, Fisher's exact test, and multivariable logistic regression were used for analyses.
  
  
  RESULTS
  Seven-day-point-prevalence-abstinence (PPA) rates were 90/132 (68%) at 3 months; 46/71 (65%) among lung and 44/61 (72%) among head and neck cancer patients, whereas 7-day-PPA rates were 74/121 (61%) at 6 months; 31/58 (53%) among lung and 43/63 (68%) among head and neck cancer patients. Continuous abstinence rates were 63/89 (71%) at 3 months; 32/45 (71%) among lung and 31/44 (70%) among head and neck cancer patients, whereas continuous abstinence rates were 46/89 (52%) at 6 months; 18/45 (40%) among lung and 28/44 (64%) among head and neck cancer patients. Lower cancer-related, psychological and nicotine withdrawal symptoms were associated with increased 7-D-PPA abstinence rates at 3 and 6 months in univariate models. In multivariable models, however, decreased craving was significantly related with 7-day-PPA at 3 months and decreased craving and increased self-efficacy were associated with 7-D-PPA at 6 months. Decreased craving was the only factor associated with continuous abstinence at 6 months.
  
  
  CONCLUSIONS
  Smoking outcomes among lung and head and neck cancer patients appear to have remained the same over the last two decades despite the availability of an increased number of pharmacotherapy options to treat tobacco dependence. Decreased craving and increased self-efficacy were the most consistent factors associated with improved smoking outcomes but symptom control may also play a role in optimal management. Use of combined, and/or higher doses of pharmacotherapy along with behavioral interventions that increase self-efficacy and manage symptoms may promote enhanced cessation rates.
authors.affiliation: Dana Farber Cancer Institute, Boston, MA 02115, USA. mary cooley@dfci.harvard.edu
authors.forename: Mary E
authors.initials: ME
authors.lastname: Cooley
authors.forename: Qian
authors.initials: Q
authors.lastname: Wang
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Johnson
authors.forename: Paul
authors.initials: P
authors.lastname: Catalano
authors.forename: Robert I
authors.initials: RI
authors.lastname: Haddad
authors.forename: Raphael
authors.initials: R
authors.lastname: Bueno
authors.forename: Karen M
authors.initials: KM
authors.lastname: Emmons
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002248:Carbon Monoxide / Q000652:urine; D003367:Cotinine / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000523:psychology* / Q000652:urine; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000523:psychology* / Q000652:urine; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012907:Smoking / Q000009:adverse effects* / Q000652:urine; D016540:Smoking Cessation / Q000523:psychology*; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000523:psychology / Q000652:urine
chemical_list: D002248:Carbon Monoxide; D003367:Cotinine
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