title: Predictors of smoking relapse in patients with thoracic cancer or head and neck cancer.
abstract: BACKGROUND
  Cancer patients who continue smoking are at increased risk for adverse outcomes including reduced treatment efficacy and poorer survival rates. Many patients spontaneously quit smoking after diagnosis; however, relapse is understudied. The goal of this study was to evaluate smoking-related, affective, cognitive, and physical variables as predictors of smoking after surgical treatment among patients with lung cancer and head and neck cancer.
  
  
  METHODS
  A longitudinal study was conducted with 154 patients (57% male) who recently quit smoking. Predictor variables were measured at baseline (ie, time of surgery); smoking behavior was assessed at 2, 4, 6, and 12 months after surgery. Analyses of 7-day point prevalence were performed using a Generalized Estimating Equations approach.
  
  
  RESULTS
  Relapse rates varied significantly depending on presurgery smoking status. At 12 months after surgery, 60% of patients who smoked during the week prior to surgery had resumed smoking versus only 13% who were abstinent prior to surgery. Smoking rates among both groups were relatively stable across the 4 follow-ups. For patients smoking before surgery (N = 101), predictors of smoking relapse included lower quitting self-efficacy, higher depression proneness, and greater fears about cancer recurrence. For patients abstinent before surgery (N = 53), higher perceived difficulty quitting and lower cancer-related risk perceptions predicted smoking relapse.
  
  
  CONCLUSIONS
  Efforts to encourage early cessation at diagnosis, and increased smoking relapse-prevention efforts in the acute period following surgery, may promote long-term abstinence. Several modifiable variables are identified to target in future smoking relapse-prevention interventions for cancer patients.
authors.affiliation: Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL 33647, USA. Vani.simmons@moffitt.org
authors.forename: Vani Nath
authors.initials: VN
authors.lastname: Simmons
authors.forename: Erika B
authors.initials: EB
authors.lastname: Litvin
authors.forename: Paul B
authors.initials: PB
authors.lastname: Jacobsen
authors.forename: Riddhi D
authors.initials: RD
authors.lastname: Patel
authors.forename: Judith C
authors.initials: JC
authors.lastname: McCaffrey
authors.forename: Jason A
authors.initials: JA
authors.lastname: Oliver
authors.forename: Steven K
authors.initials: SK
authors.lastname: Sutton
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Brandon
mesh_terms: D000368:Aged; D001007:Anxiety; D003071:Cognition; D003863:Depression; D005260:Female; D005544:Forecasting; D006258:Head and Neck Neoplasms / Q000523:psychology* / Q000601:surgery; D006801:Humans; D008175:Lung Neoplasms / Q000523:psychology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention; D012907:Smoking; D016540:Smoking Cessation / Q000523:psychology*