癌症诊断后早期干预戒烟治疗的生存效果。

IF 28.4 1区 医学 Q1 Biochemistry, Genetics and Molecular Biology Jama Oncology Pub Date : 2024-10-31 DOI:10.1001/jamaoncol.2024.4890
Paul M Cinciripini, George Kypriotakis, Janice A Blalock, Maher Karam-Hage, Diane M Beneventi, Jason D Robinson, Jennifer A Minnix, Graham W Warren
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引用次数: 0

摘要

重要性:癌症确诊后吸烟会增加死亡率和罹患第二种癌症的风险:目的:确定癌症确诊后接受戒烟干预的时间与生存结果之间的关系:采用前瞻性队列研究设计,对吸烟并接受戒烟治疗的癌症患者在烟草治疗开始后的 3 个月、6 个月和 9 个月进行评估。对 MD 安德森癌症中心烟草研究和治疗项目的患者进行了烟草治疗生存结果的测量和比较。治疗时间为 2006 年 1 月 1 日至 2022 年 3 月 3 日。如果患者在烟草治疗结束前死亡,或在开始戒烟治疗 6 个月后才确诊,或缺乏分期信息,则排除在外。数据分析时间为2023年9月至2024年5月:戒烟治疗包括 6 到 8 次个性化咨询服务和 10 到 12 周的药物治疗。95%以上的就诊是通过远程医疗提供的:主要结果是MD安德森癌症中心肿瘤登记处记录的存活率和每次随访时的7天点戒断率:主要分析样本包括4526名确诊为癌症并正在接受戒烟治疗的吸烟患者(2254人[49.8%]为女性;中位数[IQR]年龄为55[47-62]岁)。随访3个月(调整后危险比[aHR]为0.75[95% CI, 0.67-0.83])、6个月(aHR为0.79[95% CI, 0.71-0.88])和9个月(aHR为0.85[95% CI, 0.76-0.95])时戒烟的患者15年生存率均有所提高。癌症确诊后 6 个月内接受烟草治疗的患者生存率最高。以第75百分位数计算,继续吸烟者(不戒烟者)的生存期为2.1年(95% CI,1.8-2.4年),而戒烟者(戒烟者)的生存期为3.9年(95% CI,3.2-4.6年)。如果在确诊后 6 个月至 5 年内开始接受烟草治疗,则会出现类似但不太明显的结果,未戒烟者的第 75 百分位生存期为 4.8 年(95% CI,4.3-5.3 年),戒烟者为 6.0 年(95% CI,5.1-7.2 年):这项前瞻性队列研究的结果表明,在癌症确诊后 6 个月内进行循证戒烟治疗可最大限度地延长患者的生存期。这项研究支持将戒烟作为癌症患者确诊后的一项重要早期临床干预措施。
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Survival Outcomes of an Early Intervention Smoking Cessation Treatment After a Cancer Diagnosis.

Importance: Smoking after a cancer diagnosis increases mortality and risk for a second cancer.

Objective: To determine the association between time of entry into a smoking cessation intervention following a cancer diagnosis and survival outcomes.

Design, setting, and participants: Using a prospective cohort study design, patients with cancer who smoked and received cessation treatment were assessed at 3 months, 6 months, and 9 months following tobacco treatment onset. Survival outcomes of tobacco treatment were measured and compared among patients at the MD Anderson Cancer Center Tobacco Research and Treatment Program. Treatment occurred between January 1, 2006, and March 3, 2022. Patients were excluded if they died before the tobacco treatment ended, received their diagnosis more than 6 months after beginning cessation treatment, or lacked staging information. The data analysis took place from September 2023 to May 2024.

Interventions: Cessation treatment consisted of 6 to 8 personalized counseling visits and 10 to 12 weeks of pharmacotherapy. More than 95% of visits were provided via telemedicine.

Main outcomes and measures: The primary outcomes were survival as recorded in the MD Anderson Cancer Center tumor registry and 7-day point prevalence abstinence at each follow-up.

Results: The main analytical sample consisted of 4526 currently smoking patients diagnosed with cancer and receiving cessation treatment (2254 [49.8%] female; median [IQR] age, 55 [47-62] years). Survival over 15 years increased for those quitting smoking at 3 months (adjusted hazard ratio [aHR], 0.75 [95% CI, 0.67-0.83]), 6 months (aHR, 0.79 [95% CI, 0.71-0.88]), and 9 months (aHR, 0.85 [95% CI, 0.76-0.95]) of follow-up. The optimal survival outcomes were observed for patients who received tobacco treatment within 6 months of a cancer diagnosis. At the 75th percentile, their survival increased from 2.1 years (95% CI, 1.8-2.4 years) among continuing smokers (nonabstainers) vs 3.9 years (95% CI, 3.2-4.6 years) for patients who quit (abstainers). Similar but less pronounced outcomes were noted when tobacco treatment began within 6 months to 5 years following diagnosis, with survival at the 75th percentile of 4.8 years (95% CI, 4.3-5.3 years) for nonabstainers vs 6.0 years (95% CI, 5.1-7.2 years) for abstainers.

Conclusions and relevance: The results of this prospective cohort study suggest that evidence-based smoking cessation treatment within 6 months following a cancer diagnosis maximizes survival benefit. This study supports smoking cessation as an important early clinical intervention for patients after being diagnosed with cancer.

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来源期刊
Jama Oncology
Jama Oncology Medicine-Oncology
CiteScore
37.50
自引率
1.80%
发文量
423
期刊介绍: At JAMA Oncology, our primary goal is to contribute to the advancement of oncology research and enhance patient care. As a leading journal in the field, we strive to publish influential original research, opinions, and reviews that push the boundaries of oncology science. Our mission is to serve as the definitive resource for scientists, clinicians, and trainees in oncology globally. Through our innovative and timely scientific and educational content, we aim to provide a comprehensive understanding of cancer pathogenesis and the latest treatment advancements to our readers. We are dedicated to effectively disseminating the findings of significant clinical research, major scientific breakthroughs, actionable discoveries, and state-of-the-art treatment pathways to the oncology community. Our ultimate objective is to facilitate the translation of new knowledge into tangible clinical benefits for individuals living with and surviving cancer.
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