Longitudinal smoking patterns in survivors of childhood cancer: An update from the Childhood Cancer Survivor Study

• Type of Material: Article
• Authors: Todd M. Gibson, St. Jude Children’s Research Hospital; Wei Liu, St. Jude Children’s Research Hospital; Gregory T. Armstrong, St. Jude Children’s Research Hospital; Deo Kumar Srivastava, St. Jude Children’s Research Hospital; Melissa M. Hudson, St. Jude Children’s Research Hospital; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center; Ann Mertens, Emory University; Robert C. Klesges, St. Jude Children’s Research Hospital; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center; Paul C. Nathan, Hospital for Sick Children; Leslie L. Robison, St. Jude Children’s Research Hospital
• Language: English
• Date: 2015-11-15
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 American Cancer Society.
• Final Published Version (URL): http://dx.doi.org/10.1002/cncr.29609
• Title of Journal or Parent Work: Cancer
• ISSN: 0008-543X
• Volume: 121
• Issue: 22
• Start Page: 4035
• End Page: 4043
• Grant/Funding Information: NCI grant U24CA055727; Cancer Center Support (CORE) grant CA21765
• Keywords: PARTNERSHIP; Oncology; INTERVENTION; childhood cancer survivors; TOBACCO; HEALTH BEHAVIORS; smoking; Science & Technology; COHORT; PEDIATRIC CANCER; ADOLESCENT CANCER; ADULT SURVIVORS; Life Sciences & Biomedicine; 5-YEAR SURVIVORS; prevalence; smoking patterns; CESSATION; longitudinal studies; cancer treatment
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Oncology

Abstract

Background: Survivors of pediatric cancer have elevated risks of mortality and morbidity. Many adverse late effects associated with cancer treatment (e.g. second cancers, cardiac and pulmonary disease) are also associated with cigarette smoking, suggesting survivors who smoke may be at high risk for these conditions. Methods: We examined self-reported smoking status in 9,397 adult survivors of childhood cancer across 3 questionnaires (median time interval 13 years). Smoking prevalence among survivors was compared to siblings and expected prevalence based on age-, sex-, race-, and calendar time-specific U.S. population rates. Multivariable regression models examined characteristics associated with longitudinal smoking patterns across all three questionnaires. Results: At baseline, 19% of survivors were current smokers, compared with 24% of siblings and 29% expected based on U.S. rates. Current smoking among survivors dropped to 16% and 14% on follow-up questionnaires, with similar decreases in siblings and expected prevalence. Characteristics associated with consistent never smoking included higher household income (relative risk 1.16, 95% confidence interval 1.08–1.25), higher education (1.32, 1.22–1.43), and receipt of cranial radiation therapy (1.08, 1.03–1.14). Psychological distress (0.86, 0.80–0.92) and heavy alcohol drinking (0.64, 0.58–0.71) were inversely associated. Among ever smokers, higher income (1.17, 1.04–1.32) and education (1.23, 1.10–1.38) were associated with quitting, whereas cranial radiation (0.86, 0.76–0.97) and psychological distress (0.80, 0.72–0.90) were associated with not having quit (0.85, 0.76–0.96). Development of adverse health conditions was not associated with smoking patterns. Conclusion: Despite modest declines in smoking prevalence, the substantial number of consistent current smokers reinforces the need for continued development of effective smoking interventions for survivors.