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Smoking Relapse during the First Year after Treatment for Early-Stage Non–Small-Cell Lung Cancer

¹ Departments of Medicine, ² Psychology, and ³ Surgery, Washington University School of Medicine, St. Louis, Missouri; ⁴ Department of Behavioral Science, The University of Texas M.D. Anderson Cancer Center, Houston, Texas; and ⁵ Department of Health Behavior and Health Education, School of Public Health, University of North Carolina, Chapel Hill, North Carolina

Requests for reprints: Mark S. Walker, Division of Health Behavior Research, Suite 6700, 4444 Forest Park Boulevard, St. Louis, MO 63108. Phone: 314-286-2016; Fax: 314-286-1919. E-mail: mwalker{at}im.wustl.edu

Background: Non–small-cell lung cancer patients who continue to smoke after cancer diagnosis are more likely to experience disease recurrence, decreased treatment efficacy, and treatment complications. Despite this, many continue to smoke, with estimates ranging from 13% to 60%.

Methods: Participants were 154 early-stage, non–small-cell lung cancer patients who had smoked within 3 months before surgery. Patients were followed for 12 months after surgery to assess smoking status and duration of continuous abstinence after surgery. Predictors included medical, smoking history, psychosocial, and demographic characteristics.

Results: At some point after surgery, 42.9% of patients smoked; at 12 months after surgery, 36.9% were smoking. Sixty percent of patients who lapsed did so during the first 2 months after surgery. Smoking at follow-up was predicted by shorter quit duration before surgery, more intense Appetitive cravings (expectation of pleasure from smoking), lower income, and having a higher level of education. Time until the first smoking lapse was predicted by shorter quit duration before surgery, more intense Appetitive cravings to smoke, and lower income. Among those who lapsed, greater delay before the lapse was associated with abstinence at the 12-month follow-up assessment.

Conclusions: Nearly half of non–small-cell lung cancer patients return to smoking after surgery if they have recent smoking histories. Most initial lapses happen within 2 months and occur in response to more recent smoking and more intense cravings. Findings suggest that interventions to prevent relapse should target those who wait until cancer surgery to quit smoking and should be started as soon as possible after treatment. (Cancer Epidemiol Biomarkers Prev 2006;15(12):2370–7)

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