Systematic Review of Tobacco Use after Lung or Head/Neck Cancer Diagnosis: Results and Recommendations for Future Research

Abstract

Tobacco use after cancer diagnosis is associated with adverse cancer outcomes, yet reliable prevalence estimates for this behavior are lacking. We conducted a systematic literature review of the prevalence of current tobacco use among individuals with a history of lung or head/neck cancer (CRD #42012002625). An extensive search of electronic databases (MEDLINE, EMBASE, Cochrane Library, CINAHL, PsycINFO, and Web of Science) identified 7,777 potentially relevant articles published between 1980 and 2014 and 131 of these yielded pertinent information. Aggregating results across heterogeneous study designs and diverse patient samples, the overall mean prevalence rate of current tobacco use (mostly cigarette smoking) was 33.0% (median, 31.0%). Among current tobacco users at cancer diagnosis, the mean prevalence rate of current tobacco use (mostly cigarette smoking) was 53.8% (median, 50.3%). In many cases, an operational definition of "current" tobacco use was absent, and biochemical verification of self-reported smoking status was infrequent. These and other observed methodologic limitations in the assessment and reporting of cancer patients' tobacco use underscore the necessity of uniform tobacco use assessment in future clinical research and cancer care.

Figure 1

Flow diagram for paper identification, retrieval, and inclusion in systematic review.

Figure 2

A. Prevalence of current smoking after lung or head/neck cancer diagnosis by phase of survivorship. Ns denote number of studies in the analysis for Full Sample/Current Smokers at Cancer Diagnosis. Full Sample: 0-3 includes data from (4, 10, 34, 40, 42, 54, 63, 73, 80, 84, 110, 127, 132, 134, 135, 143, 145, 147, 154); 4-6 includes data from (51, 131, 153); 7-11 includes data from (49, 133); 12-59 includes data from (59, 79, 85, 86, 88, 91, 97, 100, 141, 152); 60+ includes data from (67, 70, 128); and Mixed includes data from (5, 29-31, 46, 52, 56, 62, 69, 90, 94, 95, 98, 103, 112, 115, 120-122, 125, 126, 130, 138). Current Smokers at Cancer Diagnosis: 0-3 includes data from (4, 34, 39, 40, 80, 82, 84, 110, 143, 149); 4-6 includes data from (76, 153); 7-11 includes data from (123); 12-59 includes data from (36, 97); 60+ includes data from (128); and Mixed includes data from (5, 35, 44, 46, 56, 112, 115, 125, 129, 138). B. Prevalence of current smoking after lung or head/neck cancer diagnosis by phase of treatment. Ns denote number of studies in the analysis for Full Sample/Current Smokers at Cancer Diagnosis. Full Sample: Before Treatment includes data from (4, 10, 28, 32, 43, 45, 57, 59, 63-65, 68, 73, 74, 84, 99, 101, 102, 106, 108, 109, 111, 114, 127, 132, 134, 143, 148, 151, 154); During Treatment includes data from (34, 40, 75, 104, 110, 118, 121, 133, 145-147, 152) (33, 37, 38, 50, 78, 107, 124, 139, 150); After Treatment includes data from (29, 30, 49, 53, 58-60, 67, 69, 70, 79, 85-87, 89, 92, 97, 98, 100, 103, 105, 119, 122, 128, 138, 141); and Mixed includes data from (5, 41, 42, 46, 47, 52, 55, 61, 62, 73, 77, 80, 83, 90, 91, 93, 94, 96, 115, 126, 130, 131, 133, 140, 144, 153). Current Smokers at Cancer Diagnosis: Before Treatment includes data from (4, 65, 82, 84, 143); During Treatment includes data from (34, 39, 40, 110, 117, 142, 149); After Treatment includes data from (44, 60, 87, 97, 128, 136, 138); and Mixed includes data from (5, 35, 36, 46, 56, 76, 80, 83, 112, 115, 123, 125, 129, 144, 153).

Figure 3

Variation in the prevalence of current smoking after lung or head/neck cancer diagnosis across time. Baseline was centered at Month 0 for every study; Full Sample: Month 0 includes data from (10, 42, 52-54, 80, 84, 135); Month 1 includes data from (53); Month 2 includes data from (135); Month 3 includes data from (10, 52-54, 80); Month 4 includes data from (135); Month 6 includes data from (10, 42, 52, 54, 80, 135); Month 9 includes data from (10); Month 12 includes data from (10, 135); and Month 24 includes data from (84). Current Smokers at Cancer Diagnosis: Month 0 includes data from (76, 80, 84, 129, 149); Month 3 includes data from (76, 80, 129, 149); Month 6 includes data from (80, 149); Month 12 includes data from (76, 149); and Month 24 includes data from (84).