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Nicotine Tob Res. 2019 Mar 30;21(4):497-504. doi: 10.1093/ntr/nty012.

Smoking Status and Survival Among a National Cohort of Lung and Colorectal Cancer Patients.

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Centers for Behavioral and Preventive Medicine, The Miriam Hospital and Department of Psychiatry and Human Behavior, The Alpert Medical School of Brown University, Providence, RI.
Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
Department of Biostatistics, Duke University School of Medicine, Durham, NC.
Center for Public Health Statistics, University of Iowa College of Public Health, Iowa City, IA.
David Geffen School of Medicine at University of California Los Angeles, California and Veterans Affairs Medical Center, Greater Los Angeles, CA.
Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA.
Department of Health Care Policy, Harvard Medical School, and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA.
Tobacco Research and Treatment Center, and the Mongan Institute for Health Policy Center, Massachusetts General Hospital, Boston, MA.
Department of Psychiatry, Harvard Medical School, Boston, MA.



The purpose of this study was to explore the association of smoking status and clinically relevant duration of smoking cessation with long-term survival after lung cancer (LC) or colorectal cancer (CRC) diagnosis. We compared survival of patients with LC and CRC who were never-smokers, long-term, medium-term, and short-term quitters, and current smokers around diagnosis.


We studied 5575 patients in Cancer Care Outcomes Research and Surveillance (CanCORS), a national, prospective observational cohort study, who provided smoking status information approximately 5 months after LC or CRC diagnosis. Smoking status was categorized as: never-smoker, quit >5 years prior to diagnosis, quit between 1-5 years prior to diagnosis, quit less than 1 year before diagnosis, and current smoker. We examined the relationship between smoking status around diagnosis with mortality using Cox regression models.


Among participants with LC, never-smokers had lower mortality risk compared with current smokers (HR 0.71, 95% CI 0.57 to 0.89). Among participants with CRC, never-smokers had a lower mortality risk as compared to current smokers (HR 0.79, 95% CI 0.64 to 0.99).


Among both LC and CRC patients, current smokers at diagnosis have higher mortality than never-smokers. This effect should be further studied in the context of tumor biology. However, smoking cessation around the time of diagnosis did not affect survival in this sample.


The results from our analysis of patients in the CanCORS consortium, a large, geographically diverse cohort, show that both LC and CRC patients who were actively smoking at diagnosis have worse survival as compared to never-smokers. While current smoking is detrimental to survival, cessation upon diagnosis may not mitigate this risk.

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