Who Tended to Continue Smoking after Cancer Diagnosis: The National Health and Nutrition Examination Survey 1999-2008

Background: It has been estimated that there are approximately 11.7 million cancer survivors in the United States. Continued smoking after a cancer diagnosis is linked to adverse effects among cancer survivors on overall survival, treatment effectiveness, and quality of life. Little is known about who tends to quit smoking after his/her cancer diagnosis. The objective of this study is to closely evaluate factors associated with smoking cessation in cancer survivors, which to date has not been well studied.

Method: The National Health and Nutrition Examination Survey (NHANES) 1999-2008 surveys were used in this study. A total of 2,374 cancer survivors aged 20 and over with valid smoking status in the NHANES 99-08 survey were included in this study. Among them, 566 cancer survivors who regularly smoked at the time of their cancer diagnosis were included in the analyses. Results: Around 50.6% of cancer survivors smoked regularly prior to their cancer diagnosis and only 36.1% of them quit smoking after their cancer diagnosis. Racial disparity was observed in smoking cessation among cancer survivors. Hispanics (OR=0.32, 95% CI=0.13-0.77) were less likely to quit smoking than Whites after their cancer diagnosis. Cancer survivors who continued to smoke were more likely to be female, younger, Hispanic, underweight or within normal weight limits have a longer smoking history, and were diagnosed with a cancer not related to smoking. This study suggests that smoking cessation for cancer survivors should be customized based on their special needs and different characteristics.