Abstract
Background
Lung cancer survivors are increasing, but the effect of post-diagnostic changes in smoking, alcohol use, and physical activity on survival remains unclear. We evaluated whether these modifiable behavior changes are associated with all-cause mortality in lung cancer survivors.
Methods
We conducted a nationwide cohort study using Korean National Health Insurance Service data. Adults (≥20 years) with lung cancer who completed at least one health examination before and after diagnosis were included (n = 54,141). Smoking, alcohol use, and physical activity were assessed by questionnaire. Overall survival was analyzed using Kaplan–Meier methods and multivariable Cox models.
Results
Current smoking was associated with higher mortality. Greater alcohol use was associated with higher mortality, whereas greater physical activity was associated with lower mortality. In change analyses, compared with quitting smoking after diagnosis, continued smoking was associated with higher mortality (aHR, 3.468; 95% CI, 2.111–5.696). Relative to persistent non-drinking, changing alcohol intake was associated with lower mortality (aHR, 0.341; 95% CI, 0.268–0.433), whereas continuous drinking increased mortality (aHR, 1.172; 95% CI, 1.132-1.214). Compared with consistent inactivity, changing physical activity level was associated with lower mortality (aHR, 0.245; 95% CI, 0.215–0.280), and persistent activity was also protective (aHR 0.948; 95% CI, 0.918-0.979).
Conclusions
Changes in smoking, alcohol use, and physical activity after diagnosis were associated with survival. These patterns may reflect how individuals adapt to evolving physical and clinical conditions after diagnosis and may serve as accessible signals of survivorship risk and support needs. Our findings support survivorship strategies that prioritize structured smoking cessation and routine follow-up assessment of lifestyle changes to enable timely, individualized support for alcohol use and physical activity.
Key messages
• Smoking cessation after lung cancer diagnosis was associated with lower mortality.
• Post-diagnostic changes in alcohol use and physical activity were also associated with improved survival.