Table.
Effects of current smoking on mortality, recurrence, cancer treatment toxicity, and second primary cancer in patients treated with chemotherapy or radiotherapy
| Patients | Treatments | Study period | Outcome | |
|---|---|---|---|---|
| Lung cancer | ||||
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| Florescu et al (2008)38 | 731 (NSCLC stage IIIB–IV, previous therapy unsuccessful) | Chemotherapy, erlotinib (BR21 trial) | NA | Mortality (vs never smoked) Former: HR 1·22, p<0·001 Current: HR 1·89, p<0·001 |
| Herbst et al (2005)39 | 1079 (NSCLC stage IIIB–IV) | Chemotherapy, erlotinib (TRIBUTE trial) | 2001–02 | Median survival Chemotherapy + erlotinib: Current: 8·4 months Former: 10·0 months Never: 22·5 months p=0·01 Chemotherapy: Current: 9·1 months Former: 10·9 months Never: 10·1 months |
| Holgersson et al (2012)*40 | 1146 (NSCLC) | Radiotherapy | 1990–2000 | Mortality (vs never smoking) Former: HR 1·10 (95% CI 0·82–1·45) Current: HR 1·06 (95% CI 0·80–1·41) |
| Kawaguchi et al (2012)41 | 2966 (NSCLC stage IIIB–IV, ≥70 years of age) | Chemotherapy | NA | Mortality (vs never smoking) Former: 70–74 years: HR 0·91 (95% CI 0·80–1·04) 75–79 years: HR 1·06 (95% CI 0·92–1·22) 80+ years: HR 1·08 (95% CI 0·90–1·29) Never: 70–74 years: HR 0·78 (95% CI 0·66–0·93) 75–79 years: HR 0·80 (95% CI 0·66–0·97) ≥80 years: HR 0·99 (95% CI 0·80–1·21) |
| Lee et al (2012)42 | 670 (NSCLC stage IIIB–IV) | Erlotinib (TOPICAL trial) | NA | Cancer-specific mortality (vs never smoking) Former: HR 1·02 (95% CI 0·79–1·32) Current: HR 1·61 (95% CI 0·91–2·86) |
| Li et al (2011)43 | 1214 (NSCLC stage IIIB–IV) | Chemotherapy | NA | Mortality (vs never smoking) Former: HR 1·10 (95% CI 0·79–1·54) Current: HR 1·05 (95% CI 0·63–1·75) |
| Pirker et al (2012)44 | 1125 (NSCLC stage IIIB–IV) | Chemotherapy, cetuximab (phase III FLEX study) | NA | Mortality (vs current smoking): HR 1.0 (referent) Former: HR 0·86 (95% CI 0·73–1·02) Never: HR 0·72 (95% CI 0·58–0·88) |
| Richardson et al (1993)45 | 540 (SCLC) | National Cancer Institute intramural trials | 1973–89 | Second primary cancer (vs general population) Current smoking after diagnosis: RR 32 (95% CI 12–69) Quit smoking after diagnosis: RR 11 (95% CI 4·4–23) |
| Tsao et al (2006)*46 | 1379 (NSCLC stage III–IV) | Chemotherapy | NA | Mortality (vs never smoking) Former: OR 1·47, p=0·003 Current: OR 1·55, p=0·0004 |
| Tucker et al (1997)47 | 611 (SCLC survivors) | Chemotherapy, radiotherapy | 2 years | Second primary cancer (vs general population) Current smoking after diagnosis: RR 17 (95% CI 11–26) Quit smoking at diagnosis: RR 9·9 (95% CI 5·3–17) Quit smoking before diagnosis: RR 9·4 (95% CI 4·7–17) |
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| Head and neck cancer | ||||
|
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| Fortin et al (2009)*48 | 1871 | Radiotherapy, chemotherapy, systemic therapy | 1989–2006 | Mortality (vs never smoking) Former: HR 1·23 (p value unavailable) Current: HR 1·35, p=0·0005 |
| Gillison et al (2012)49 | 502 (stage III–IV) | Radiotherapy, chemotherapy, (RTOG9003 and RTOG0129) | NA | Mortality (vs all other patients) Overall: HR 2·34 (95% CI 1·56–3·50) Cancer-specific mortality Radiotherapy treated patients: HR 2·19 (95% CI 1·48–3·25) Chemotherapy treated patients: HR 2·73 (95% CI 1·37–5·45) |
| Khuri et al (2006)50 | 1190 (stage I–II) | Radiotherapy, systemic therapy (no chemotherapy), isoretinoin (phase III trial) | NA | Mortality Current vs former: RR 1·60 (95% CI 1·23–2·07) Current vs never: RR 2·51 (95% CI 1·54–4·10) Recurrence Current vs former: RR 1·12 (95% CI 0·76–1·65) Current vs never: RR 1·37 (95% CI 0·76–2·46) |
| Meyer et al (2008)51 | 540 | Radiotherapy, β-carotene | 1994–2000 | Mortality (vs all other patients) Current: HR 2·26 (95% CI 1·29–3·97) |
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| Prostate cancer | ||||
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| Alsadius et al (2011)52 | 836 | Radiotherapy | 1993–2006 | Rectal toxicity (vs never smoking): Current: Abdominal cramps: RR 9·0, p=0·004 Urgency: RR 2·65, p<0·001 Diarrhoea: RR 2·67, p=0·017 Incomplete emptying: RR2·57, p=0·003 Sudden emptying: RR 4·6, p=0·003 |
| Bittner et al (2008)53 | 1354 | Radiotherapy, ADT | 1993–2004 | Mortality (current vs never smoking) Current: Prostate cancer mortality: NS Non-prostate cancer mortality Heart disease: RR 3·05, p=0·007 Non-prostate: RR 5·52, p=0·002 Other: RR 4·09, p=0·002 |
| Boorjian et al (2007)54 | 9780 | Systemic therapy, radiotherapy, ADT (CaPSURE study) | NA | Bladder cancer (vs all other patients) No radiotherapy (all): HR 1·0 (referent) Yes radiotherapy (all): HR 1·59 (95% CI 0·97–2·6) Current (all): HR 2·08 (95% CI 1·09–3·97) Current + radiotherapy: HR 3·65 (95% CI 1·45–9·16) |
| Merrick et al (2006)55 | 938 (stage T1b–T3a) | Radiotherapy, ADT | 1995–2002 | Mortality (vs never smoked) Former: RR 2·15, p=0·007 Current: RR 4·27, p<0·001 Cancer-specific mortality (vs never smoked) Former: p=0·19 Current: p=0·48 Recurrence (vs never smoked) Former: RR 0·95, p=0·43 Current: RR 2·10, p=0·04 |
| Pickles et al (2004)56 | 601 | Radiotherapy | 1994–97 | Mortality, 6-year (vs all other patients) Current: RR 2·38, p=0·009 Cancer-specific mortality (vs all other patients Current: RR 2·89, p=0·08 Recurrence (vs all other patients) Current: OR 1·68 (95% CI 1·11–2·56) |
| Taira et al (2011)57 | 1656 | Radiotherapy, ADT | NA | Mortality (vs never smoking) Former: HR 1·43, p=0·017 Current: HR 2·86, p<0·001 |
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| Breast cancer | ||||
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| Gold et al (2006)58 | 2198 (stage I–IIIA) | Tamoxifen (WHEAL study) | 1995–2000 | Vasomotor toxicity (vs never smoking) Former: OR 1·40 (95% CI 1·10–1·78) Current: OR 2·12 (95% CI 1·19–3·78) |
| Li et al (2009)59 | 1091 (ER positive) | Systemic therapy, radiotherapy, chemotherapy | 1990–2007 | Lung cancer (vs never smoking) Former smoker at diagnosis: OR 1·2 (95% CI 0·8–1·7) Current smoker at diagnosis: OR 1·8 (95% CI 1·1–3·2) Former smoker at most recent follow-up: OR 1·2 (95% CI 0·8–1·7) Current smoker at most recent follow-up: OR 2·2 (95% CI 1·2–4·0) |
| Obedian et al (2000)*60 | 1029 (early stage) | Systemic therapy, radiotherapy, | 1970–90 | Lung cancer (vs never smoking) Former: RR 7·01 Current: RR 8·96, p=0·06 |
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| Other cancers | ||||
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| Eifel et al (2002)*61 | 3489 (stage I–II cervical cancer) | Radiotherapy | 1960–94 | Pelvic complications (vs never smoking) Former: HR 1·40 (95% CI 0·81–2·41) Current: <1 PPD: HR 1·25 (95% CI 0·88–1·79) >1 PPD: HR 2·43 (95% CI 1·95–3·04) |
| Gilbert et al (2003)*62 | 592 (Hodgkin’s disease) | Radiotherapy | 1965–94 | Lung cancer (vs never smoking) Former: RR 6·8 (95% CI 2·8–19·5) Current: RR 24·0 (95% CI 10·3–68) |
| McCleary et al (2010)63 | 1045 (stage III colon cancer) | Systemic therapy, chemotherapy (CALGB 89803 trial) | ·· | Mortality (vs never smoking) Former: HR 1·17 (95% CI 0·87–1·57) Current: HR 1·38 (95% CI 0·87–2·18) Recurrence Former: HR 1·15 (95% CI 0·89–1·48) Current: HR 0·90 (95% CI 0·58–1·41) |
| Park et al (2007)64 | 14 181 (male head and neck, lung, esophageal, laryngeal, oral, kidney, bladder, pancreas, liver, gallbladder, and prostate cancer) | Systemic therapy, radiotherapy, chemotherapy (NHIC study) | 1996–2002 | Second primary cancer (vs never smoking) All cancers: Former: RR 0·87 (95% CI 0·56–1·35) Current: RR 1·13 (95% CI 0·77–1·67) Smoking related: Former: RR 1·03 (95% CI 0·46–2·31) Current: RR 2·02 (95% CI 1·02–4·03) |
95% CI given when available.
*
Patients treated with surgery, chemotherapy, or radiotherapy included.
NA=not available. ADT=androgen deprivation therapy. RR=relative risk. CaPSURE=Cancer of the Prostate Strategic Urologic Research Endeavor. NHIC=national health insurance corporation. NSCLC=non-small cell lung cancer. HR=hazard ratio. RTOG=Radiation Therapy Oncology Group. NS=not statistically significant. PPD=pack per day. SCLC=small-cell lung cancer. WHEAL=Women’s Healthy Eating and Living Study. ER=oestrogen receptor.
*
Studies in which tobacco information was captured through a non-standardised assessment or through patients’ chart reviews.