Advertisement
No AccessJournal of UrologyAdult Urology1 Aug 2019

Does the Diagnosis of Bladder Cancer Lead to Higher Rates of Smoking Cessation? Findings from the Medicare Health Outcomes Survey

View All Author Information

Purpose:

Smoking is the most common risk factor for bladder cancer and it is associated with adverse clinical outcomes. The bladder cancer diagnosis represents a teachable moment for smoking cessation. We investigated the likelihood of smoking cessation after bladder cancer diagnosis in a population database.

Materials and Methods:

We evaluated the 1998 to 2013 SEER (Surveillance, Epidemiology and End Results)-MHOS (Medicare Health Outcomes Survey) data on all patients diagnosed with incident bladder cancer on whom survey data were available before and after diagnosis. We compared these patients to propensity matched noncancer controls and to a cohort of patients with incident renal cell carcinoma. Differences in smoking cessation were compared between the groups and multivariate logistic regression was performed to assess the likelihood of smoking cessation.

Results:

We propensity matched 394 patients with newly diagnosed bladder cancer to 1,970 noncancer controls and compared them with 169 patients with incident renal cell carcinoma. Baseline smoking prevalence was more common in patients diagnosed with bladder cancer compared to renal cell carcinoma (16% vs 11%) but the difference was not significant. The smoking cessation rate in patients with bladder cancer was 27% compared with 21% in noncancer controls and 26% in patients with renal cell carcinoma (p = 0.30 and 0.90, respectively). There was no significant difference in the adjusted OR of quitting smoking in patients with bladder cancer vs those with renal cell carcinoma compared to noncancer controls (OR 1.3, 95% CI 0.7–2.5 vs OR 1.2, 95% CI 0.4–3.6). Independent predictors of smoking cessation in patients with bladder cancer included age (p = 0.03), African American race (p = 0.03) and college education (p = 0.01).

Conclusions:

Compared to propensity matched noncancer controls smoking cessation did not significantly differ after a diagnosis of bladder cancer. The proportion of individuals who quit was low overall, suggesting that improved efforts are needed to use this teachable moment in patients with bladder cancer.

References

  • 1. : Current cigarette smoking among adults—United States, 2016. MMWR Morb Mortal Wkly Rep 2018; 67: 53. Google Scholar
  • 2. : Fifty years of tobacco carcinogenesis research: from mechanisms to early detection and prevention of lung cancer. Cancer Prev Res (Phila) 2014; 7: 1. Google Scholar
  • 3. : Tobacco control and the reduction in smoking-related premature deaths in the United States, 1964-2012. JAMA 2014; 311: 164. Google Scholar
  • 4. : Toward the 1990 objectives for smoking: measuring the progress with 1985 NHIS data. Public Health Rep 1987; 102: 68. Google Scholar
  • 5. : Quantified relations between exposure to tobacco smoking and bladder cancer risk: a meta-analysis of 89 observational studies. Int J Epidemiol 2016; 45: 857. Google Scholar
  • 6. : Cigarette smoking prior to first cancer and risk of second smoking-associated cancers among survivors of bladder, kidney, head and neck, and stage I lung cancers. J Clin Oncol 2014; 32: 3989. Google Scholar
  • 7. : Understanding the potential of teachable moments: the case of smoking cessation. Health Educ Res 2003; 18: 156. Google Scholar
  • 8. : Smoking behavior following diagnosis in patients with stage I non-small cell lung cancer. Cancer Causes Control 1991; 2: 105. Google Scholar
  • 9. : Prevalence and predictors of continued tobacco use after treatment of patients with head and neck cancer. Cancer 1995; 75: 569. Google Scholar
  • 10. : Tobacco use and cessation for cancer survivors: an overview for clinicians. CA Cancer J Clin 2014; 64: 272. Google Scholar
  • 11. : Associations between cigarette smoking and each of 21 types of cancer: a multi-site case-control study. Int J Epidemiol 1995; 24: 504. Google Scholar
  • 12. : Persistence of urothelial carcinoma of the bladder risk among former smokers: results from a contemporary, prospective cohort study. Urol Oncol 2014; 32: 25.e21. Google Scholar
  • 13. : Risk factors for renal cell carcinoma in the VITAL study. J Urol 2013; 190: 1657. LinkGoogle Scholar
  • 14. : Epidemiology and risk factors of urothelial bladder cancer. Eur Urol 2013; 63: 234. Google Scholar
  • 15. : The causal role of cigarette smoking in bladder cancer initiation and progression, and the role of urologists in smoking cessation. J Urol 2008; 180: 31. LinkGoogle Scholar
  • 16. : Are patients aware of the association between smoking and bladder cancer?J Urol 2006; 176: 2405. LinkGoogle Scholar
  • 17. : Ethnicity and smoking status are associated with awareness of smoking related genitourinary diseases. J Urol 2012; 188: 724. LinkGoogle Scholar
  • 18. : Cigarette smoking patterns in patients after treatment of bladder cancer. J Cancer Educ 2000; 15: 86. Google Scholar
  • 19. : Impact of a bladder cancer diagnosis on smoking behavior. J Clin Oncol 2012; 30: 1871. Google Scholar
  • 20. : The association between smoking cessation before and after diagnosis and non-muscle-invasive bladder cancer recurrence: a prospective cohort study. Cancer Causes Control 2018; 29: 675. Google Scholar
  • 21. : Overview of the SEER-Medicare health outcomes survey linked dataset. Health Care Financ Rev 2008; 29: 5. Google Scholar
  • 22. : Does a recent cancer diagnosis predict smoking cessation? An analysis from a large prospective US cohort. J Clin Oncol 2015; 33: 1647. Google Scholar
  • 23. : Influence of smoking status on the disease-related outcomes of patients with tobacco-associated superficial transitional cell carcinoma of the bladder. Cancer 1999; 86: 2337. Google Scholar
  • 24. : Stopping smoking might reduce tumour recurrence in nonmuscle-invasive bladder cancer. BJU Int 2007; 100: 281. Google Scholar
  • 25. : Association of smoking status with prognosis in bladder cancer: a meta-analysis. Oncotarget 2017; 8: 1278. Google Scholar
  • 26. : The California Tobacco Control Program's effect on adult smokers: (1) Smoking cessation. Tob Control 2007; 16: 85. Google Scholar
  • 27. : Underuse and underreporting of smoking cessation for smokers with a new urologic cancer diagnosis. Urol Oncol 2015; 33: 504.e501. Google Scholar
  • 28. : Smoking cessation assistance for patients with bladder cancer: a national survey of American urologists. J Urol 2010; 184: 1901. LinkGoogle Scholar
  • 29. : Brief smoking cessation intervention: a prospective trial in the urology setting. J Urol 2013; 189: 1843. LinkGoogle Scholar

The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number.

No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article.

Editor’s Note: This article is the first of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 424 and 425.

Advertisement