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It's worth taking every opportunity to push smoking cessation even to the most dyed-in-the-wool smokers, a researcher suggested.

In a retrospective study involving nearly 7,500 patients in the Veterans Affairs (VA) health system listed as current or former smokers just before undergoing surgery for stage I lung cancer, a solid 43% were still smoking -- or smoking again -- a year later, reported Brendan Heiden, MD, of Washington University in St. Louis.

And those individuals were about 30% more likely to die in the succeeding years (HR 1.288, 95% CI 1.195-1.389; median follow-up 6.6 years), he told attendees at CHEST 2021, the American College of Chest Physicians' annual meeting held online. Median overall survival time was about 1 year shorter for the persistent smokers.

Granted, long-term survival rates in general were not great, at less than 40% at 10 years irrespective of smoking status at year 1. But Heiden said it still makes sense to try to get persistent smokers to quit.

It did not appear that clinicians treating these VA patients had done so with any persistence themselves, he lamented. Only about 15%-25% of patients included in the study had been prescribed smoking cessation pharmacotherapies, for example, perhaps suggesting that their providers had simply given up.

Despite the overall poor survival prospects for ex-smokers with lung cancer, it's incumbent on clinicians to inform them that quitting increases their chances, Heiden suggested, particularly in the VA system with its many tools and resources.

Study Details

Heiden and colleagues drew on several VA databases to identify patients with stage I non-small cell lung cancer from 2006 to 2016, excluding about 2,600 who received neoadjuvant therapy, died within 30 days of surgery, lacked smoking status data, or exited the VA system. In the end, the group found 7,489 with adequate follow-up.

Mean patient age at surgery was 67, almost all were men, and 82% were white. Just over 60% were current smokers and the rest were listed as ex-smokers. Perhaps contributing to the patients' poor outcomes, their median Charlson score was 7 (interquartile range 5-8).

One year after surgery, 58% of those smoking at baseline were still doing so, and 20% of the former smokers had resumed the habit.

Demographic and clinical factors significantly associated with post-surgery smoking included:

• Black race
• Higher BMI
• Higher Charlson score
• Time from diagnosis to surgery <12 weeks
• Wedge resection

Perhaps surprisingly, while mortality was substantially higher for the persistent smokers, their risk of disease recurrence, about 27%, was virtually the same as for those not smoking after surgery (HR 0.987, P=0.82).

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