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This research has been funded by The Global Research Awards for Nicotine Dependence

Rachel Roberts, Robin Ghosal, Ian Campbell, Helen Davies, Diane Parry, Gareth Collier, & Keir Lewis. This research has been funded by The Global Research Awards for Nicotine Dependence. Smoking causes over 85% of lung cancer (Peto et al, 2000) ‏.

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This research has been funded by The Global Research Awards for Nicotine Dependence

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  1. Rachel Roberts, Robin Ghosal, Ian Campbell, Helen Davies, Diane Parry, Gareth Collier, & Keir Lewis • This research has been funded by The Global Research Awards for Nicotine Dependence

  2. Smoking causes over 85% of lung cancer (Peto et al, 2000)‏

  3. 47% of patients with Lung Cancer were smoking at the time of diagnosis • Retrospective and self-reported studies suggest that continued smoking after a diagnosis of Lung Cancer (LC) independently worsens quality of life, and shortens life expectancy. • Studies suggest that stopping smoking can potential increase life expectancy by around 3-6 months, at least in early stage cancer.

  4. Effect on Treatment

  5. No prospective studies • Smoking status only self reported • Smoking reported only at baseline not account for quitters or relapsers • No controls i.e. could stopping smoking merely be a marker for other healthy behaviours? • Mechanisms of how therapy is affected by smoking?

  6. Longitudinal Observational Study

  7. Method

  8. Results

  9. LungCAST Effect of smoking following a diagnosis of lung cancer Keir Lewis(1,2) & Rachel Roberts (1,2) 1. Hywel Dda Health Board, Wales, UK. 2. College of Medicine, Swansea University, Wales, UK. Conclusion Introduction Methods 6 month survival was slightly improved in non-smokers (69.1%) compared to smokers (67.6%) however this was not significantly significant (p=0.492). The table illustrates smokers and non smokers six months following diagnosis. Smoking at time of lung cancer diagnosis increases occurrence of complications and decreases performance status six months after a diagnosis of LC after accounting for known confounders. Quitting smoking following a diagnosis was associated with a decrease in the rate of complications but there was no statistically significant effect on mortality, this could be due to the size of this cohort. These findings indicate that quitting smoking will improve outcomes in LC patients, suggesting that smoking cessation should be provided more often and more intensely at the time of diagnosis. Further data collection regarding histology, treatments and clinical outcomes is ongoing in order to determine the effects of quitting smoking on prognosis and outcomes. Tobacco smoking causes over 80% of lung cancer but the importance of smoking after a diagnosis of lung cancer has only been reported retrospectively and not biologically validated. Retrospective and self-reported studies suggest that continued smoking is associated with worse outcomes in Lung Cancer (LC) patients. LungCAST (REC 09/WMW01/28, UKCRN 9851) is a longitudinal study examining the influence of smoking status at the time of lung cancer diagnosis and effect of cessation on outcomes. Following ethical approval, data was collected from all consecutive attendees to Rapid Access Lung Clinics and any inpatients suspected or recently diagnosed with lung cancer. 403 newly diagnosed LC patients were followed up over 6 months and data was collected with regards to smoking status, performance status (PS), mortality and treatment complications. Self-reported smoking status was verified by exhaled carbon monoxide (eCO) levels at each visit. Anyone who admitted to smoking or had an eCO>10 parts per million were deemed smokers. Pack years were calculated based on duration and amount smoked. Aims Smokers had a significantly poorer performance status 6 months after diagnosis compared to non-smokers (t(69) = -2.02, p = 0.047). There was no significant difference in those who quit smoking after diagnosis. Smokers had increased number of complications at 6 months (X2 (5) = 13.126, p =0.022). Those who quit smoking after a diagnosis of LC experienced less complications within the 6 months following diagnosis than patients who continued to smoke (X2 (1, N = 79) = 8.050, p =0.005) Results The table illustrates smokers and non smokers at the time of diagnosis. Aims Contact As part of this larger UK multicentre study (14 sites) we wish to asses the extent to which smoking status affects outcomes six months after a diagnosis. Rachel Roberts rachel.roberts3@wales.nhs.uk Tel: +44 1554 779309 Figure 2: % of complications in patients who quit smoking after a diagnosis of LC compared to those who continued to smoke. Funded by a grant from The Global Research Awards for Nicotine Dependence (Pfizer Inc)

  10. 6 month survival was slightly improved in non-smokers (69.1%) compared to smokers (67.6%) however this was not significantly significant (p=0.492).

  11. Smokers had a significantly poorer performance status at 6 months after diagnosis compared to non-smokers (t(69) = -2.02, p = 0.047) • There was no significant difference on QoL

  12. Smokers had increased number of complications at 6 months (X2 (5) = 13.126, p =0.022) Those who quit smoking after a diagnosis of LC experienced less complications within the 6 months following diagnosis than patients who continued to smoke (X2 (1, N = 79) = 8.050, p =0.005)

  13. Implications

  14. NICE Guidelines Nice Guidelines: CG121 - Lung cancer: The diagnosis and treatment of lung cancer 1.4 Treatment Smoking cessation 1.4.1 Inform patients that smoking increases the risk of pulmonary complications after lung cancer surgery. [new 2011] 1.4.2 Advise patients to stop smoking as soon as the diagnosis of lung cancer is suspected and tell them why this is important. [new 2011] 1.4.3 Offer nicotine replacement therapy and other therapies to help patients to stop smoking in line with Smoking cessation services (NICE public health guidance 10) [new 2011]

  15. Further data collection regarding influence of smoking on histology, staging, change in QoL, complications for specific treatments and clinical outcomes is ongoing • Closure of RCT • Future studies: • Evaluation of Smoking Cessation Strategies in Lung Cancer Patients: Developing a Tailored and Specialist Service

  16. Investigate barriers to smokers with a diagnosis of LC in attending a HSCS (patient and health care workers) • By identifying barriers we can generate a more appropriate cessation service • Regulatory approvals in Nov 2013

  17. Contact information Rachel Roberts Portfolio Research Coordinator Clinical Research Centre Prince Phillip Hospital Llanelli SA14 8QF Rachel.Roberts3@wales.nhs.uk Tel: 01554 779309

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