Chest
Volume 125, Issue 1, January 2004, Pages 27-37
Journal home page for Chest

Clinical Investigations
SMOKING
Smoking and Lung Cancer Survival: The Role of Comorbidity and Treatment

https://doi.org/10.1378/chest.125.1.27Get rights and content

Study objectives

Numerous studies indicate that smoking is associated with poorer outcomes in patients with cancer. The aim of this study was to determine whether smoking independently predicts survival in patients with lung cancer or whether an existent effect is mediated through comorbidity and/or treatment.

Design and setting

Cox proportional hazards analysis was used to study a cohort of 1,155 patients with lung cancer diagnosed at the Henry Ford Health System between 1995 and 1998, inclusive.

Results

Adjusted for the baseline covariates, age, gender, illicit drug use, adverse symptoms, histology, and stage, the hazard ratio (HR) for smoking (current vs former/never) was 1.37 (95% confidence interval [CI], 1.18 to 1.59; p < 0.001). Adjusted for the baseline covariates and for 18 deleterious comorbidities, the HR for smoking was 1.38 (95% CI, 1.18 to 1.60; p < 0.001), indicating that the hazardous effect of smoking was not mediated through comorbidity. Current smoking was inversely associated with treatment (any surgery and/or chemotherapy and/or radiation therapy vs none) [odds ratio, 0.73; 95% CI, 0.55 to 0.98 (p = 0.03)]. Adjusted for baseline covariates, comorbidities and treatment, the HR for current smoker vs former/never was 1.26 (95% CI, 1.08 to 1.47; p = 0.003), a decline of 30.7% explained by treatment (HR for any treatment vs none, 0.40; 95% CI, 0.33 to 0.48; p < 0.001).

Conclusions

Current smoking at diagnosis is an important independent predictor of shortened lung cancer survival. That this effect was not explained by sociodemographic/exposure factors, adverse symptoms, histology, stage, comorbidity, and treatment suggests that it may be mediated through direct biological effects.

Section snippets

Materials and Methods

A historical cohort study was carried out in the Henry Ford Health System to evaluate the impact of comorbidity, smoking, and other factors on the survival of patients with lung cancer. Study subjects, identified through the Josephine Ford Cancer Center Tumor Registry, had primary bronchogenic lung cancer diagnosed between January 1, 1995, and December 31, 1998, and received their principal care at the Henry Ford Health System. The study was limited to black and white patients because all other

Results

The sample consisted of 470 women (41%), 685 men (59%), 462 blacks (40%), and 693 whites (60%). The distribution of selected sociodemographic, smoking, clinicopathologic, and treatment variables, stratified by gender and race/ethnicity, are presented in Table 1. The mean age of subjects was 67.2 years, and age did not differ significantly by gender and race/ethnicity. SES was considerably lower in blacks than in whites (BGMHI, $19,903 vs $38,812; p = 0.0001). Being without a spouse was

Discussion

Current smoking at diagnosis increased the hazard of dying by approximately one third compared to former/never smokers, and this effect was observed in different age, gender, race/ethnic, histologic, and stage groups. Patients with lung cancer who were current smokers at diagnosis were more likely to have numerous negative prognostic factors. However, adjusted for important sociodemographic, exposure, clinicopathologic, comorbidity, and treatment factors, current smoking remained a significant

ACKNOWLEDGMENT

We thank Drs. Joseph L. Lewis and Mei Lu for their reviews of the manuscript, and medical students Ginja B. Massey and Mandira Ray for assistance in abstracting data.

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