Predictors of Smoking Cessation and Relapse in Cancer Patients and Effect on Psychological Variables: an 18-Month Observational Study
Predictors of Smoking Cessation and Relapse in Cancer Patients and Effect on Psychological Variables: an 18-Month Observational Study
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DOI：
10.1007/s12160-016-9834-4
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发表时间：
2017-02-01
影响因子：
3.8
通讯作者：
Savard, Josee
中科院分区：
文献类型：
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作者：
Guimond, Anne-Josee;Croteau, Virginie A.;Savard, Josee
尽管通常强烈建议癌症患者戒烟以提高治疗效果和生存率，但高达 68% 在癌症诊断时吸烟的患者仍在吸烟。抑郁和焦虑等心理因素可能与癌症诊断后的吸烟行为有关，但实证证据很少。这项观察性研究旨在估计戒烟率并评估戒烟对心理症状的影响，以及相同心理变量对癌症手术后戒烟和复吸的预测作用。作为一项更大的前瞻性流行病学研究的一部分，首次诊断为非转移性癌症的吸烟者 (n = 175) 完成了医院的研究焦虑和抑郁量表、失眠严重程度指数和癌症复发恐惧量表。对戒烟者 (n = 55) 和配对的不戒烟者 (n = 55) 在戒烟前、戒烟后和 4 个月随访时的每种症状进行比较。还调查了戒烟和复吸的预测因素，包括心理变量。在研究期间，55 名患者 (31.4%) 至少戒烟过一次。在 55 名戒烟者中，27 名（49.1%）出现了复吸。在戒烟前，戒烟者的焦虑水平 (p = .03) 和对癌症复发的恐惧 (p = .01) 明显高于非戒烟者，在戒烟后和 4 个月后，该亚组患者的症状显着减轻。患有乳腺癌可显着预测戒烟（相对风险 [RR] = 3.08），而抑郁症状是复吸的显着预测因子（RR = 1.07）。这项研究强调了心理症状在预测癌症患者戒烟和复吸方面的重要性。我们的研究结果表明，乳腺癌患者比其他癌症患者更倾向于戒烟，但未来的研究应尝试描绘该亚组的性别和其他人口统计特征对戒烟的影响。这项研究还表明，应特别注意抑郁症状的早期管理，以防止复吸。
Although cancer patients are generally strongly advised to quit smoking in order to improve treatment efficacy and survival, up to 68 % of patients who were smokers at the time of cancer diagnosis continue smoking. Psychological factors such as depression and anxiety are likely to be associated with smoking behavior following a cancer diagnosis, but the empirical evidence is scarce.This observational study aimed at estimating smoking cessation rates and assessing the effect of smoking cessation on psychological symptoms, as well as the predictive role of the same psychological variables on smoking cessation and smoking relapse following cancer surgery.As part of a larger prospective, epidemiological study, smokers (n = 175) with a first diagnosis of nonmetastatic cancer completed the Hospital Anxiety and Depression Scale, the Insomnia Severity Index, and the Fear of Cancer Recurrence Inventory. Quitters (n = 55) and pair-matched nonquitters (n = 55) were compared on each symptom at pre-quitting, post-quitting, and at a 4-month follow-up. Predictors of smoking cessation and smoking relapse, including psychological variables, were also investigated.Fifty-five patients (31.4 %) stopped smoking at least on one occasion during the study. Of the 55 quitters, 27 (49.1 %) experienced a relapse. At pre-quitting, quitters had significantly higher levels of anxiety (p = .03) and fear of cancer recurrence (p = .01) than nonquitters, symptoms that significantly diminished at post-quitting and 4 months later in this subgroup of patients. Having breast cancer significantly predicted smoking cessation (relative risk [RR] = 3.08), while depressive symptoms were a significant predictor of smoking relapse (RR = 1.07).This study highlights the importance of psychological symptoms in predicting tobacco cessation and relapse among individuals with cancer. Our findings suggest that breast cancer patients are more inclined to stop smoking than patients with other cancers, but future studies should attempt to delineate the effect on smoking cessation of gender and other demographics that characterize this subgroup. This study also suggests that a particular attention should be paid to the early management of depressive symptoms in order to prevent smoking relapse.