Cancer Research and Treatment

Original Articles

Effect of Smoking Cessation Duration on Lung Cancer Incidence: A Nationwide Retrospective Cohort Study in Korea: Myeong Geun Choi, Min-Ho Kim, Hong Jin Kim, Eun Mi Chun; Received October 10, 2025 Accepted February 25, 2026 Published online February 26, 2026; DOI: https://doi.org/10.4143/crt.2025.1099 [Accepted]

Abstract PDF: Purpose
While smoking cessation is known to reduce lung cancer risk, the extent to which smoking cessation duration mitigates lung cancer risk remains unclear. This study aimed to analyze the association between smoking cessation duration and the reduction in lung cancer incidence using large-scale health insurance data from Korea.
Materials and Methods
In this retrospective cohort study, we utilized the cohort from the Korea National Health Insurance Corporation. Approximately 50% of the adults aged ≥50 years who underwent health examinations in 2009–2013 were randomly sampled and followed using medical and health examination records. The participants were classified into three groups: never-smokers, former smokers, and current smokers, and the incidence rates of lung cancer were compared among these groups.
Results
We analyzed 165,512 individuals selected through propensity score matching (82,756 never-smokers, 41,378 former smokers, and 41,378 current smokers). Lung cancer risk significantly decreased after two years of smoking cessation (2–3 years after cessation: hazard ratio 0.760, p<0.001) but remained higher than that of never-smokers for up to 10 years. Subgroup analyses revealed similar tendencies among males, whereas no consistent patterns were observed among females. Moreover, a longer duration of smoking cessation was generally required for heavy smokers (≥20 pack-years) than for light smokers (<20 pack-years).
Conclusion
This nationwide cohort study highlights the significant impact of smoking cessation duration on lung cancer risk, emphasizing the substantial benefits of even short-term cessation regardless of prior smoking history.

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Gastrointestinal cancer

Daily Vigorous Intensity Physical Activity and Its Preventive Effect on Pancreatic Cancer: Sung Keun Park, Ju Young Jung, Chang-Mo Oh, Min-Ho Kim, Eunhee Ha, Yeji Kim, Do Jin Nam, Jae-Hong Ryoo; Cancer Res Treat. 2022;54(3):873-881. Published online September 27, 2021; DOI: https://doi.org/10.4143/crt.2021.400

Abstract PDF Supplementary Material PubReader ePub

Purpose
There has been accumulating evidence for the preventive effect of high physical activity on cancer. However, it is still unclear which level of physical activity is associated with the decreased risk of pancreatic cancer. The purpose of current study is to assess the association between the frequency of vigorous intensity physical activity and the risk of pancreatic cancer.
Materials and Methods
The nationwide retrospective cohort study was conducted using the National Health Information Database. Study participants were 220,357 Koreans who received health check-up in 2009. They were divided into four groups by the weekly frequency of vigorous intensity physical activity longer than 20 minutes (group 1, no vigorous intensity physical activity (reference); group 2, 1-3 days; group 3, 4-5 days and group 4, 6-7 days). Cox proportional hazard model was used to calculate the adjusted hazard ratios (HRs) and 95% confidence interval (CI) for incident pancreatic cancer (adjusted HRs [95% CI]) according to the weekly frequency of vigorous intensity physical activity.
Results
For 4.38 years’ follow-up on average, 377 cases of pancreatic cancer developed. Subjects without incident pancreatic cancer had more favorable metabolic condition and higher physical activity than subjects with incident pancreatic cancer. Adjusted HRs and 95% CI indicated that only group 4 was significantly associated with the decreased risk of pancreatic cancer (group 1, reference; group 2, 1.10 [0.86-1.40]; group 3, 0.75 [0.45-1.25] and group 4, 0.47 [0.25-0.89]).
Conclusion
In this nationwide representative cohort study, near daily vigorous intensity physical activity showed the preventive effect on pancreatic cancer.

Citations

Citations to this article as recorded by

Physical activity, sedentary behaviour, and exocrine and endocrine pancreatic diseases: results from a prospective cohort study and Mendelian randomization
Tianyi Che, Zhipeng Wu, Shenglan You, Xixian Ruan, Lintao Dan, Yao Zhang, Susanna C Larsson, Xiaoyan Wang, Jie Chen, Chunhua Zhou
Gastroenterology Report.2026;[Epub] CrossRef
The effect of vigorous physical activity on the incidence of kidney cancer
Lawrence H. Kim, Albert Bang, Daniel A. Galvao, David P. Smith, Manish I. Patel
Cancer Epidemiology.2026; 102: 103089. CrossRef
Physical Activity and Cancer Incidence and Mortality: Current Evidence and Biological Mechanisms
Joanna Kruk, Basil Hassan Aboul-Enein, Marta Ewelina Gołębiewska, Ewa Duchnik, Urszula Czerniak, Mariola Marchlewicz
Cancers.2025; 17(9): 1410. CrossRef
Lifestyle‐Related Risk Factors for Pancreatic Ductal Adenocarcinoma: A Longitudinal Analysis of 1,120,377 Individuals From the NHISS Cohort
Hyunseok Jee
Cancer Medicine.2025;[Epub] CrossRef
Association between waist circumference change after smoking cessation and incidence of hypertension in Korean adults
H.J. Lee, J.W. Choi
Public Health.2024; 229: 73. CrossRef
Physical Activity Decreases Inflammation and Delays the Development of Obesity-Associated Pancreatic Ductal Adenocarcinoma
Valentina Pita-Grisanti, Ericka Velez-Bonet, Kaylin Chasser, Zachary Hurst, Alexus Liette, Grace Vulic, Kelly Dubay, Ali Lahooti, Niharika Badi, Olivia Ueltschi, Kristyn Gumpper-Fedus, Hsiang-Yin Hsueh, Ila Lahooti, Myrriah Chavez-Tomar, Samantha Terhorst
Cancer Research.2024; 84(18): 3058. CrossRef
The role of exercise in obesity-related cancers: Current evidence and biological mechanisms
Elisabeth A. Larson, Maria Dalamaga, Faidon Magkos
Seminars in Cancer Biology.2023; 91: 16. CrossRef
Effect of physical activity on incidence and mortality in patients with gastric cancer: evidence from real-world studies
Shaodi Ma, Haixia Liu, Chenyu Sun, Muzi Meng, Guangbo Qu, Yuemeng Jiang, Birong Wu, Juan Gao, Linya Feng, Peng Xie, Weihang Xia, Yehuan Sun
Cancer Causes & Control.2023; 34(12): 1095. CrossRef
Integrated procedures for accelerating, deepening, and leading genetic inquiry: A first application on human muscle secretome
Danilo Bondi, Michele Bevere, Rosanna Piccirillo, Guglielmo Sorci, Valentina Di Felice, Andrea David Re Cecconi, Daniela D'Amico, Tiziana Pietrangelo, Stefania Fulle
Molecular Genetics and Metabolism.2023; 140(3): 107705. CrossRef

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Feasibility Study of Physician Orders for Life-Sustaining Treatment for Patients with Terminal Cancer: Ho Jung An, Hyun Jeong Jeon, Sang Hoon Chun, Hyun Ae Jung, Hee Kyung Ahn, Kyung Hee Lee, Min-ho Kim, Ju Hee Kim, Jaekyung Cheon, JinShil Kim, Su-Jin Koh; Cancer Res Treat. 2019;51(4):1632-1638. Published online April 18, 2019; DOI: https://doi.org/10.4143/crt.2019.009

Abstract PDF PubReader ePub

Purpose
Physician Orders for Life-Sustaining Treatment (POLST) form is a legal document for terminally ill patients to make medical decisions with physicians near the end-of-life. A multicenter prospective study was conducted to evaluate the feasibility of POLST administration in actual oncological practice.
Materials and Methods
Patients with terminal cancer, age ≥ 20 years, and capable of communicating were eligible. The primary endpoint was the completion rate of POLST. Data about physicians’ or patients’ barriers were also collected.
Results
From June to December 2017, 336 patients from seven hospitals were eligible. Median patient age was 66 years (range, 20 to 94 years); 52.7% were male; and 60.4% had poor performance status. Primary cancer sites were hepato-pancreato-biliary (26.2%), lung (23.2%), and gastrointestinal (19.9%). Expected survival duration was 10.6±7.3 weeks, with 41.2% receiving hospice care, 37.9% showing progression after cancer treatment, and the remaining patients were under active treatment (15.8%) or initially diagnosed with terminal cancer (5.1%). POLST forms were introduced to 60.1% of patients, and 31.3% signed the form. Physicians’ barriers were reluctance of family (49.7%), lack of rapport (44.8%), patients’ denial of prognosis (34.3%), lack of time (22.7%), guilty feelings (21.5%), and uncertainty about either prognosis (21.0%) or the right time to discuss POLST (16.6%). The patients’ barriers were the lack of knowledge/understanding of POLST (65.1%), emotional discomfort (63.5%), difficulty in decision-making (66.7%), or denial of prognosis (14.3%).
Conclusion
One-third of patients completed POLST forms, and various barriers were identified. To overcome such barriers, social engagement, education, and systematic support might be necessary.

Citations

Citations to this article as recorded by

Characteristics of Life-Sustaining Treatment Decisions: National Data Analysis in South Korea
Jiyeon Choi, Heejung Jeon, Ilhak Lee
Asian Bioethics Review.2024; 16(1): 33. CrossRef
An Integrative Review of the State of POLST Science: What Do We Know and Where Do We Go?
Elizabeth E. Umberfield, Matthew C. Fields, Rachel Lenko, Teryn P. Morgan, Elissa Schuler Adair, Erik K. Fromme, Hillary D. Lum, Alvin H. Moss, Neil S. Wenger, Rebecca L. Sudore, Susan E. Hickman
Journal of the American Medical Directors Association.2024; 25(4): 557. CrossRef
Experience and perspectives of end-of-life care discussion and physician orders for life-sustaining treatment of Korea (POLST-K): a cross-sectional study
Hyeon-Su Im, Insook Lee, Shinmi Kim, Jong Soo Lee, Ju-Hee Kim, Jae Young Moon, Byung Kyu Park, Kyung Hee Lee, Myung Ah Lee, Sanghoon Han, Yoonki Hong, Hyeyeoung Kim, Jaekyung Cheon, Su-Jin Koh
BMC Medical Ethics.2023;[Epub] CrossRef
Problems Related to the Act on Decisions on Life-Sustaining Treatment and Directions for Improvement
Dae Seog Heo, Shin Hye Yoo, Bhumsuk Keam, Sang Ho Yoo, Younsuck Koh
The Korean Journal of Hospice and Palliative Care.2022; 25(1): 1. CrossRef
Discussing POLST-facilitated hospice care enrollment in patients with terminal cancer
Ho Jung An, Hyun Jeong Jeon, Sang Hoon Chun, Hyun Ae Jung, Hee Kyung Ahn, Kyung Hee Lee, Min-ho Kim, Ju Hee Kim, Jaekyung Cheon, Su-Jin Koh
Supportive Care in Cancer.2022; 30(9): 7431. CrossRef
The Medical Orders for Scope of Treatment (MOST) form completion: a retrospective study
Anastasia A. Mallidou, Coby Tschanz, Elisabeth Antifeau, Kyoung Young Lee, Jenipher Kayuni Mtambo, Holly Heckl
BMC Health Services Research.2022;[Epub] CrossRef
Recommended summary plan for emergency care and treatment: ReSPECT a mixed-methods study
Gavin D Perkins, Claire A Hawkes, Karin Eli, James Griffin, Claire Jacques, Caroline J Huxley, Keith Couper, Cynthia Ochieng, Jonathan Fuld, Zoe Fritz, Rob George, Doug Gould, Richard Lilford, Martin Underwood, Catherine Baldock, Chris Bassford, Peter-Mar
Health and Social Care Delivery Research.2022; 10(40): 1. CrossRef
Emergency Healthcare Providers’ Knowledge about and Attitudes toward Advance Directives: A Cross-Sectional Study between Nurses and Emergency Medical Technicians at an Emergency Department
Sun Woo Hong, Shinmi Kim, Yu Jin Yun, Hyun Sook Jung, JaeLan Shim, JinShil Kim
International Journal of Environmental Research and Public Health.2021; 18(3): 1158. CrossRef
Difficulties Doctors Experience during Life-Sustaining Treatment Discussion after Enactment of the Life-Sustaining Treatment Decisions Act: A Cross-Sectional Study
Shin Hye Yoo, Wonho Choi, Yejin Kim, Min Sun Kim, Hye Yoon Park, Bhumsuk Keam, Dae Seog Heo
Cancer Research and Treatment.2021; 53(2): 584. CrossRef
We Want More Than Life-Sustaining Treatment during End-of-Life Care: Focus-Group Interviews
Mirinae Kim, Minju Kim
International Journal of Environmental Research and Public Health.2021; 18(9): 4415. CrossRef
Changes in decision-making process for life-sustaining treatment in patients with advanced cancer after the life-sustaining treatment decisions-making act
Hyeyeong Kim, Hyeon-Su Im, Kyong Og Lee, Young Joo Min, Jae-Cheol Jo, Yunsuk Choi, Yoo Jin Lee, Daseul Kang, Changyoung Kim, Su-Jin Koh, Jaekyung Cheon
BMC Palliative Care.2021;[Epub] CrossRef
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Palliative Medicine.2021; 35(10): 1776. CrossRef
Life-Sustaining Treatment States in Korean Cancer Patients after Enforcement of Act on Decisions on Life-Sustaining Treatment for Patients at the End of Life
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Cancer Research and Treatment.2021; 53(4): 908. CrossRef
Advance care planning in Asian culture
Shao-Yi Cheng, Cheng-Pei Lin, Helen Yue-lai Chan, Diah Martina, Masanori Mori, Sun-Hyun Kim, Raymond Ng
Japanese Journal of Clinical Oncology.2020; 50(9): 976. CrossRef
Preference and Performance Fidelity of Modified Korean Physician Order for Life-Sustaining Treatment (MK-POLST) Items in Hospice Patients with Cancer
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The Korean Journal of Hospice and Palliative Care.2019; 22(4): 198. CrossRef

10,952 View
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12 Web of Science
15 Crossref

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