Cancer Research and Treatment

Original Articles

Factors Associated with Smoking Cessation of Participants in the National Lung Cancer Screening Program in Korea: Na-Young Yoon, Minji Seo, Nayoung Lee, Yeol Kim; Received July 16, 2024 Accepted January 10, 2025 Published online January 10, 2025; DOI: https://doi.org/10.4143/crt.2024.653 [Accepted]

Abstract PDF: Purpose
Smoking cessation interventions for participants in lung cancer screening are essential for increasing the effectiveness of screening to reduce lung cancer mortality. This study aimed to investigate the factors that lead to smoking cessation after lung cancer screening.
Materials and Methods
The Korean National Lung Cancer Screening (KNLCS) Satisfaction Survey was conducted from 2021 to 2022 with 1,000 samples per year among participants in KNLCS targets 30 or more pack-year smokers. Factors associated with smoking cessation were analyzed based on the survey.
Results
Among 1,525 current smokers in the survey participants, 728 (47.7%) received screening result counseling from physician after screening and showed significantly higher smoking cessation rate than non-counselling participants [OR 2.17, 95% CI 1.27–3.70]. The participants who considered the counseling helpful were more likely to quit smoking [OR 3.53, 95% CI 2.00–6.22] and to reduce smoking amount [OR 2.05, 95% CI 1.54–2.71]. Similarly, those who received physicians’ active recommendations to quit smoking were likely to quit smoking [OR 2.20, 95% CI 1.25–3.87] and to decrease smoking amount [OR 1.30, 95% CI 1.00-1.68]. In contrast, participants who had no abnormal findings from screening tended to have no significant change in smoking status despite the physicians’ active recommendations to quit smoking.
Conclusion
Physicians’ active recommendations and effective counseling to quit smoking could be a key factor in increasing smoking cessation among lung cancer screening participants. Further research should be conducted to develop more effective strategies for smoking cessation to participants without abnormal findings in lung cancer screening.

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Lung and Thoracic cancer

Strategies to Improve Smoking Cessation for Participants in Lung Cancer Screening Program: Analysis of Factors Associated with Smoking Cessation in Korean Lung Cancer Screening Project (K-LUCAS): Yeol Kim, Jaeho Lee, Eunju Lee, Juntae Lim, Yonghyun Kim, Choon-Taek Lee, Seung Hun Jang, Yu-Jin Paek, Won-Chul Lee, Chan Wha Lee, Hyae Young Kim, Jin Mo Goo, Kui Son Choi, Boyoung Park, Duk Hyoung Lee, Hong Gwan Seo; Cancer Res Treat. 2024;56(1):92-103. Published online August 7, 2023; DOI: https://doi.org/10.4143/crt.2022.1598

Abstract PDF PubReader ePub

Purpose
Smoking cessation intervention is one of the key components of successful lung cancer screening program. We investigated the effectiveness and related factors of smoking cessation services provided to the participants in a population-based lung cancer screening trial.
Materials and Methods
The Korean Lung Cancer Screening Project (K-LUCAS) is a nationwide, multi-center lung cancer screening trial that evaluates the feasibility of implementing population-based lung cancer screening. All 5,144 current smokers who participated in the K-LUCAS received a mandatory smoking cessation counseling. Changes in smoking status were followed up using a telephone survey in 6 months after lung cancer screening participation. The lung cancer screening’s impact on smoking cessation is analyzed by variations in the smoking cessation interventions provided in screening units.
Results
Among 4,136 survey responders, participant’s motivation to quit smoking increased by 9.4% on average after lung cancer screening. After 6 months from the initial screening, 24.3% of participants stopped smoking, and 10.6% of participants had not smoked continuously for at least 6 months after screening. Over 80% of quitters stated that participation in lung cancer screening motivated them to quit smoking. Low-cost public smoking cessation program combined with lung cancer screening increased the abstinence rates. The smokers were three times more likely to quit smoking when the smoking cessation counseling was provided simultaneously with low-dose computed tomography screening results than when provided separately.
Conclusion
A mandatory smoking cessation intervention integrated with screening result counselling by a physician after participation in lung cancer screening could be effective for increasing smoking cessation attempts.

Citations

Citations to this article as recorded by

p53 Genetics and Biology in Lung Carcinomas: Insights, Implications and Clinical Applications
Dixan A. Benitez, Guadalupe Cumplido-Laso, Marcos Olivera-Gómez, Nuria Del Valle-Del Pino, Alba Díaz-Pizarro, Sonia Mulero-Navarro, Angel Román-García, Jose Maria Carvajal-Gonzalez
Biomedicines.2024; 12(7): 1453. CrossRef
Problems and Alternatives for Korea National Lung Cancer Screening Program for Smoking Cessation: Analysis of a Survey Involving Experts
Cheol Min Lee, Sil Vi Han Park, Jinri Kim, Bumjo Oh, Kiheon Lee, Yeol Kim, Yu-Jin Paek
Journal of the Korean Society for Research on Nicotine and Tobacco.2024; 15(2): 49. CrossRef
The pros and cons of lung cancer screening
Roberta Eufrasia Ledda, Georg-Christian Funk, Nicola Sverzellati
European Radiology.2024; 35(1): 267. CrossRef
Effective Smoking Cessation Counseling for Participants in a Lung Cancer Screening
Choon-Young Kim, Yeol Kim, Cheol Min Lee
Journal of the Korean Society for Research on Nicotine and Tobacco.2024; 15(3): 88. CrossRef

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General

Longitudinal Changes in Smoking Behaviors and Cancer-Related Mortality Risk in Middle-Aged Korean Women: Thi Xuan Mai Tran, Soyeoun Kim, Seonju Kim, Boyoung Park; Cancer Res Treat. 2024;56(1):18-26. Published online August 2, 2023; DOI: https://doi.org/10.4143/crt.2023.341

Abstract PDF PubReader ePub: Purpose
This study investigated association between smoking habit change and cancer-related mortality risk in Korean women.
Materials and Methods
Study population were women aged ≥ 40 years who underwent two biennial cancer screenings during 2009-2012 and were followed up until 2020. Participants were grouped into sustained nonsmokers, sustained quitters, new quitters, relapsers/smoking initiators, and sustained smokers. Outcomes included all-cause and cancer-related deaths. Cox regression and competing risk analysis was used to assess association between smoking habit change and mortality risk.
Results
Of 2,892,590 women, 54,443 death cases were recorded (median follow-up of 9.0 years). Compared with sustained nonsmokers, mortality risk from all causes and cancer-related causes increased in all other smoking groups. Cancer-related risk increased 1.22-fold among sustained quitters (95% confidence interval [CI], 1.10 to 1.36), 1.56-fold (95% CI, 1.40 to 1.75) in new quitters, 1.40-fold (95% CI, 1.21 to 1.62) in relapsers/smoking initiators, and 1.61-fold (95% CI, 1.46 to 1.78) in sustained smokers compared with sustained nonsmokers. Women who were sustained smokers with higher smoking intensity had a higher mortality risk in terms of hazard ratios compared to nonsmokers (< 5 pack-years 2.12-fold, 5-10 pack-years 2.15-fold, and > 10 pack-years 2.27-fold).
Conclusion
Quitting smoking earlier is critical for preventing death from all causes and cancer among female smokers.

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Prevalence and Predictors of Sustained Smoking after a Cancer Diagnosis in Korean Men: Hye Yeon Koo, Kiheon Lee, Sang Min Park, Jooyoung Chang, Kyuwoong Kim, Seulggie Choi, Mi Hee Cho, Jihye Jun, Sung Min Kim; Cancer Res Treat. 2020;52(1):139-148. Published online June 25, 2019; DOI: https://doi.org/10.4143/crt.2018.609

Abstract PDF PubReader ePub

Purpose
Although smoking has a significant impact on mortality and morbidity of cancer patients, many patients continue to smoke post-diagnosis. The purpose of this study was to investigate prevalence and predictors of sustained smoking among male cancer survivors.
Materials and Methods
The Korean National Health Insurance Service-National Health Screening Cohort database was used for this population-based, retrospective study. Study subjects were 15,141 men who were diagnosed with their first incident cancer between 2004 and 2011. Changes in smoking status before and after a cancer diagnosis were investigated. For patients who were current smokers pre-diagnosis, association between post-diagnosis sustained smoking and demographic, socioeconomic, and clinical variables were examined.
Results
Of the 4,657 pre-diagnosis smokers, 2,255 (48%) had quit after cancer diagnosis, while 2,402 (51.6%) continued to smoke. In a multivariate logistic regression analysis, younger age at cancer diagnosis (adjusted odds ratio [aOR], 1.37; 95% confidence interval [CI], 1.21 to 1.55; p < 0.001), low socioeconomic status (aOR, 1.29; 95% CI, 1.15 to 1.45; p ≤ 0.001), pre-diagnosis heavy smoking (aOR, 1.24; 95% CI, 1.09 to 1.41; p=0.001), diagnosis of non-smoking– related cancer (aOR, 1.67; 95% CI, 1.42 to 1.96; p < 0.001), and high serum glucose level (aOR, 1.23; 95% CI, 1.03 to 1.46; p=0.019) were associated with sustained smoking after a cancer diagnosis.
Conclusion
Almost half of the male smokers continue to smoke after a cancer diagnosis. Targeted interventions for smoking cessation should be considered for patients with younger age, low socioeconomic status, heavy smoking history, non-smoking–related cancer, and high blood glucose levels.

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Zilong Bian, Rongqi Zhang, Shuai Yuan, Rong Fan, Lijuan Wang, Susanna C. Larsson, Evropi Theodoratou, Yimin Zhu, Shouling Wu, Yuan Ding, Xue Li
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Smoking Cessation Support: A Marathon, Not a Sprint; The Perspectives of Cancer Patients Who Smoke
Patricia Fox, Nancy Bhardwaj, Ailsa Lyons, Vikram Niranjan, Kate Frazer, Shiraz Syed, Amanda McCann, Sinead Brennan, Donal Brennan, Catherine Kelly, Michael Keane, Patricia Fitzpatrick
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Feras I. Hawari, Minas A. Abu Alhalawa, Rasha H. Alshrideh, Ahmad M. Al Nawaiseh, Alia Khamis, Yasmeen I. Dodin, Nour A. Obeidat
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Effect of Smoking Cessation and Reduction on the Risk of Cancer in Korean Men: A Population Based Study: Seulggie Choi, Jooyoung Chang, Kyuwoong Kim, Sang Min Park, Kiheon Lee; Cancer Res Treat. 2018;50(4):1114-1120. Published online November 24, 2017; DOI: https://doi.org/10.4143/crt.2017.326

Abstract PDF Supplementary Material PubReader ePub

Purpose
The purpose of this study was to investigate the effect of smoking habit change on the risk of cancer.
Materials and Methods
From the Korean National Health Insurance Service database, we determined the change in smoking habit between the first (2002 and 2003) and second (2004 and 2005) health examination periods. A total of 143,071 men were categorized into baseline heavy (≥ 20 cigarettes per day), moderate (10-19 cigarettes per day), light (< 10 cigarettes per day) smokers, quitters, and never smokers, after which the change in smoking status was determined during the second health examination. The participants were then followed up from 2006 to 2013 for all cancer, smoking related cancer, and lung cancer.
Results
Compared to heavy continual smokers, heavy smokers who quit had reduced risk of smoking related cancer (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.56 to 0.97) and tended to have reduced risk of all cancer (HR, 0.87; 95% CI, 0.75 to 1.00). Moderate smokers who reduced the amount of smoking to light levels had decreased risk of all cancer (HR, 0.82; 95% CI, 0.72 to 0.94), smoking related cancer (HR, 0.74; 95% CI, 0.59 to 0.93), and lung cancer (HR, 0.55; 95% CI, 0.38 to 0.79) compared to heavy continual smokers.
Conclusion
Smoking reduction decreases the risk of all cancer, smoking related cancer, and lung cancer. While smoking cessation should be the treatment of choice for smokers, smoking reduction may serve as an alternative strategy for those who cannot quit.

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