Quitting smoking may improve HRQoL in advanced lung cancer

By Sarah Guy, medwireNews Reporter

The health-related quality of life (HRQoL) of patients with advanced-stage lung cancer is worsened if they smoke, report UK researchers.

However, the evidence base is relatively weak, remarks the team, suggesting that more longitudinal research in the area is needed, given that survival rates for lung cancer patients are poor and HRQoL is consequently a major consideration.

"With many cancers diagnosed at an advanced stage, HRQoL is highly valued by patients and smoking cessation may be one way in which HRQoL could be improved," say Christine Rowland, from the University of Sheffield, and colleagues in BMJ Supportive and Palliative Care.

They highlight that HRQoL can often indicate patients' well-being more successfully and comprehensively than measures of physical function alone, yet their database search only identified eight studies that addressed smoking and HRQoL in lung cancer patients.

Each study included between 51 and 1019 participants, with an approximately even gender distribution, and a time from patient diagnosis to HRQoL assessment of between 2 weeks and over 5 years.

HRQoL was measured using generic tools (including the Short Form-36) and/or disease-specific measures (including the Functional Assessment of Cancer Therapy-Lung instrument).

Rowland and co-reviewers found no significant difference in HRQoL according to smoker status (current, former, never) in four studies, while overall, patients who smoked the longest tended toward having lower HRQoL than those who had smoked for the shortest period, or never.

Two studies reported significant differences in HRQoL between smoking and nonsmoking groups, with never-smokers having the highest and current smokers the lowest HRQoL values. Patients who quit smoking before their HRQoL assessment had scores more similar to their never-smoking than their smoking counterparts'.

One study showed that the mental health component of HRQoL assessment was significantly lower among patients who continued to smoke than former or never-smokers, while another study reported that smokers had significantly higher pain subscales than their former- or never-smoking peers.

In the single longitudinal study identified, current smokers reported significantly worse HRQoL than former smokers, who reported significantly worse HRQoL than never-smokers both at less than 3 years and at more than 5 years after diagnosis, note Rowland et al.

"It is essential to identify the longer-term consequences of smoking on HRQoL and factors that influence changes in smoking behavior given the implications for planning patient care," they conclude.

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