Impact of Smoking Cessation on Health-Related Quality of Life in Patients With Cancer: A Systematic Review

OBJECTIVES: Smoking cessation (SC) is an important intervention in patients after cancer diagnosis to ensure better health-related quality of life (HRQoL) but often ignored. This systematic review aimed to determine the relationship between SC and HRQoL in patients with cancer.

METHODS: A comprehensive literature search was performed across Medline and Embase databases (database start-May 2022). Studies published in the English language and addressing the impact of SC on HRQoL in people with cancer were included using pre-defined eligibility criteria.

RESULTS: Of the 1200 articles screened, a total of 22 studies were included in the final analysis. Majority of the studies were prospective observational (73%) and conducted in North America (54%) and Europe (32%). Sample size across studies ranged from 63 to 2725 with majority of studies including patients with only lung cancer (41%), lung and head & neck cancers (36%), and mixed cancers (23%).

A total of 15 different scales were used to measure HRQoL in which EORTC-QLQ-C-30 scale was most frequently used in 32% of the studies whereas only study used Smoking Cessation Quality of Life (SCQoL) questionnaire. HRQoL was assessed within 1 year for majority of the observational studies, whereas four studies reported impact on long-term HRQoL (≥2 years of follow-up).

Current-smokers reported significantly lower HRQoL than former-smokers, and never-smokers. Further, longer duration of abstinence was observed to be associated with better QoL. Patients who continued smoking after cancer diagnosis reported significantly higher incidence of depression (p<0.001) and lower QoL in terms of physical well-being (p=0.01) and emotional well-being (p=0.02) in comparison to those who quit smoking.

CONCLUSIONS: Smokers had poor HRQoL as compared to former and never smokers. In view of lack of efforts on smoking cessation interventions after cancer diagnosis, there is a need to include tobacco cessation initiatives in the continuum of cancer care to improve HRQoL.