Jennifer Byrne , 2025-04-29 11:00:00
April 29, 2025
4 min read
Key takeaways:
- Current smoking rates at the time of cancer diagnosis varied by sociodemographic and socioeconomic factors.
- These data could help inform treatment decisions and aid smoking cessation interventions for patients.
Smoking status added to the National Cancer Database for patients diagnosed with cancer in 2023 revealed variations in sociodemographic and socioeconomic factors, according to a research letter in JAMA Oncology.
The availability of this information provides “a critical adjustment opportunity” when caring for these patients, researchers wrote.
“We know that smoking history can change the way tumors behave, so it’s an important thing to know about a patient with cancer,” study author Daniel J. Boffa, MD, MBA, professor and division chief of thoracic surgery and clinical director of the Center for Thoracic Cancers at Yale School of Medicine, told Healio. “It’s important to know which patients are currently smoking and which have smoked in the past, because there are different opportunities to use this information to improve care for these patients.”
‘The conversation is happening’
In a cross-sectional study, certified oncology data specialists captured the smoking status of patients diagnosed with cancer in the United States in 2023 and added this information to the National Cancer Database.
Boffa and colleagues also collected data on race and ethnicity to identify potential sociodemographic differences among patients.
The researchers found that of 1,596,789 patients (mean age, 65.18 years; 55% women) diagnosed with cancer in 2023, smoking status was documented for 1,546,747 (96.8%).
“The first thing our study did was ask whether smoking status information was available on these patients, and whether that was being discussed,” Boffa said. “We looked at hospitals that were accredited by the Commission on Cancer, which is an organization that works in the shadows to make sure hospitals are following best practices in cancer care. We found that in the case of more than 96% of patients being cared for at Commission on Cancer hospitals, the conversation is happening, according to the data.”
Results also showed that 47.3% of patients had a smoking history and 14.7% smoked at the time of diagnosis.
The percentage of patients with smoking history appeared highest among those with lung cancer (84.5%) and lowest among those with thyroid cancer (29.8%).
Never-smoking status at cancer diagnosis was reported in 70.5% of Asian patients, 63.8% of Hispanic patients, 50.4% of Native Hawaiian or Pacific Islander patients, 51.1% of Black patients, 46.7% of white patients and 42.6% of American Indian or Alaska Native patients.
“We do know that there are patients with no smoking history whose cancers develop through other mechanisms, such as genetic mutations or hereditary factors,” Boffa said. “Having this information will allow us to zero in on these patients and learn more about what is best for them specifically.”
Identifying, helping current smokers
Current smoking status also varied by sex, age and race, with 18.9% of Black patients and 15.2% of white patients smoking at diagnosis.
Results also showed variations in current smoking rates by socioeconomic characteristics, with 22.1% of those in the lowest household income quartile smoking vs. 9.7% in the highest quartile.
Boffa said he found it “telling” that approximately 15% of patients smoked at the time of cancer diagnosis.
“For patients with lung cancer, in particular, more than a third were actively smoking at the time of diagnosis,” he said. “That presents an opportunity to support the person in efforts to quit smoking. We know there are tremendous benefits to quitting at any point in your life, and it has real benefits to people with cancer. It can make treatments easier to get through and avoid complications.”
Patients should be aware that smoking at the time of cancer diagnosis can potentially influence cancer outcomes, despite perceptions that efforts to quit are “too late” at this point, Boffa added.
“There is a survival advantage to quitting once you’ve been diagnosed,” he said. “These individuals might think that because they already have cancer, there’s no point in quitting. Being diagnosed with cancer is incredibly stressful, but there is a real opportunity here for us to help patients get through treatment more safely and potentially live longer.”
The need to improve implementation of smoking cessation programs has been noted in previous research.
In 2024, Healio reported on a survey study that identified numerous gaps in the execution of smoking cessation interventions. Researchers found that although there is “near-universal endorsement” of the value of smoking cessation programs in the cancer setting, less than half of respondents reported regularly helping patients quit.
Having detailed information about which patients are more likely to be current smokers at diagnosis enables hospitals to target appropriate patients for smoking cessation interventions, Boffa said. For example, knowing that approximately 34% of patients with lung cancer or head and neck cancer are current smokers at diagnosis could help centers steer resources toward this population, he added.
“There are also geographical differences — in the south, in particular, there is a higher likelihood that patients are actively smoking at the time of diagnosis,” Boffa said. “There are also variations based on whether the person lives in a city vs. a rural community.
“We could match resources to help the most people quit smoking and help them take advantage of the benefits of quitting smoking during treatment,” he added. “It’s difficult, but it’s something patients can do for themselves to potentially live longer and live better.”
For more information:
Daniel J. Boffa, MD, MBA, can be reached at daniel.boffa@yale.edu.
