Session: MP54: Health Services Research: Practice Patterns, Quality of Life and Shared Decision Making III
MP54-06: Effect of Smoking on Prostate Cancer Survivors' Function and Quality of Life: An analysis of the CEASAR (Comparative Effectiveness Analysis of Surgery and Radiation) study
Introduction: Tobacco smoking negatively impacts cancer treatment and prognoses. However, there is limited evidence of its effect on cancer survivors' quality of life (QOL) and function. As the natural history of localized prostate cancer (PCa) is protracted, there is a need to identify modifiable risk factors that can influence survivorship, such as tobacco smoking. Methods: We used 5-year data from the CEASAR (Comparative Effectiveness Analysis of Surgery and Radiation) study, a prospective, population-based, observational study of men diagnosed with localized PCa in 2011-2012. We excluded patients that did not complete the smoking-related and baseline questions and those that did not have at least one post-baseline response. Survivors were categorized as never, former, and current smokers. Multivariable linear regression models adjusting for baseline quality of life and function, treatment type, patient characteristics, and disease characteristics were used to assess the association between smoking history and 5-year scores on the 26-Item Expanded Prostate Index Composite (EPIC-26; PCa-specific domains: sexual, urinary incontinence, urinary irritative, bowel, and hormonal) and the Medical Outcomes Study 36-Item Short Form Survey (SF-36; general-health domains: physical, emotional, and energy and fatigue). Results: We included 2185 men of which 109 (5%) were current smokers, 925 (42%) former smokers, and 1151 (53%) never smokers. In unadjusted analyses, current smokers had worse scores on all domains of EPIC-26 and SF-36 compared to never smokers (p < 0.05). In adjusted analyses, there was no association between smoking history with EPIC-26 domains (all p>0.05). With regards to SF-36 outcomes, in adjusted analyses, compared to never smokers, current smokers had worse physical function (-7.53, 95%CI -11.16 to -3.89, p<0.01), emotional well-being (-5.03, 95%CI -7.78 to -2.27, p<0.01), and energy and fatigue (-4.51, 95%CI -7.73 to -1.28, p<0.01). Compared to never smokers, former smokers were only found to have worse physical function (-2.46, 95%CI -4.10 to -0.82, p<0.01). There was no interaction between smoking history and treatment (p>0.05). These findings were robust to more lenient definitions of smoking. Conclusions: PCa survivors that continue to smoke experience worse PCa-specific functional outcomes and physical functioning compared to never smokers. After adjustments, active smoking was associated with clinically relevant worse physical functioning. Tobacco smoking cessation in PCa survivors can enhance QOL and function regardless of initial treatment and should be integrated into survivorship care. SOURCE OF Funding: None
