PLYMOUTH MEETING, PA — New research published online in JNCCN—Journal of the National Comprehensive Cancer Network finds that people with cancer who quit smoking had a much lower risk of dying within two years compared to those who kept smoking. Researchers followed 13,282 individuals with cancer, tracking whether they quit in the first six months after being seen in clinic. The survival benefit was seen across all cancer types and stages, including stages III and IV. Despite these benefits, only about 1 in 5 smokers quit within six months of their visit.
The analysis was conducted within the Cancer Center Cessation Initiative (C3I), part of the NCI Cancer Moonshot program, which implemented ELEVATE, an electronic health record–based tool that streamlines assessing smoking status and delivering quit support. Of patients studied, 13% self-identified as current smokers; 22.1% of them quit within six months. Those who continued smoking had a 97% higher risk of death within two years than those who quit.
“Lifestyle change such as quitting smoking can prolong survival even more than some chemotherapies. Our research reinforces the idea that smoking cessation should be considered the fourth pillar of cancer care—alongside surgery, radiation therapy, and chemo/immunotherapy,” said lead author Steven Tohmasi, MD, MPHS, Siteman Cancer Center, based at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis. “Future cancer care must treat smoking cessation not as an optional extra, but as a core part of the treatment plan. By doing so, we can maximize survival, improve quality of life, and truly deliver comprehensive oncology care.”
“It is never too late, and no one is ever ‘too sick’ to quit smoking,” added senior author Li-Shiun Chen, MD, MPH, ScD, Siteman Cancer Center, based at Barnes-Jewish Hospital and WashU Medicine. “Our study found that individuals with cancer who stop smoking after their diagnosis live significantly longer than those who continue smoking, even when their cancer is at an advanced stage. This data argues for an important paradigm shift to routinely include tobacco treatment as part of care in order to extend survival and improve outcomes for all people with cancer.”
The researchers pointed to free NCCN resources to guide clinician–patient conversations about cessation. Dr. Tohmasi said: “The NCCN Guidelines for Smoking Cessation provide a trusted, evidence-based framework for delivering these interventions consistently across all cancer types and stages. They translate research into clear clinical steps, from assessing readiness to quit, to recommending effective medications, to offering behavioral counseling. Aligning practice with these guidelines not only standardizes care across providers but also ensures that each patient receives the most effective, science-backed treatment available. The NCCN Guidelines for Patients: Quitting Smoking further reinforce these efforts by giving patients accessible, easy-to-understand materials that can motivate and guide them between clinic visits.”
Commenting on the study, James M. Davis, MD, Associate Professor of Medicine and Medical Director for the Duke Center for Smoking Cessation, Duke Cancer Institute—an NCCN Guidelines® Smoking Cessation Panel member who was not involved with the research—said: “Several things impressed me about this study—patients who quit smoking after their cancer diagnosis showed a two-fold lower rate of all-cause mortality. That is a huge effect. Because this is an observational study, we need to be careful about inferring causality—we can’t say with confidence that smoking cessation saved all of these people’s lives. We can say however, that in the context of what we already know about smoking and cancer, this study suggests a profound impact of smoking cessation before and after a person develops cancer.”
The full study, “Smoking Cessation and Mortality Risk in Cancer Survivorship: Real-World Data From a National Cancer Institute–Designated Cancer Center,” is available at JNCCN.org.
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