Introduction: Quitting smoking after cancer diagnosis is associated with better treatment outcomes and improved quality of life. Many cancer patients who smoke decline tobacco treatment, often citing a desire to quit on their own. However, unassisted quit attempts are a well-cited reason for quit failure. This longitudinal mixed-methods study aims to determine the role of modifiable quality of life and psychosocial factors in cancer patients’ desire to quit smoking without assistance. These modifiable factors can inform future interventions to increase tobacco treatment uptake among cancer patients.
Method: The sample was 35 adult cancer patients (69% female, 86% White, non-Hispanic, 57% unemployed due to disability, 54% rural residents, 28% gynecologic cancer) who reported smoking 12.2 ± 7.8 cigarettes per day at baseline. Patients were eligible if they declined tobacco treatment offered at a cancer center due to the desire to quit without assistance. Participants completed two semi-structured interviews and three surveys across 60 days. The sample answered interview questions about how quality of life and psychosocial functioning impact their decision to quit without assistance. Participants responded to the single-item Distress Thermometer (0-10 range) and PROMIS Global Health (10-item) measure. PROMIS domain scores are reported as a T-score, normed to the US population. Higher scores on each measure indicate higher levels of that construct.
Results: Themes that emerged from the interviews included physical health (e.g., pain, fatigue), psychological functioning (e.g., distress, anxiety), social constraint, and practical problems (e.g., finances), all being barriers to tobacco treatment acceptance. Across the 60-day study, distress scores were moderate (5.2 ± 2.5). Average scores on PROMIS Global Health scales were 35.8 (SD 6.8) for physical health, 36.3 (SD 5.9) for mental health.
Conclusions: Cancer patients who smoke experience significant quality of life (e.g., physical health symptoms) and psychosocial functioning (e.g., distress, social constraint) barriers to accepting tobacco treatment when offered at a cancer center. Given the adverse health outcomes associated with persistent smoking post- cancer diagnosis and low success of unassisted quit attempts, interventions to increase uptake of tobacco treatment are sorely needed. These interventions should look to improve quality of life and psychosocial functioning barriers identified in this study.