Smoking cessation interventions for people with lung cancer

Background

Lung cancer is the most common cause of death from cancer worldwide. Tobacco smoking constitutes the most important risk factor for lung cancer. Most people with lung cancer are still active smokers at diagnosis or frequently relapse (restart) after smoking cessation. Quitting smoking is the most effective way for smokers to reduce the risk of premature death and disability. Smoking cessation interventions can be divided into psychosocial interventions (methods that do not use medicines, such as advice and counselling) and pharmacological (medicines, such as nicotine patched) interventions. Behavioural (methods that change a person's behaviour) and pharmacological treatments are believed to have complementary methods of working, and to improve the chances of maintaining long-term abstinence independently. Quitting smoking after a diagnosis of lung cancer might be associated with decreased mortality (death), postoperative complications, recurrence and incidence of second primary lung cancer, and a greater treatment effectiveness and quality of life. Tobacco smoking cessation interventions play an important role in the management of people with cancer. Current and former smokers, especially people with lung cancer, should be encouraged to quit smoking. However, the effects of any type of smoking cessation programme for people with lung cancer are unclear.

Review question

We aimed to determine the effectiveness of any type of smoking cessation programme for people with lung cancer.

Key results

We searched medical databases to 22 December 2018 and other websites to 30 December 2018. We found no randomised controlled trials (clinical studies where people are randomly put into one of two or more treatment groups) for inclusion. We found four ongoing trials for inclusion when data become available. As of today, we are unable to conclude whether smoking cessation interventions are effective for people with lung cancer and whether one method is more effective than any other. People with lung cancer should be encouraged to quit smoking and offered help with smoking cessation, but we cannot recommend any type of smoking cessation intervention for people with lung cancer. High-quality randomised controlled trials are needed to answer this question.

Quality of evidence

No trials met our inclusion criteria, so there was no good-quality evidence.

Authors' conclusions: 

There were no RCTs that determined the effectiveness of any type of smoking cessation programme for people with lung cancer. There was insufficient evidence to determine whether smoking cessation interventions are effective for people with lung cancer and whether one programme is more effective than any other. People with lung cancer should be encouraged to quit smoking and offered smoking cessation interventions. However, due to the lack of RCTs, the efficacy of smoking cessation interventions for people with lung cancer cannot be evaluated and concluded. This systematic review identified a need for RCTs to explore these.

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Background: 

Lung cancer is one of the most common causes of death from cancer worldwide. Smoking induces and aggravates many health problems, including vascular diseases, respiratory illnesses and cancers. Tobacco smoking constitutes the most important risk factor for lung cancer. Most people with lung cancer are still active smokers at diagnosis or frequently relapse after smoking cessation. Quitting smoking is the most effective way for smokers to reduce the risk of premature death and disability. People with lung cancer may benefit from stopping smoking. Whether smoking cessation interventions are effective for people with lung cancer and whether one method of quitting is more effective than any other has not been systematically reviewed.

Objectives: 

To determine the effectiveness of smoking cessation programmes for people with lung cancer.

Search strategy: 

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (accessed via PubMed) and Embase up to 22 December 2018. We also searched the American Society of Clinical Oncology (ASCO) Annual Meeting proceedings, the lung cancer sections of the proceedings of the ESMO Congress, the lung cancer sections of the proceedings of the European Conference of Clinical Oncology (ECCO) Congress, the World Conference on Lung Cancer proceedings, the Society for Research on Nicotine and Tobacco Annual Meeting from 2013, the Food and Drug Administration website, the European Medicine Agency for drug registration website, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal, ClinicalTrials.gov, and the metaRegister of Controlled Trials (mRCT) to 30 December 2018. We applied no restriction on language of publication.

Selection criteria: 

We planned to include any randomised controlled trial (RCT) of any psychosocial or pharmacological smoking cessation intervention or combinations of both, compared with no intervention, a different psychosocial or pharmacological (or both) intervention or placebo for pharmacological interventions in people with lung cancer.

Data collection and analysis: 

Two review authors independently screened the studies from the initial search for potential trials for inclusion. We planned to use standard methodological procedures expected by Cochrane. We found no trials that met the inclusion criteria.

Main results: 

We identified no RCTs that met our inclusion criteria. Among the 1817 records retrieved using our search strategy, we retrieved 19 studies for further investigation. We excluded 15 trials: ten trials because we could not distinguish people with lung cancer from the other participants, or the participants were not people with lung cancer, four because they were not randomised, or RCTs. We excluded one trial because, though it was completed in 2004, no results are available. We assessed four ongoing trials for inclusion when data become available.

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