Postoperative Termination of Tobacco Smoke Improves Quality of Life and Lung Capacity in Non-Small Cell Lung Cancer

Objectives: Tobacco smoke is the main risk factor for non-small cell lung cancer (NSCLC) and leads to a reduce lung capacity. A termination of tobacco smoke improves the response to adjuvant chemotherapy and prolongs overall survival. The purpose of this study was to observe if a postoperative termination of tobacco smoke improves the lung capacity and the quality of life in NSCLC patients.

Methods: Between January 2013 and December 2016, 464 patients underwent lobectomy. Postoperatively, we offered our patients a voluntary “smoke free” program to assist in quitting tobacco consumption. One year after the operation we measured the delta-FEV1 (in liters) and the delta-DLCO (in mmol/L/min*Pa) in comparison to the preoperative parameters. The quality of life was assessed one year after the operation by the “SF-36” questionnaire and all patients were tested for freedom of pain. We executed a 2:1 pair matching for age, gender, smoking history, NSCLC stage, and postoperative pain and finally formed two identical study groups. Group A (n = 42): patients who successfully stopped smoking >10 months. Group B (n = 21): patients who continued smoking.

Results: In this study, 70.3% of the 464 patients were active smokers at the time of operation. All relevant baseline characteristics were identical in both groups (p > 0.05). The mean age of all patients was 63.6 ± 11.0 years; 64% of the patients were male. Both groups had identical smoking habits (mean “pack years”: Group A: 49 ± 31; Group B: 47 ± 26; p = 0.61). All patients reported of similar pain control (mean pain on numeric rating scale [1–10]: Group A: 1.4 ± 0.8; Group B: 1.3 ± 0.6; p = 0.74). Both groups showed a reduced FEV1 in comparison to the pre-operative parameters. The FEV1-reduction in the “smoke free” group was significantly less than in the control group (Group A: 90 ± 23%; Group B: 75 ± 12%; p = 0.03). The DLCO values of the “smoke free” group improved significantly in comparison to the preoperative values. The continuation of tobacco smoke lead to a significantly reduced DLCO (Group A: 117 ± 11%; Group B: 80 ± 14%; p < 0.001). The quality of life in Group A was significant better in the following “SF-36” parameters: “vitality” (p = 0.044), “physical role function” (p = 0.028), and “general health perceptions” (p = 0.031).

Conclusion: The quality of life after lobectomy for NSCLC depends on the smoking status. It is significantly better after termination of tobacco smoke which also leads to clear improvement of lung capacity.