Smoking Lung Cancer Patients and Tobacco Cessation – Is the Current Treatment in Germany Sufficient?

Abstract

Lung cancer is the most preventable neoplastic disease for men and women. The incidence rate per year is 14.000 in Germany. Smoking is the main risk factor for the onset of lung cancer and for a share of 90 % of cases, lung cancer is associated with smoking. Recent studies have shown that the time slot of diagnosing lung cancer is a teachable moment for tobacco cessation interventions. The therapy that was rated most effective was a combination of cognitive behavioral therapy and pharmacotherapy (e. g. NRT, Bupropion, Varenicline).

We examined the smoking status of all patients undergoing lung cancer surgery in 2011, 2012 and 2013 in this study. A retrospective semi structured interview via telephone was conducted regarding smoking habits and current quality of life. 131 patients (36.6 % female, average age of 68.7 years) of an urban German hospital were included.

Results showed a relapse rate of 22.3 %, while 86.2 % used to be highly addicted smokers; A multivariate analysis of covariance (MANCOVA) indicated a significant overall impact of smoking status on quality of life with a medium effect size, controlled for age, gender, living conditions, tumor stage, duration of smoking abstinence, type of cancer therapy, type of resection method, and the time period between the date of surgery and of the survey. Two thirds of all smokers did not see an association between their habit and their disease.

So far motivation to quit and long term abstinence rates are not sufficiently established even among seriously sick patients in Germany; further initiatives should focus on new and more intense interventions and educational strategies.

Zusammenfassung

Lungenkrebs ist die vermeidbarste neoplastische Erkrankung für Männer und Frauen. Die Inzidenzrate liegt in Deutschland jährlich bei 14.000. Rauchen ist der Hauptrisikofaktor für Lungenkrebs und in 90% der Fälle mit der Krankheit assoziiert. Studien haben gezeigt, dass der Zeitpunkt der Diagnosestellung ein günstiger Moment für Rauchstopp-Interventionen ist. Die effektivste Therapie-Methode war dabei eine Kombination aus Verhalten- und Pharmakotherapie (z.B. NET, Bupropion, Vareniclin).

In dieser Studie wurde der Rauchstatus aller resezierten Lungenkrebspatienten aus den Jahren 2011, 2012 und 2013 untersucht. Ein retrospektives, halb-strukturiertes Telefoninterview zu Rauchgewohnheiten und Lebensqualität wurde durchgeführt. 131 Patienten (36,6 % weiblich, Durchschnittsalter 68,7 Jahre) einer städtischen, deutschen Klinik wurden eingeschlossen.

Die Ergebnisse zeigen eine Rückfallrate von 22,3 %, wovon 86,2 % stark abhängige Raucher waren. Eine multivariate Analyse der Kovarianz (MANCOVA) zeigte einen signifikanten Einfluss des Rauchstatus auf die Lebensqualität mit mittlerer Effektstärke (kontrolliert nach Alter, Geschlecht, Lebensumstände, Tumorstadium, Dauer der Rauchabstinenz, Art der Krebstherapie, Operationsmethode und Zeitraum zwischen Untersuchung und OP-Termin). Zwei Drittel aller Patienten sahen keinen Zusammenhang zwischen der Erkrankung und ihrem Rauchverhalten.

Bisher wird die Rauchstoppmotivation und die Langzeitabstinenz auch von lebensbedrohlich erkrankten Menschen in Deutschland nicht umfassend berücksichtigt. Zukünftige Forschungsvorhaben sollten sich auf neue und intensivere Interventionen und psychoedukative Strategien konzentrieren.

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