Effect of Smoking on the Outcomes of Cancer Patients After Hematopoietic Stem Cell Transplantation

Abstract

Tobacco use is the leading preventable cause of death in the United States. Recent research in Hematopoietic Stem Cell Transplant (HSCT) populations has begun to examine smoking cigarettes as a risk factor for adverse transplant outcomes. Based on these early studies, estimated prevalence rates vary widely. Lifetime history of smoking among HSCT patients likely approximates that of the general population, while current use appears less than the general population. Smoking has been associated with multiple adverse HSCT outcomes, including shorter duration of disease-free and overall survival; higher treatment related mortality; higher pulmonary infection and respiratory failure rates; higher rates of disease recurrence; increased risk for cardiovascular events; and longer duration of hospitalization. Potential mechanisms are likely many, and include impaired bone marrow hematopoiesis, inflammation, impaired pulmonary function, and also significant associations with other maladaptive health behaviors know to adversely affect general population health outcomes, but understudied in HSCT populations. Future directions for tobacco research in HSCT should focus on use of behavior science methodology to minimize biases common to self-report methodology, and analyzing the effects of both current and lifetime use. Current use is a modifiable risk factor. Cancer diagnosis and HSCT serve as “teachable moments” during which patient motivation to quit tobacco use is increased. Survivor care plans serve as a timely platform for integration of evidence-based tobacco dependence treatment into a comprehensive care plan that targets all known significant risk factors to optimize HSCT outcomes.