The gold standard program (GSP) for smoking cessation: a cohort study of its effectiveness among smokers with and without cancer

Smoking cessation treatment is an important prognostic factor for survival after a cancer diagnosis, especially for tobacco-related cancers. After being diagnosed with lung cancer, approximately 50% of patients continue smoking or frequently relapse after a quit attempt. Given the importance of smoking cessation treatment for cancer survivors, the objective was to compare the effectiveness of a 6-week intensive smoking cessation intervention, the Gold Standard Program (GSP), among cancer survivors compared with smokers without cancer. Second, we compared successful quitting among socioeconomically disadvantaged cancer survivors with that among nondisadvantaged cancer survivors.
This was a cohort study based on 38,345 smokers from the Danish Smoking Cessation Database (2006–2016). Linkage to the National Patient Register was used to identify cancer survivors undergoing the GSP after being diagnosed with cancer (except nonmelanoma skin cancer). Linkage to the Danish Civil Registration System was used to identify participants who died, went missing, or emigrated before the follow-up. Logistic regression models were applied to evaluate effectiveness.
Six percent (2438) of the included smokers were cancer survivors at the time they undertook the GSP. Their 6-month successful quitting showed no difference compared to that of smokers without cancer, neither before nor after adjustment; 35% versus 37% in crude rates and an aOR of 1.13 (95% CI: 0.97–1.32). Likewise, the results for disadvantaged compared to nondisadvantaged cancer survivors were not significantly different (32% versus 33% and an adjusted aOR of 0.87 (95% CI 0.69–1.11)). Overall, an intensive smoking cessation program seems effective in helping both people without cancer and cancer survivors become successful quitters.

戒烟治疗是癌症确诊后患者生存预后的重要影响因素，对于烟草相关癌症患者尤为如此。在确诊肺癌后，约50%的患者仍会继续吸烟，或在尝试戒烟后频繁复吸。鉴于戒烟治疗对癌症幸存者的重要性，本研究旨在对比6周强化戒烟干预方案——黄金标准方案（Gold Standard Program, GSP）在癌症幸存者与非癌症吸烟者中的干预效果；其次，本研究还对比了社会经济地位弱势的癌症幸存者与非弱势癌症幸存者的戒烟成功率。
本研究为一项队列研究，研究对象源自2006至2016年的丹麦戒烟数据库（Danish Smoking Cessation Database）中的38345名吸烟者。通过与丹麦国家患者登记系统（National Patient Register）进行数据关联，筛选出确诊癌症（非黑色素瘤皮肤癌除外）后接受GSP干预的癌症幸存者；通过与丹麦民事登记系统（Danish Civil Registration System）进行数据关联，识别出随访前已死亡、失联或移民的研究对象。本研究采用logistic回归模型对干预效果进行评估。
纳入研究的吸烟者中，有6%（共2438名）在接受GSP干预时已为癌症幸存者。其6个月戒烟成功率与非癌症吸烟者无显著差异，无论是否经过混杂因素校正：未校正率分别为35%与37%，校正后的优势比（adjusted Odds Ratio, aOR）为1.13（95%置信区间：0.97~1.32）。同样，社会经济地位弱势与非弱势癌症幸存者的戒烟成功率亦无显著差异：两组未校正率分别为32%与33%，校正后aOR为0.87（95%置信区间：0.69~1.11）。综上，强化戒烟方案对非癌症吸烟者与癌症幸存者均能有效帮助其成功戒烟。