Formerly Smoking and Currently Smoking Cancer Survivors' View on Smoking Cessation - A Qualitative Study

Drastic life events, such as a cancer diagnosis, do not necessarily lead to a reduction in unhealthy and dysfunctional behaviors like smoking. Continued smoking among cancer survivors significantly increases the risk of recurrence and worsens treatment outcomes. While evidence-based smoking cessation treatments have demonstrated their effectiveness in acute cancer care, their impact among long-term cancer survivors remains limited, and overall quit rates remain low. To cessation outcome and improve long-term support strategies, it is essential to better understand the experiences, attitudes, and perceived barriers of both current and former smoking cancer survivors.

This qualitative study included semi-structured interviews with six cancer survivors (50% female), aged 34 to 81 years, with different cancer types (breast, skin, lung, urinary bladder cancer, and GIST). At the time of the interview, three participants were still smoking, two had quit at the time of their diagnosis, and one had quit beforehand. All had completed cancer treatment at least four years prior without relapse. Interviews were transcribed verbatim and analyzed using qualitative content analysis, applying an inductive approach to identify recurring themes and categorize the data using computer-assisted analysis software.

Four main categories emerged from the interviews: (1) motivations for quitting, (2) perceived barriers, (3) facilitators of cessation, and (4) contextual influences.Key motives for continued smoking after a cancer diagnosis included managing nicotine cravings and stress, experiencing pleasure and boredom relief, and a perceived lack of negative health consequences. Some participants reported smoking to cope with treatment-related discomfort. A general lack of knowledge regarding the link between smoking and cancer contributed to low motivation to quit and limited risk awareness. Participants who had successfully quit cited improvements in health and well-being as primary reasons for cessation, alongside external factors such as financial savings and the aversion to cigarette odor. Medical advice and support from healthcare providers were mentioned frequently - both as motivating factors and, in cases where such support was absent or discouraging, as barriers.Barriers to quitting included a persistent smoking environment, negative emotions during cessation attempts, poor timing related to the cancer experience, and previous failed quit attempts.Conversely, facilitators of cessation included external regulations (eg, smoking bans, legal restrictions), a tobacco-free environment, strong internal motivation, individual coping strategies for withdrawal symptoms and craving, medical recommendations, and support from family or peers.

The results highlight the need for a better adaptation of smoking cessation interventions to the specific needs of cancer survivors. This has significant implications for oncology professionals and healthcare providers in cancer care. The inconsistency in smoking cessation advice from healthcare providers, ranging from discouragement to strong encouragement, points to the necessity of re-evaluating current policies and establishing more standardized communication within oncology settings. Cancer survivors require improved education about the health risks associated with continued smoking, as well as information about available cessation aids and pharmacological support options. The "teachable moment" following a cancer diagnosis presents an opportunity to integrate smoking cessation support into routine oncological care. Practical strategies for cancer survivors who wish to quit include the development of alternative behaviors, effective stress management techniques, and further enhancement of legal restrictions to promote a smoke-free environment. Such measures would not only support individual cessation efforts but also contribute to broader public health goals, protecting cancer survivors and the general population from smoking-related harm. The insights from this study provide a foundation for the development of more tailored cessation interventions for cancer survivors.