Patients With Cancer Who Continue to Smoke Incur Significant Incremental Cost Increases for Treatment

Continued smoking is associated with significant incremental cost increases for subsequent cancer treatments, according to researchers from the Medical University of South Carolina (MUSC) who published their findings in JAMA.

In this economic evaluation, researchers developed a model in 2018 using data from a 2014 U.S. Surgeon General’s report and assessed expected failure rates of first-line cancer treatment in nonsmoking patients, smoking prevalence, odds ratio of first-line cancer treatment failure attributed to smoking juxtaposed to nonsmoking, and cost associated with cancer treatment subsequent to failure of first-line cancer treatment. The study’s main outcomes and measures comprised attributable failures of first-line cancer treatment and incremental cost for ensuing treatment correlated with continued smoking among patients with cancer.

Markedly Higher Costs

According to the study results, attributable treatment failures were increased under conditions in which high first-line cure rates were expected in nonsmoking patients juxtaposed with conditions in which low cure rates were expected. The study showed peak attributable failures transpired under the conditions in which expected cure rates among nonsmoking patients ranged from 50% to 65%. Furthermore, under the conditions of a 30% expected treatment failure rate among nonsmoking patients, 20% smoking prevalence, 60% increased risk of failure of first-line cancer treatment, and $100,000 mean added cost of treating a first-line cancer treatment failure, the added incremental cost per 1,000 total patients was estimated to be $2.1 million, reflecting an additional cost of $10,678 per smoking patient. Overall, the study indicates that the estimated cost of 1.6 million patients with cancer diagnosed annually reflects a potential $3.4 billion in incremental cost.

These Estimates are Conservative

Moreover, Graham Warren, MD, PhD, one of the study’s authors, said in a press release that these estimates are very likely conservative. “The study only focused on the cost of additional cancer treatment but did not include the cost of treating side effects from smoking, such as increased cancer treatment toxicity or treatment of other smoking related diseases such as heart disease, stroke, and other diseases known to be caused by continued smoking.”

Kathleen Cartmell, PhD, a co-author and associate professor in the College of Nursing at the Medical University of South Carolina (MUSC), said the study lays the groundwork for uncovering the financial magnitude of how smoking can affect cancer treatment. “Now, we are better prepared to approach patients, providers, and health systems to develop approaches to help prevent these costs.”

“Our patients need our help,” said Gustavo Leone, PhD, director of the Hollings Cancer Center. “We have a dedicated smoking cessation program at MUSC to help patients quit. We have many investigators at Hollings with expertise in smoking cessation, as well as investigating the impacts of smoking on health and the effectiveness of cancer treatment. We want to provide ways our patients can have the best outcomes.”