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Second Hand Smoke Exposure and Survival in Early-Stage Non–Small-Cell Lung Cancer Patients

Authors' Affiliations: Departments of ¹ Environmental Health and ² Biostatistics, Harvard School of Public Health; ³ Department of Medicine and ⁴ Thoracic Surgery Unit, Department of Surgery, Massachusetts General Hospital, Harvard Medical School; and ⁵ Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts

Requests for reprints: Wei Zhou, Occupational Health Program, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115. Phone: 617-432-1641; Fax: 617-432-6981; E-mail: wzhou{at}hsph.harvard.edu.

Purpose: Second hand smoke (SHS) exposure is associated with higher risk of lung cancer. However, the role of SHS in lung cancer survival is not clear.

Experimental Design: We examined the association between self-reported SHS exposure before diagnosis and overall survival and recurrence-free survival in 393 early-stage non–small-cell lung cancer patients. SHS exposure was analyzed by both duration and location of exposure using log-rank test and Cox proportional hazard models, adjusting for covariates including pack-years of smoking.

Results: The median follow-up time was 66 months (range, 0.2-140 months). There were 135 recurrences and 213 deaths. The 5-year overall survival rates were 71% [95% confidence interval (95% CI), 62-81%], 61% (51-72%), 49% (38-60%), and 47% (37-58%), respectively, for patients with the lowest to highest quartile of SHS exposure durations (P < 0.001, log-rank test), with the adjusted hazard ratio (AHR) of 1.57 (95% CI, 1.02-2.41) for the highest versus lowest quartile of SHS exposure durations (P_trend = 0.04). For different SHS exposure locations, a stronger association was found for SHS exposure at work (AHR of the highest versus lowest quartile, 1.71; 95% CI, 1.12-2.61; P_trend = 0.03) than for exposure at home (AHR, 1.26; 95% CI, 0.86-1.86; P_trend = 0.20) or leisure places (AHR, 1.28; 95% CI, 0.83-1.95; P_trend = 0.16). Similar associations were observed when SHS exposure durations were dichotomized into two or three groups and between SHS exposure and recurrence-free survival.

Conclusions: SHS exposure is associated with worse survival in early-stage non–small-cell lung cancer patients, especially for SHS exposure at the work.

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				T F P. McKeagney Second hand smoke exposure is associated with worse survival in early stage non-small cell lung cancer Thorax, May 1, 2007; 62(5): 437 - 437. [Full Text] [PDF]