Investigators develop method to spot young survivors at risk for tobacco use

    James Klosky, PhD and Melissa Hudson, MD

    St. Jude researchers have developed a simple, effective method for identifying young cancer survivors who are most likely to start using tobacco and who might benefit most from prevention efforts.

    The new tool ranks the likelihood survivors will start smoking based on their answers to six questions designed to measure smoking intentions. Investigators reported that young cancer survivors whose responses suggested uncertainty in their commitment to abstain were almost three times more likely to become tobacco users than were survivors classified as committed nonsmokers based on their answers. The research was published in a recent issue of the Journal of Clinical Oncology.

    “This has significant clinical implications,” said James Klosky, PhD, Behavioral Medicine, the paper’s lead author. “Smoking is associated with a range of health problems, including heart disease and cancer. We want to intervene with these young survivors before they start smoking. We can now use this tool to identify who is most likely to smoke and who needs to be targeted for tobacco prevention.”

    Melissa Hudson, MD, Oncology, said cancer treatment leaves many survivors at increased risk for heart and lung problems as well as second cancers.

    “Many survivors are medically vulnerable. Smoking adds another risk that they need to avoid,” said Hudson, the study’s senior author. Hudson is also director of the St. Jude Cancer Survivorship Division and co-leader of the Cancer Prevention and Control Program.

    National surveys suggest about 22 percent of healthy young people use tobacco. In comparison, about 23 percent of the 119 young St. Jude survivors of leukemia and solid tumors included in this study reported using tobacco. The volunteers were age 10 to 18 and were self-reported nonsmokers when the study began. All completed the six-question survey St. Jude investigators developed for an earlier project.

    For this study, investigators compared survivors’ responses on the smoking intention questionnaire with later, self-reported tobacco use. After an average follow-up of five years, almost 30 percent of survivors categorized as susceptible to smoking based on survey results reported tobacco use. That compares to about 13 percent of those classified as committed nonsmokers.

    The survey categorized 44 percent of the volunteers as committed nonsmokers because they answered “very unlikely” to such questions as “How likely is it that you will use tobacco in the next year?” and “How likely is it that you will be tempted to use tobacco in the future?” The remaining 56 percent of survivors were classified as susceptible to smoking based on their answers to the same questions. Answering “somewhat unlikely” to “very likely” to even one question was enough to categorize a survivor as susceptible to smoking.

    Past smokers were nearly four times more likely than survivors who had never smoked to report tobacco use. Others at high risk were survivors who reported having peers who smoked.

    Klosky said that the usefulness of employing smoking intentions to predict later smoking has already been established among healthy children and adolescents. But the questionnaire developed for this study is the first designed specifically for young cancer survivors. He hopes the new survey will become part of a comprehensive program to help keep young survivors tobacco free.

    Hudson said tobacco use is a topic clinicians should raise whenever possible not only with long-term survivors, but also with patients still in treatment as well as their families and caregivers.

    “These conversations can help put children on the right track in terms of understanding their vulnerability to tobacco-related health risks and avoiding future tobacco use,” she said.

    The Cancer Survivor Tobacco Quit Line is available through St. Jude to offer free counseling and nicotine replacement therapy to adult survivors of childhood cancer who want to quit smoking.

    Klosky said there are fewer options to help younger smokers. “We want to identify and prevent those survivors at highest risk for smoking before they are exposed to tobacco and become addicted to nicotine,” he said.

    Other St. Jude authors are Vida Tyc, PhD, and Ashley Hum, both of Behavioral Medicine.

    The research was supported in part by the National Cancer Institute and ALSAC.

    January 2010