CONTINUED SMOKING AFTER CANCER DIAGNOSIS IN PATIENTS TREATED IN THE BRAZILIAN PUBLIC HEALTH SYSTEM: PERCEIVED HARMS AND AWARENESS

Background: Continued smoking after cancer diagnosis (CSAC) negatively impacts survival. Patients’ (pts) perceptions and awareness of tobacco’s harms are strongly associated with smoking cessation. We hypothesize that pts with cancer who CSAC have an attenuated perception and are less aware of tobacco’s harms than their caregivers. Moreover, we hypothesize that straw-cigarettes (SC) users perceive tobacco as less harmful than manufactured cigarettes (MC) users. Methods: Pts with cancer treated at Hospital de Base (São José do Rio Preto, SP) who CSAC were included. We surveyed pts for sociodemographic variables, smoking history, perceptions of CSAC on quality of life and fatigue, awareness of CSAC impact on survival and treatment outcomes, and awareness of CSAC as a risk factor for developing other cancers. Pts’ caregivers were also surveyed and used as controls about perceptions and awareness of CSAC. We abstracted tumor information from the charts. Data were summarized in means, medians, and percentages. We utilized the Chi-square test for associations and the T-test to compare means. Results: Of 1,148 pts surveyed between Oct21 and May22, 587 (51%) were never-smokers, 354 (31%) ex-smokers, and 207 (18%) current smokers. Of the latter, 144 (69%) pts and their caregivers (total=288) responded to the survey. Pts’ median age was 63yo, and 69% were male. Forty-two pts (29%) had tobacco-related cancers, (lung head&neck) and 26 (18%) had more than one primary tumor. Most pts smoked MC (54%) or SC (32%). Pts perceived CSAC as less harmful (p<0.001), were less aware of the impact of CSAC on cancer survival and treatment efficacy (p=0.02), and less aware of CSAC as a risk factor for a new cancer diagnosis (p<0.001) in comparison to their caregivers. SC users perceived CSAC as less harmful than MC users (64%×41%, p=0.009). Eighty (57%) pts and 99 (69%) caregivers believed smoking cessation after cancer diagnosis positively impacts cancer outcomes. However, 72 (50%) pts described not feeling encouraged to quit smoking by their medical team; SC users feel even less encouraged compared to MC users (69%×38% p<0.01). Conclusions: Pts who CSAC treated in the Brazilian public health system underestimate tobacco’s harms. SC use is associated with even less accurate perceptions and feeling less encouraged by their medical teams to quit smoking. Our data emphasize the importance of patient education and the medical team’s role in promoting smoking cessation.