Qualitative cross-country comparison of whether, when and how people diagnosed with lung cancer talk about cigarette smoking in narrative interviews

ObjectivesTo compare and examine whether, when and how patients with lung cancer in three countries, with different survival rates, talk about cigarette smoking and its relationship with help-seeking.DesignA qualitative cross-country comparison with analysis of narrative interviews.SettingParticipants in Sweden, Denmark and England were interviewed during 2015–2016. Interviews, using a narrative approach, were conducted in participants’ home by trained and experienced qualitative researchers.ParticipantsSeventy-two men and women diagnosed with lung cancer were interviewed within 6 months of their diagnosis.ResultsThe English participants, regardless of their own smoking status, typically raised the topic of smoking early in their interviews. Smoking was mentioned in relation to symptom appraisal and interactions with others, including health professionals. Participants in all three countries interpreted their symptoms in relation to their smoking status, but in Sweden (unlike England) there was no suggestion that this deterred them from seeking care. English participants, but not Swedish or Danish, recounted reluctance to consult healthcare professionals with their symptoms while they were still smoking, some gave up shortly before consulting. Some English patients described defensive strategies to challenge stigma or pre-empt other people’s assumptions about their culpability for the disease. A quarter of the Danish and 40% of the Swedish participants did not raise the topic of smoking at any point in their interview.ConclusionThe causal relationship between smoking and lung cancer is well known in all three countries, yet this comparative analysis suggests that the links between a sense of responsibility, stigma and reluctance to consult are not inevitable. These findings help illuminate why English patients with lung cancer tend to be diagnosed at a later stage than their Swedish counterparts.

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Understanding symptom appraisal and help-seeking in people with symptoms suggestive of pancreatic cancer: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2016-015682 ◽

2017 ◽

Vol 7 (9) ◽

pp. e015682 ◽

Cited By ~ 6

Author(s):

Katie Mills ◽

Linda Birt ◽

Jon D Emery ◽

Nicola Hall ◽

Jonathan Banks ◽

...

Keyword(s):

Pancreatic Cancer ◽

Help Seeking ◽

Survival Rates ◽

Initial Symptom ◽

Self Medication ◽

Gastrointestinal Conditions ◽

Symptom Appraisal ◽

Age Range ◽

Specific Symptoms ◽

Symptom Changes

ObjectivePancreatic cancer has poor survival rates due to non-specific symptoms leading to later diagnosis. Understanding how patients interpret their symptoms could inform approaches to earlier diagnosis. This study sought to explore symptom appraisal and help-seeking among patients referred to secondary care for symptoms suggestive of pancreatic cancer.DesignQualitative analysis of semistructured in-depth interviews. Data were analysed iteratively and thematically, informed by the Model of Pathways to Treatment.Participants and settingPancreatic cancer occurs rarely in younger adults, therefore patients aged ≥40 years were recruited from nine hospitals after being referred to hospital with symptoms suggestive of pancreatic cancer; all were participants in a cohort study. Interviews were conducted soon after referral, and where possible, before diagnosis.ResultsTwenty-six interviews were conducted (cancer n=13 (pancreas n=9, other intra-abdominal n=4), non-cancer conditions n=13; age range 48–84 years; 14 women). Time from first symptoms to first presentation to healthcare ranged from 1 day to 270 days, median 21 days. We identified three main themes. Initial symptom appraisal usually began with intermittent, non-specific symptoms such as tiredness or appetite changes, attributed to diet and lifestyle, existing gastrointestinal conditions or side effects of medication. Responses to initial symptom appraisal included changes in meal type or frequency, or self-medication. Symptom changes such as alterations in appetite and enjoyment of food or weight loss usually prompted further appraisal. Triggers to seek help included a change or worsening of symptoms, particularly pain, which was often a ‘tipping point’. Help-seeking was often encouraged by others. We found no differences in symptom appraisal and help-seeking between people diagnosed with cancer and those with other conditions.ConclusionsGreater public and healthcare professional awareness of the combinations of subtle and intermittent symptoms, and their evolving nature, is needed to prompt timelier help-seeking and investigation among people with symptoms of pancreatic cancer.

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Residential Radon Exposure and Cigarette Smoking in Association with Lung Cancer: A Matched Case-Control Study in Korea

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17082946 ◽

2020 ◽

Vol 17 (8) ◽

pp. 2946

Author(s):

Eung Joo Park ◽

Hokyou Lee ◽

Hyeon Chang Kim ◽

Seung Soo Sheen ◽

Sang Baek Koh ◽

...

Keyword(s):

Lung Cancer ◽

Cigarette Smoking ◽

Case Control Study ◽

Smoking Status ◽

Case Control ◽

Radon Exposure ◽

Matched Case ◽

Matched Case Control Study ◽

Control Study ◽

Residential Radon

Residential radon exposure and cigarette smoking are the two most important risk factors for lung cancer. The combined effects thereof were evaluated in a multi-center matched case-control study in South Korea. A total of 1038 participants were included, comprising 519 non-small cell lung cancer cases and 519 age- and sex- matched community-based controls. Residential radon levels were measured for all participants. Multivariate logistic regression was used to calculate odds ratios (OR) for lung cancer according to radon exposure (high ≥ 100 Bq/m3 vs. low < 100 Bq/m3), smoking status, and combinations of the two after adjusting for age, sex, indoor hours, and other housing information. The median age of the participants was 64 years, and 51.3% were women. The adjusted ORs (95% confidence intervals [CIs]) for high radon and cigarette smoking were 1.56 (1.03–2.37) and 2.53 (1.60–3.99), respectively. When stratified according to combinations of radon exposure and smoking status, the adjusted ORs (95% CIs) for lung cancer in high-radon non-smokers, low-radon smokers, and high-radon smokers were 1.40 (0.81–2.43), 2.42 (1.49–3.92), and 4.27 (2.14–8.52), respectively, with reference to low-radon non-smokers. Both residential radon and cigarette smoking were associated with increased odds for lung cancer, and the difference in ORs according to radon exposure was much greater in smokers than in non-smokers.

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Reduction and Cessation of Cigarette Smoking and Risk of Cancer: A Cohort Study of Korean Men

Journal of Clinical Oncology ◽

10.1200/jco.2008.17.0498 ◽

2008 ◽

Vol 26 (31) ◽

pp. 5101-5106 ◽

Cited By ~ 29

Author(s):

Yun-Mi Song ◽

Joohon Sung ◽

Hong-Jun Cho

Keyword(s):

Lung Cancer ◽

Smoking Cessation ◽

Cigarette Smoking ◽

Smoking Status ◽

Smoking Reduction ◽

Lung Cancer Patients ◽

Asian Populations ◽

Study Participants ◽

Risk Of Cancer ◽

Heavy Smokers

Purpose Reducing cigarette smoking has been proposed as a method of harm reduction. The effect of smoking reduction on cancer risk has not been studied in Asian populations. Patients and Methods A total of 479,156 Korean men, age 30 to 58 years, were stratified into nine groups based on smoking status in 1990 and 1992. From 1992 to 2003, patients were observed and tested for the occurrence of cancer. Results There was no association between smoking reduction and risk of all cancers. However, the risk of smoking-related cancers tended to decrease, though not significantly, when heavy smokers (≥ 20 cigarettes/d) became moderate smokers (10 to 19 cigarettes/d), with a hazard ratio (HR) of 0.91 (95% CI, 0.82 to 1.02). For lung cancer, patients who reduced from heavy to moderate smoking and from heavy to light smoking (< 10 cigarettes/d) had significantly decreased risks based on multivariable-adjusted HRs (HR = 0.72, 95% CI, 0.49 to 0.89; HR = 0.63, 95% CI, 0.46 to 0.84, respectively). Study participants who never smoked, sustained ex-smokers, and quitters had lower risks for all cancers, smoking-related cancers, and lung cancer in a dose-response manner as compared with heavy smokers. Conclusion Smoking reduction was associated with a significant decrease in the risk of lung cancer, but the size of risk reduction was disproportionately smaller than that expected from the reduced amount of cigarette consumption. Although smoking cessation should be the cornerstone of preventing smoking-related cancers, smoking reduction could be considered as a strategy to supplement smoking cessation for those who are unable to quit smoking immediately.

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A 2-year retrospective review of the effect of cigarette smoking status on the histological cell types of lung carcinoma in the Western Cape

South African Respiratory Journal ◽

10.7196/sarj.8441 ◽

2015 ◽

Vol 21 (2) ◽

pp. 23

Author(s):

A S Pellizzon ◽

C F N Koegelenberg ◽

E M Irusen

Keyword(s):

Lung Cancer ◽

Squamous Cell Carcinoma ◽

Cigarette Smoking ◽

Cell Carcinoma ◽

Squamous Cell ◽

Smoking Status ◽

Cell Types ◽

Small Cell ◽

Western Cape ◽

Significant Difference

Background. Cigarette smoking is variably associated with the various histological cell types of lung cancer. The primary aim of this study was to analyse various strengths of association between the common histological cell types of lung cancer and smoking in a Western Cape population. The secondary aim examined whether an association exists between scar carcinoma and smoking.Methods. We retrospectively analysed the records from 386 patients over a 2-year period. Both smokers and non-smokers were subdivided and analysed as two groups, which included those with non-small cell and small cell lung cancer. Smokers and non-smokers were also analysed separately according to the presence or absence of lung scarring.Results. In total, 94.3% of all patients with lung cancer were current or past smokers. There was a disproportionately higher number of patients with adenocarcinoma who were non-smokers compared with all the other cell types (p=0.01), whereas patients with squamous cell carcinoma were more likely to be smokers (p=0.05). Although the vast majority of patients with and without lung scars were found to be smokers (96.4% v. 93.7% respectively), there was no statistically significant difference found between these two groups (p=0.43).Conclusion. In a Western Cape population, patients with adenocarcinoma were more likely to be non-smokers, while those with squamous cell carcinoma were relatively more likely to be smokers. No clear association between scar carcinoma and smoking status was found.

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Residential Radon Exposure and Cigarette Smoking in Association with Lung Cancer: a Matched Case-control Study in Korea

10.21203/rs.2.15523/v1 ◽

2019 ◽

Author(s):

Eung Joo Park ◽

Hokyou Lee ◽

Hyeon Chang Kim ◽

Seung soo Sheen ◽

Sang Baek Koh ◽

...

Keyword(s):

Lung Cancer ◽

Cigarette Smoking ◽

Case Control Study ◽

Smoking Status ◽

Case Control ◽

Radon Exposure ◽

Matched Case ◽

Matched Case Control Study ◽

Control Study ◽

Residential Radon

Abstract Background: Residential radon exposure and cigarette smoking are the two most important risk factors for lung cancer. The combined effects thereof were evaluated in a multi-center matched case-control study in South Korea.Methods: A total of 1,038 participants were included, comprising 519 non-small cell lung cancer cases and 519 age- and sex- matched community-based controls. Residential radon levels were measured for all participants. Multivariate logistic regression was used to calculate odds ratios (OR) for lung cancer according to radon exposure (high ≥100 Bq/m3 vs. low <100 Bq/m3), smoking status, and combinations of the two after adjusting for age, sex, indoor hours, and other housing information.Results: The median age of the participants was 64 years, and 51.3% were women. The adjusted ORs (95% confidence intervals [CIs]) for high radon and cigarette smoking were 1.56 (1.03-2.37) and 2.53 (1.60-3.99), respectively. When stratified according to combinations of radon exposure and smoking status, the adjusted ORs (95% CIs) for lung cancer in high-radon non-smokers, low-radon smokers, and high-radon smokers were 1.40 (0.81-2.43), 2.42 (1.49-3.92), and 4.27 (2.14-8.52), respectively, with reference to low-radon non-smokers.Conclusion: Both residential radon and cigarette smoking were associated with increased odds for lung cancer, and the difference in ORs according to radon exposure was much greater in smokers than in non-smokers.

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Abstract C46: Fruit and vegetable intake and lung cancer incidence among Black women according to cigarette smoking status

10.1158/1538-7755.disp17-c46 ◽

2018 ◽

Author(s):

Sarah JO Nomura ◽

Chiranjeev Dash ◽

Lynn Rosenberg ◽

Julie Palmer ◽

Lucile L. Adams-Campbell

Keyword(s):

Lung Cancer ◽

Black Women ◽

Cigarette Smoking ◽

Cancer Incidence ◽

Vegetable Intake ◽

Smoking Status ◽

Fruit And Vegetable Intake ◽

Lung Cancer Incidence ◽

Fruit And Vegetable

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Public and private stigma, and help-seeking intent for mental health issues: A cross-country comparison between the U.S. and Philippines.

Stigma and Health ◽

10.1037/sah0000296 ◽

2021 ◽

Author(s):

Antover P. Tuliao

Keyword(s):

Mental Health ◽

Help Seeking ◽

Health Issues ◽

Public And Private ◽

Mental Health Issues ◽

Country Comparison ◽

Cross Country ◽

The U.S

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Fruit and VegeTable Intake and Lung Cancer Incidence Among Black Women According to Cigarette Smoking Status

Nutrition and Cancer ◽

10.1080/01635581.2018.1491608 ◽

2018 ◽

Vol 70 (6) ◽

pp. 904-912 ◽

Cited By ~ 1

Author(s):

Sarah J. O. Nomura ◽

Chiranjeev Dash ◽

Lynn Rosenberg ◽

Julie Palmer ◽

Lucile L. Adams-Campbell

Keyword(s):

Lung Cancer ◽

Black Women ◽

Cigarette Smoking ◽

Cancer Incidence ◽

Vegetable Intake ◽

Smoking Status ◽

Fruit And Vegetable Intake ◽

Lung Cancer Incidence ◽

Fruit And Vegetable

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Cigarette Smoking Alters the Expression of Circulating microRNAs and Its Potential Diagnostic Value in Female Lung Cancer Patients

Biology ◽

10.3390/biology10080793 ◽

2021 ◽

Vol 10 (8) ◽

pp. 793

Author(s):

Eric Gustavo Ramírez-Salazar ◽

Luis Vicente Gayosso-Gómez ◽

Renata Baez-Saldaña ◽

Ramcés Falfán-Valencia ◽

Rogelio Pérez-Padilla ◽

...

Keyword(s):

Lung Cancer ◽

Cigarette Smoking ◽

Smoking Status ◽

Diagnostic Value ◽

Circulating Microrna ◽

Diagnostic Biomarkers ◽

Expression Levels ◽

Lung Cancer Patients ◽

Never Smokers

Cigarette smoking is a known risk factor for the development of lung cancer. We investigated whether circulating microRNA expression levels and their potential diagnostic value are affected by cigarette smoking in adenocarcinoma (AD) patients and healthy (H) participants. In total, 71 female AD patients and 91 H individuals were recruited, including 42 AD never-smokers (AD/CS−), 29 AD smokers (AD/CS+), 54 H never-smokers (H/CS−), and 37 H smokers (H/CS+). PCR array (754 microRNAs) and qPCR were performed on sera from the discovery and validation cohorts, respectively. The expression levels of miR-532-5p, miR-25-3p, and miR-133a-3p were significantly higher in adenocarcinoma patients than in healthy participants, independent of their smoking status. Multivariate analysis showed that levels of miR-133a-3p were independently associated with smoking. ROC analysis showed that only miR-532-5p discriminated AD patients from H controls (AUC: 0.745). However, when making comparisons according to cigarette smoking status, miR-532-5p discriminated AD/CS− patients from H/CS− controls with a higher AUC (AUC:0.762); miR-25-3p discriminated AD/CS+ patients from H/CS+ controls (AUC: 0.779), and miR-133a discriminated AD/CS+ patients from H/CS+ controls with the highest AUC of 0.935. Cancer and lung-cancer-enriched pathways were significantly associated with the three miRNAs; in addition, nicotinate/nicotinamide metabolism, inflammation, and pulmonary hypertension were associated with miR-133a-3p. Our findings highlight how cigarette smoking affects the reliable identification of circulating miRNAs as diagnostic biomarkers in lung cancer and suggest a smoking-dependent pathogenic role of miR-133a-3p in smokers.

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