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Peer-reviewedCC BY-NC-NDESMO real world data and digital oncology

Smoking status and survival by cancer type and treatment intent in a population-based cohort with adjustment for major prognostic factors.

  • E Heervä1,2
  • A Ellonen1,2
  • S Kukkurainen3
  • T Mikkola3
  • K Savolainen4
  • T Laitinen5
  • K Mattila6
  • H Blomster7
  • H Minn1
  • H Irjala8
  • A Karlsson9
  • M Bärlund10
1 more authors
  • P Österlund10
10 affiliations
  1. 1Department of Oncology, Turku University Hospital and University of Turku, Turku, Finland.
  2. 2Wellbeing Services County of Southwest Finland and FICAN West Cancer Centre, Turku, Finland.
  3. 3Research Services, Tampere University Hospital, Tampere, Finland.
  4. 4Department of Obstetrics and Gynaecology, Tampere University Hospital and FICAN Mid Cancer Centre, Tampere, Finland.
  5. 5Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland.
  6. 6Department of Oncology, Helsinki University Hospital and University of Helsinki, FICAN South Cancer Center, Helsinki, Finland.
  7. 7Department of Otorhinolaryngology-Head and Neck Surgery, Tampere University Hospital, Tampere, Finland.
  8. 8Department of Otorhinolaryngology-Head and Neck Surgery, University of Turku and Turku University Hospital, Turku, Finland.
  9. 9Department of Medicine, University of Turku, Turku, Finland.
  10. 10Department of Oncology, Tampere University Hospital and University of Tampere, Wellbeing Services County of Pirkanmaa, Tampere, Finland.
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Abstract

Background

Tobacco smoking after cancer diagnosis is associated with impaired survival but large real-world evidence across cancers accounting for treatment intent and key prognostic factors remains scarce. We evaluated associations between smoking and survival in a population-based cohort.Materials and methods

We identified all patients who were diagnosed with solid cancers (International Classification of Diseases, 10th Revision codes C00-C43, C45-C68) and treated at two Finnish university hospitals (2009-2019). Smoking status (never, former, and current) was extracted from medical narratives using a validated natural language processing (NLP) pipeline linked to nationwide mortality data. Overall survival (OS) and cancer-specific survival (CSS) were estimated using Kaplan-Meier and multivariable Cox hazard ratios (HRs) adjusted for age, sex, performance status, comorbidity, nodal status, and treatment intent.Results

Among 62 893 patients, smoking status was available for 45 395 (72%). Five-year OS was 71% in never, 58% in former, and 49% in current smokers; HR reference, 1.48 [95% confidence interval (CI) 1.43-1.53], and 1.91 (95% CI 1.85-1.97), respectively. Corresponding HRs for CSS were 1.52 (95% CI 1.47-1.59) and 2.09 (95% CI 2.02-2.17). Across most cancer types, 5-year CSS was 4%-19% lower in current versus never smokers. Impaired survival among current smokers (OS: HR 1.15-3.96; CSS: HR 1.12-4.07) and intermediate outcomes in former smokers were observed. Associations persisted after adjustment, including in the curative-intent subgroup (n = 36 936).Conclusions

Current and former smoking are associated with impaired survival across multiple cancers, including after curative-intent treatment. These findings support systematic integration of smoking assessment and cessation into oncology care and demonstrate the utility of NLP for large-scale lifestyle outcome research.

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Cite

BibTeXRIS
BibTeX
@article{heerva2026smoking,
  title = {{Smoking status and survival by cancer type and treatment intent in a population-based cohort with adjustment for major prognostic factors.}},
  author = {E Heervä and A Ellonen and S Kukkurainen and T Mikkola and K Savolainen and T Laitinen and K Mattila and H Blomster and H Minn and H Irjala and A Karlsson and M Bärlund and P Österlund},
  journal = {ESMO real world data and digital oncology},
  year = {2026},
  month = oct,
  doi = {10.1016/j.esmorw.2026.100791},
  url = {https://europepmc.org/article/MED/42904091},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Smoking status and survival by cancer type and treatment intent in a population-based cohort with adjustment for major prognostic factors.
AU  - E Heervä
AU  - A Ellonen
AU  - S Kukkurainen
AU  - T Mikkola
AU  - K Savolainen
AU  - T Laitinen
AU  - K Mattila
AU  - H Blomster
AU  - H Minn
AU  - H Irjala
AU  - A Karlsson
AU  - M Bärlund
AU  - P Österlund
PY  - 2026
DA  - 2026/10/12
JO  - ESMO real world data and digital oncology
DO  - 10.1016/j.esmorw.2026.100791
UR  - https://europepmc.org/article/MED/42904091
AB  - Background  Tobacco smoking after cancer diagnosis is associated with impaired survival but large real-world evidence across cancers accounting for treatment intent and key prognostic factors remains scarce. We evaluated associations between smoking and survival in a population-based cohort.Materials and methods  We identified all patients who were diagnosed with solid cancers (International Classification of Diseases, 10th Revision codes C00-C43, C45-C68) and treated at two Finnish university hospitals (2009-2019). Smoking status (never, former, and current) was extracted from medical narratives using a validated natural language processing (NLP) pipeline linked to nationwide mortality data. Overall survival (OS) and cancer-specific survival (CSS) were estimated using Kaplan-Meier and multivariable Cox hazard ratios (HRs) adjusted for age, sex, performance status, comorbidity, nodal status, and treatment intent.Results  Among 62 893 patients, smoking status was available for 45 395 (72%). Five-year OS was 71% in never, 58% in former, and 49% in current smokers; HR reference, 1.48 [95% confidence interval (CI) 1.43-1.53], and 1.91 (95% CI 1.85-1.97), respectively. Corresponding HRs for CSS were 1.52 (95% CI 1.47-1.59) and 2.09 (95% CI 2.02-2.17). Across most cancer types, 5-year CSS was 4%-19% lower in current versus never smokers. Impaired survival among current smokers (OS: HR 1.15-3.96; CSS: HR 1.12-4.07) and intermediate outcomes in former smokers were observed. Associations persisted after adjustment, including in the curative-intent subgroup (n = 36 936).Conclusions  Current and former smoking are associated with impaired survival across multiple cancers, including after curative-intent treatment. These findings support systematic integration of smoking assessment and cessation into oncology care and demonstrate the utility of NLP for large-scale lifestyle outcome research.
SN  - 2949-8201
ER  -