Smoking and heavy drinking affect NHL survival

April 11, 2008

NEW YORK (Reuters Health) - The results of a study published in the April issue of the International Journal of Cancer suggest that tobacco smoking and moderate-to-high alcohol consumption negatively affect the survival of patients with non-Hodgkin lymphoma (NHL).

The effect of smoking and drinking on the prognosis of lymphomas has been uncertain, Dr. Renato Talamini, of the National Cancer Institute, Aviano, Italy, and colleagues note. "To our knowledge, only a recent population-based prospective study conducted in Italy investigated the issue."

To further explore these relationships, the researchers evaluated the survival rates of 268 NHL patients (median age 57 years) according to their smoking and drinking habits, who were admitted to the Division of Medical Oncology between 1983 and 2002. The subjects were enrolled as cases in case-control studies conducted at the same institution over the same time period.

Clinical data, including histological subtype, major prognostic factors, and treatment, were available for all patients. Epidemiological data, including smoking and drinking habits, were also available. Kaplan-Meier methods were used to compute the survival analyses.

At a mean follow-up of 60 months, 158 patients had died. Forty-four patients did not complete the study. The most frequent cause of death was NHL progression (74%).

Patients who smoked at least 20 cigarettes per day had a significantly higher risk of death compared with never smokers (HR = 1.70). Compared with patients who consumed fewer than two drinks per day, those who consumed four or more drinks per day also had a significantly higher risk of death (HR = 1.69).

When the authors combined exposure to alcohol and smoking, they found no excess deaths among subjects who drank fewer than four drinks per day. However, the risk of death was increased among current or former smokers who consumed four or more drinks per day (HR = 1.99).

"Studies have demonstrated that tobacco and alcohol habits are risk factors for a wide range of diseases, such as cardiovascular diseases, respiratory infections, some types of cancers, liver diseases, malnutrition, and impairment of the immune system," Dr. Talamini said in an interview with Reuters Health.

"NHL patients who smoked tobacco and/or drank alcoholic beverages could be more vulnerable to the complications and side effects of cancer treatments," he noted.

"Moreover, concomitant diseases due to tobacco and alcohol consumption may increase the probability of treatment toxicity, and thus, may represent an obstacle to an adequate chemotherapy and/or radiotherapy," he continued.

"Our findings provide strong encouragement to physicians to advise their patients with NHL to stop smoking and lower alcohol consumption in order to obtain a general health benefit and improvements in the course of treatment," Dr. Talamini said.

The next step will be to evaluate if smoking cessation or reducing alcohol consumption improve survival or treatment responses in these patients. "In pursuit of this, we will follow-up the same cohort," he added.