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Smoking and quality of life in lung cancer patients: systematic review
  1. Theresa Halms1,
  2. Martina Strasser1,
  3. Alkomiet Hasan1,
  4. Tobias Rüther2,
  5. Martin Trepel3,4,
  6. Stephan Raab5 and
  7. Marcus Gertzen1
  1. 1Department of Psychiatry and Psychotherapy, Medical Faculty, University of Augsburg, Augsburg, Germany
  2. 2Department of Psychiatry and Psychotherapy, University Hospital, Ludwig‑Maximilians University Munich, Munich, Germany
  3. 3Department of Hematology and Oncology, Medical Faculty, University of Augsburg, University Hospital Augsburg, Augsburg, Germany
  4. 4Comprehensive Cancer Center Augsburg (CCCA), Augsburg, Germany
  5. 5Department of Thoracic Surgery, University Hospital Augsburg, Augsburg, Germany
  1. Correspondence to Theresa Halms, Department of Psychiatry and Psychotherapy, University of Augsburg, Augsburg, Germany; theresa.halms{at}


Objectives Lung cancer (LC) accounts for the largest number of cancer deaths worldwide, with smoking being the leading cause for its development. While quality of life (QoL) is a crucial factor in the treatment of patients with LC, the impact of smoking status on QoL remains unclear. This systematic review aims to provide a comprehensive overview of available evidence on the relationship between smoking status and QoL among patients with LC.

Methods A systematic search of Embase, Medline and Web of Science was conducted. Studies reporting the impact of smoking status on QoL among patients with LC were eligible for inclusion. Two reviewers independently assessed the eligibility of studies, extracted data and evaluated the risk of bias using the Critical Appraisal Skills Programme appraisal tool for cohort studies. A descriptive synthesis was performed due to the heterogeneity of the studies.

Results A total of 23 studies met the inclusion criteria (17 studies providing cross-sectional and 6 longitudinal data). The studies included a total of 10 251 participants. The results suggested a tendency towards lower QoL among smokers compared with non-smokers. The effect of smoking cessation on QoL was insufficiently investigated in the included studies and therefore remains inconclusive.

Conclusions The findings of this review suggest that current smokers may experience worse QoL than former and never smokers. The results of this systematic review should, however, be viewed in the context of the difficulty of data collection in this patient group given the low survival rates and low performance status, among other factors and in light of the large variety of different QoL measures used. Future research requires uniform QoL measures, a holistic representation of all patients with LC as well as a comprehensive consideration of all potential determinants of QoL. The potential benefits of smoking cessation on QoL among patients with LC require investigation.

  • quality of life
  • lung

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors Conceptualisation: TH and MG; methodology: TH and MG; data collection: TH and MS; analysis and interpretation of results: TH, MS, MG; writing – original draft preparation: TH; writing – review and editing: MS, AH, TR, SR, MT, MG; supervision: AH and MG. TH is responsible for the overall content as guarantor. All authors have read and agreed to the published version of the manuscript.

  • Funding This work was funded by a grant of the medical faculty of the University of Augsburg to Marcus Gertzen (Project TEMPO). The Comprehensive Cancer Center Augsburg is funded by the State of Bavaria within the Bavarian Center for Cancer Research (BZKF), by the Deutsche Krebshilfe (within the WERA network as an Oncology Center of Excellence) and the BMBF (within the WERA network as a member of the National Center for Tumor Diseases – NCT).

  • Competing interests The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. AH is coeditor of the German (DGPPN) Schizophrenia treatment guidelines and first author of the WFSBP Schizophrenia treatment guidelines. AH has received paid speakerships from Janssen, Otsuka, Rovi, Recordati, Advanz and AbbVie. He was member of Rovi, Recordati, Otsuka, Lundbeck and Janssen advisory boards. MG is chair person of the German Federal Association of Sexualized Substance Use (BISS) and received honorariums for talks from several HIV and drug counselling centers. Furthermore he received honorariums from Gilead sciences and travel expenses for a conference journey and is medical consultant of the district of Swabia for addiction issues. TR received travel expenses and congress fees from the Sanofi company. SR received travel support and congress fees from MedXpert. Within the past 5 years, MT has received speakers or advisory honoraria and travel support from Novartis, Amgen, Roche, Celgene, Janssen, Klinikum Stuttgart, ConEvent, MedUpdate, Sirtex, COCS, FOMF, Klinikum Esslingen, VHS Stadtbergen.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.