Impact of smoking on health‐related quality‐of‐life outcomes in prostate cancer survivors

BACKGROUND: Smoking may negatively affect health-related quality of life (HRQOL) in prostate cancer survivors, even though it is not a smoking-related malignancy. The longitudinal association of smoking with HRQOL was evaluated by focusing on intensity and duration. METHODS: Patients from the population-based North Carolina Prostate Cancer Comparative Effectiveness and Survivorship Study, enrolled via the state cancer registry (2011-2013), were analyzed. HRQOL was measured with the Short Form 12 instrument at intervals of up to 5 years posttreatment. Smoking status was self-reported. Linear and mixed-effects models assessed associations with controlling for age, treatment, and time. RESULTS: Of 842 participants, 474 underwent prostatectomy, 258 had radiation therapy, and 110 had brachytherapy. Concurrent smoking was associated with worse general health, mental health, and physical functioning (all p < .05). Graded analysis revealed a significant dose response, with smoking ≥1 pack/day linked to the greatest declines in general health (β = -3.25; p < .001) and physical functioning (β = -2.35; p = .003) at 5 years. CONCLUSIONS: Smoking demonstrates significant concurrent and longitudinal associations with poorer HRQOL in prostate cancer survivors, with a clear dose-response pattern. These results underscore the critical need to integrate structured smoking assessment and cessation support as a core component of comprehensive prostate cancer survivorship care.