Lead Researcher(s): Wanrudee Isaranuwatchai
Lead Institution: St. Michael’s Hospital/Cancer Care Ontario
Co-Investigators: Claire de Oliveira, Nicole Mittmann, Kelvin Chan
Collaborators: Bill Evans, Alice Peter, Rebecca Truscott
ARCC Program Area(s): Health Systems, Services, and Policy
Funding Term: 2017
Cancer is not a single disease; depending on the classification, there are more than 200 types of cancer, and 1 in 2 Canadians are expected to have cancer in their lifetime. Cancer care represents a substantial component of health-care expenditure, and the high costs associated with cancer drugs are well known. Understanding how certain factors influence cancer (e.g., how smoking influences cancer outcomes and costs) may help advance our understanding of cancer prevention and control.
Directly or indirectly, smoking can harm almost every organ of the body and is responsible for more than 5 million deaths per year worldwide. The negative impact of smoking on health is well documented as the leading risk factor for diseases (i.e., respiratory disease and cancer), including premature death, around the world. The economic burden of smoking can account for up to 6% of national health expenditure in developed countries, and approximately 2% of gross domestic product in Canada. Most evidence on the impact of smoking focuses on the general population, whereas the impact of smoking on specific disease populations (i.e., cancer patients) could be just as significant.
Smoking is the main modifiable cancer risk factor. The economic burden of cancer in Canada was estimated at
$7.5 billion in 2012, and almost 50% of that could be attributed to smoking. Smoking contributes to approximately 30% of all cancer deaths and is the major cause of lung cancer incidence and mortality. Quitting smoking after a diagnosis of cancer has been associated with improved general health, better quality of life, reduced toxicity, greater response to treatment (such as radiation therapy), and decreased risk of disease recurrence and second primary cancers. Nevertheless, cancer patients are just as likely to smoke as the general public (with the smoking rate being approximately 20%), and smoking cessation programs are rare in oncology settings. Given the significant burden of smoking and cancer, we hypothesized that among cancer patients, smoking is associated with higher overall health system cost. Understanding the cost burden in smokers with cancer could identify evidence to inform policy change in cancer prevention and control.
We conducted an economic analysis to examine the impact of smoking on health-care costs among cancer patients. Specifically, we compared the health-care costs of cancer patients who were current smokers and non-smokers between 2014 and 2016, from the perspective of public health-care payer, using administrative databases in Ontario.
This study provides information that can advance our understanding of the economic burden of smoking, which may assist in our effort for cancer prevention and cancer control and identifying opportunities for smoking cessation interventions. Specifically, the findings can support the integration of a prevention intervention, namely smoking cessation programs, into the cancer care and treatment plans, and will support further research in smoking cessation programs that can contribute to the improvement of cancer care and the reduction in morbidity and mortality. The findings will add to the burden evidence which will help decision-makers design appropriate programs to support cancer prevention and control. Smoking status has a significant impact on health-care costs among cancer patients. On average, smokers incurred higher health-care costs than non-smokers. These findings support the need for evidence-based smoking cessation programs for cancer patients, as they have the potential to improve patients’ outcomes and reduce the economic burden of smoking on the health-care system