TY - JOUR

T1 - Effect of a Smoking and Alcohol Cessation Intervention Initiated Shortly Before Radical Cystectomy — the STOP-OP Study

T2 - A Randomised Clinical Trial

AU - Lauridsen, Susanne Vahr

AU - Thomsen, Thordis

AU - Jensen, Jørgen Bjerggaard

AU - Kallemose, Thomas

AU - Schmidt Behrend, Monika

AU - Steffensen, Kirsten

AU - Poulsen, Alicia Martin

AU - Jacobsen, André

AU - Walther, Lisa

AU - Isaksson, Anders

AU - Thind, Peter

AU - Tønnesen, Hanne

N1 - Publisher Copyright: © 2022 The Author(s)

PY - 2022

Y1 - 2022

N2 - Background: Evidence concerning the reduction of postoperative complications due to smoking and alcohol drinking in patients undergoing radical cystectomy is incomplete. Objective: To evaluate the efficacy of a 6-wk smoking and/or alcohol cessation intervention, initiated shortly before surgery and continued until 4 wk after, in reducing complications. Design, setting, and participants: Between 2014 and 2018, we enrolled 104 patients with high-risk bladder cancer who were daily smokers or consuming at least 3 units of alcohol daily in a multicentre randomised clinical trial. Intervention: Patients were randomised to a 6-wk intensive smoking and/or alcohol cessation intervention or treatment as usual. Outcome measurements and statistical analysis: The primary endpoint was the number of patients developing any postoperative complication, or death, within 30 d after surgery. The secondary endpoints were successful quitters, health-related quality of life, length of stay, time back to habitual activity, and mortality. An intention-to-treat analysis was applied to evaluate treatment effect. Results and limitations: There were some differences in baseline demographic and lifestyle characteristics. Postoperatively, 64% in the intervention group versus 70% in the control group (risk ratio [RR] 0.91, confidence interval [CI] 0.68–1.21, p = 0.51) developed complications. Significantly fewer patients developed three or more complications after 30 d (RR 0.39; CI 0.18–0.84, p = 0.01). The rates of successful quitting were 51% in the intervention group and 27% in the control group (RR 2, CI 1.14–3.51, p = 0.01). The external validity of this trial may be limited because 53% of eligible patients refused participation. Conclusions: Despite a significant effect on the quit rate at completion of the intervention, this multimodal prehabilitation did not show a significant difference regarding our primary outcome postoperative complications. Patient summary: A 6-wk smoking and alcohol cessation intervention in relation to bladder cancer surgery did not reduce postoperative complications, but it was effective in supporting people to quit in the short term.

AB - Background: Evidence concerning the reduction of postoperative complications due to smoking and alcohol drinking in patients undergoing radical cystectomy is incomplete. Objective: To evaluate the efficacy of a 6-wk smoking and/or alcohol cessation intervention, initiated shortly before surgery and continued until 4 wk after, in reducing complications. Design, setting, and participants: Between 2014 and 2018, we enrolled 104 patients with high-risk bladder cancer who were daily smokers or consuming at least 3 units of alcohol daily in a multicentre randomised clinical trial. Intervention: Patients were randomised to a 6-wk intensive smoking and/or alcohol cessation intervention or treatment as usual. Outcome measurements and statistical analysis: The primary endpoint was the number of patients developing any postoperative complication, or death, within 30 d after surgery. The secondary endpoints were successful quitters, health-related quality of life, length of stay, time back to habitual activity, and mortality. An intention-to-treat analysis was applied to evaluate treatment effect. Results and limitations: There were some differences in baseline demographic and lifestyle characteristics. Postoperatively, 64% in the intervention group versus 70% in the control group (risk ratio [RR] 0.91, confidence interval [CI] 0.68–1.21, p = 0.51) developed complications. Significantly fewer patients developed three or more complications after 30 d (RR 0.39; CI 0.18–0.84, p = 0.01). The rates of successful quitting were 51% in the intervention group and 27% in the control group (RR 2, CI 1.14–3.51, p = 0.01). The external validity of this trial may be limited because 53% of eligible patients refused participation. Conclusions: Despite a significant effect on the quit rate at completion of the intervention, this multimodal prehabilitation did not show a significant difference regarding our primary outcome postoperative complications. Patient summary: A 6-wk smoking and alcohol cessation intervention in relation to bladder cancer surgery did not reduce postoperative complications, but it was effective in supporting people to quit in the short term.

KW - Alcohol drinking

KW - Bladder cancer

KW - Postoperative complications

KW - Radical cystectomy

KW - Smoking

KW - Surgery

U2 - 10.1016/j.euf.2022.02.005

DO - 10.1016/j.euf.2022.02.005

M3 - Journal article

C2 - 35241394

AN - SCOPUS:85125435836

VL - 8

SP - 1650

EP - 1658

JO - European Urology Focus

JF - European Urology Focus

SN - 2405-4569

IS - 6

ER -