Effect of a Smoking and Alcohol Cessation Intervention Initiated Shortly Before Radical Cystectomy-the STOP-OP Study: A Randomised Clinical Trial

Susanne Vahr Lauridsen*, Thordis Thomsen, Jørgen Bjerggaard Jensen, Thomas Kallemose, Monika Schmidt Behrend, Kirsten Steffensen, Alicia Martin Poulsen, André Jacobsen, Lisa Walther, Anders Isaksson, Peter Thind, Hanne Tønnesen

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

14 Citations (Scopus)
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Abstract

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.

Original languageEnglish
JournalEuropean urology focus
Volume8
Issue number6
Pages (from-to)1650-1658
Number of pages9
ISSN2405-4569
DOIs
Publication statusPublished - Nov 2022

Bibliographical note

Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.

Keywords

  • Alcohol drinking
  • Bladder cancer
  • Postoperative complications
  • Radical cystectomy
  • Smoking
  • Surgery

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