Influence of Gender and Age on the Willingness to Reduce Nicotine Consumption—Results of a Survey in Urological Cancer Patients (KRAUT Study)

Published:August 10, 2018DOI:



      Our objective was to investigate whether patients with urologic tumors were aware of smoking as a risk factor for the development and progression of several urologic cancers and the extent of the medical education they had received. Another aim was to investigate whether gender or age influenced patients’ willingness to change their smoking habits.

      Materials and Methods

      Patients with histologically malignant urologic tumors were enrolled in our questionnaire-based study from September 2013 to December 2014 in 2 urology departments. Patients were asked about their smoking habits and their general understanding of the relationship between smoking and the onset of cancer (urologic cancer and lung cancer). Also, the extent of information they had acquired from a physician was assessed. The descriptive and oncologic data of the patients were recorded.


      Of 258 enrolled patients, 186 (72.1%) had never had an informational discussion with a doctor about smoking and their urologic tumor disease. Of the 160 active and former smokers, only 45 (28.1%) were planning to stop or reduce smoking because of their tumor disease. The willingness to change smoking habits was greater for women, with a statistically significant difference (odds ratio, 5.59; P = .002). Younger patients aged <58 years were also more willing to reduce or stop smoking.


      In our study, most patients with urologic cancer were unaware of smoking as the most probable cause of tumor development. The patients had not received proper counseling from doctors on smoking and the risk it poses for tumor progression. Efforts to balance compliance among the genders and age groups through risk-adapted counseling should be undertaken.


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        • Agudo A.
        • Bonet C.
        • Travier N.
        • et al.
        Impact of cigarette smoking on cancer risk in the European prospective investigation into cancer and nutrition study.
        J Clin Oncol. 2012; 30: 4550-4557
        • Daling J.R.
        • Sherman K.J.
        • Hislop T.G.
        • et al.
        Cigarette smoking and the risk of anogenital cancer.
        Am J Epidemiol. 1992; 135: 180-189
        • Burger M.
        • Catto J.W.F.
        • Dalbagni G.
        • et al.
        Epidemiology and risk factors of urothelial bladder cancer.
        Eur Urol. 2013; 63: 234-241
        • Lammers R.J.M.
        • Witjes W.P.J.
        • Hendricksen K.
        • et al.
        Smoking status is a risk factor for recurrence after transurethral resection of non-muscle-invasive bladder cancer.
        Eur Urol. 2011; 60: 713-720
        • van Osch F.H.M.
        • Jochems S.H.J.
        • van Schooten F.J.
        • et al.
        Significant role of lifetime cigarette smoking in worsening bladder cancer and upper tract urothelial carcinoma prognosis: a meta-analysis.
        J Urol. 2016; 195: 872-879
        • Huncharek M.
        • Haddock K.S.
        • Reid R.
        • et al.
        Smoking as a risk factor for prostate cancer: a meta-analysis of 24 prospective cohort studies.
        Am J Public Health. 2010; 100: 693-701
        • Islami F.
        • Moreira D.M.
        • Boffetta P.
        • et al.
        A systematic review and meta-analysis of tobacco use and prostate cancer mortality and incidence in prospective cohort studies.
        Eur Urol. 2014; 66: 1054-1064
        • Rieken M.
        • Shariat S.F.
        • Kluth L.A.
        • et al.
        Association of cigarette smoking and smoking cessation with biochemical recurrence of prostate cancer in patients treated with radical prostatectomy.
        Eur Urol. 2015; 68: 949-956
        • Froehner M.
        • Koch R.
        • Heberling U.
        • et al.
        An easily applicable single condition-based mortality index for patients undergoing radical prostatectomy or radical cystectomy.
        Urol Oncol. 2016; 35: 32.e17-32.e23
        • Ogunmoroti O.
        • Allen N.B.
        • Cushman M.
        • et al.
        Association between life's simple 7 and noncardiovascular disease: the multi-ethnic study of atherosclerosis.
        J Am Heart Assoc. 2016; 5: 1-17
        • Miao C.
        • Bao M.
        • Xing A.
        • et al.
        Cardiovascular health score and the risk of cardiovascular diseases.
        PLoS One. 2015; 10: e0131537
        • Deaton C.
        • Froelicher E.S.
        • Wu L.H.
        • et al.
        The global burden of cardiovascular disease.
        Eur J Cardiovasc Nurs. 2011; 10: 5-13
        • Guzzo T.J.
        • Hockenberry M.S.
        • Mucksavage P.
        • et al.
        Smoking knowledge assessment and cessation trends in patients with bladder cancer presenting to a tertiary referral center.
        Urology. 2012; 79: 166-171
        • Westhoff E.
        • de Oliveira-Neumayer M.J.
        • Aben K.K.
        • et al.
        Low awareness of risk factors among bladder cancer survivors: new evidence and a literature overview.
        Eur J Cancer. 2016; 60: 136-145
        • Bassett J.C.
        • Gore J.L.
        • Kwan L.
        • et al.
        Knowledge of the harms of tobacco use among patients with bladder cancer.
        Cancer. 2014; 120: 3914-3922
        • Anastasiou I.
        • Mygdalis V.
        • Mihalakis A.
        • et al.
        Patient awareness of smoking as a risk factor for bladder cancer.
        Int Urol Nephrol. 2010; 42: 309-314
        • Nieder A.M.
        • John S.
        • Messina C.R.
        • et al.
        Are patients aware of the association between smoking and bladder cancer?.
        J Urol. 2006; 176: 2405-2408
        • Dearing J.
        Disease-centred advice for patients with superficial transitional cell carcinoma of the bladder.
        Ann R Coll Surg Engl. 2005; 87: 85-87
        • Yuruk E.
        • Tuken M.
        • Colakerol A.
        • et al.
        The awareness of patients with non-muscle invasive bladder cancer regarding the importance of smoking cessation and their access to smoking cessation programs.
        Int Braz J Urol. 2017; 43: 607-614
        • May M.
        • Gilfrich C.
        • Spachmann P.
        • et al.
        Was wissen Patienten mit einem Prostatakarzinom über das Rauchen? Ergebnisse einer bizentrischen Fragebogenstudie (KRAUT-Studie) [What do prostate cancer patients know about smoking? Results of a bicentric questionnaire study (KRAUT study)].
        Urologe A. 2016; 55 ([German]): 1078-1085
        • Bowling A.
        Mode of questionnaire administration can have serious effects on data quality.
        J Public Health. 2005; 27: 281-291
        • May M.
        • Fritsche H.M.
        • Gilfrich C.
        • et al.
        What do patients with urothelial cancer know about the association of their tumor disease with smoking habits? Results of a German survey study.
        Investig Clin Urol. 2018; 59: 91-97