Original Study
Exercise Decreases and Smoking Increases Bladder Cancer Mortality

https://doi.org/10.1016/j.clgc.2016.11.006Get rights and content

Abstract

Background

The aim of this study was to investigate modifiable lifestyle factors of smoking, exercise, and obesity with bladder cancer mortality.

Patients and Methods

We used mortality-linked data from the National Health Information Survey from 1998 through 2006. The primary outcome was bladder cancer-specific mortality. The primary exposures were self-reported smoking status (never- vs. former vs. current smoker), self-reported exercise (dichotomized as “did no exercise” vs. “light, moderate, or vigorous exercise in ≥ 10-minute bouts”), and body mass index. We utilized multivariable adjusted Cox proportional hazards regression models, with delayed entry to account for age at survey interview.

Results

Complete data were available on 222,163 participants, of whom 96,715 (44%) were men and 146,014 (66%) were non-Hispanic whites, and among whom we identified 83 bladder cancer-specific deaths. In multivariate analyses, individuals who reported any exercise were 47% less likely (adjusted hazard ratio [HRadj], 0.53; 95% confidence interval [CI], 0.29-0.96; P = .038) to die of bladder cancer than “no exercise”. Compared with never-smokers, current (HRadj, 4.24; 95% CI, 1.89-9.65; P = .001) and former (HRadj, 2.95; 95% CI, 1.50-5.79; P = .002) smokers were 4 and 3 times more likely, respectively, to die of bladder cancer. There were no significant associations of body mass index with bladder cancer mortality.

Conclusion

Exercise decreases and current smoking increases the risk of bladder cancer-specific mortality. These data suggest that exercise and smoking cessation interventions may reduce bladder cancer death.

Introduction

Bladder cancer is the seventh most common cancer in the world and accounts for approximately 50,000 deaths a year in the United States (US) and European Union.1 The US population prevalence is estimated to be at least 600,000 individuals and continues to grow annually.2, 3 Bladder cancer is the fourth most frequently diagnosed cancer among men and—owing to the high costs of diagnosis, treatment, and posttreatment surveillance—the single most expensive cancer to treat.4 These observations underscore the considerable challenges that bladder cancer poses to the public health and highlight an important need to develop innovative, novel therapies.

A potential method of decreasing the morbidity and mortality of bladder cancer is through behavior change interventions focused on modifiable risk factors. Modulation of lifestyle factors—for example, exercise, weight loss, and diet change—may exert beneficial, disease-specific health effects.5, 6, 7, 8 Smoking is strongly associated with increased bladder cancer incidence, and smoking cessation is a potential target for improving outcomes in patients with bladder cancer.9, 10, 11 However, other modifiable risk factors, such as obesity12, 13, 14, 15 and exercise,16, 17, 18, 19 also may play important roles in bladder cancer outcomes. Therefore, we investigated associations of obesity, physical activity, and smoking with bladder cancer mortality in the National Health Information Survey (NHIS).

Section snippets

NHIS

The NHIS is the primary source of information on the United States population conducted by the National Center for Health Statistics as part of the Centers for Disease Control and Prevention. The annual survey provides information regarding illness and disability since the National Health Survey Act of 1956. The NHIS is an annual representative cross-sectional household interview survey of the civilian noninstitutionalized population performed in the US (//www.cdc.gov/nchs/nhis/about_nhis.htm

Results

Complete data were available on 222,163 participants, of whom 96,715 (44%) were men and 146,014 (66%) non-Hispanic whites, and among whom we identified 83 bladder cancer-specific deaths (Table 1). Bladder cancer mortality was noted lowest in those patients who obtained the recommended amount of exercise from the Healthy People 2020 Physical Activity Guidelines as compared with no exercise (0.05%; n = 56 of 116,390 vs. 0.01%; n = 4 of 30,945; P = .006). Figure 1 displays a bar graph for

Discussion

In this study, we observed a 47% decreased risk of bladder cancer death in individuals who reported any form of exercise compared with those who did not exercise. Current and former smokers were 4 and 3 times, respectively, more likely to die of bladder cancer than never-smokers. Therefore, a prospective clinical trial encouraging smoking cessation and physical exercise could provide evidence that behavioral modification may impact bladder cancer outcomes.

Bladder cancer was one of the first

Disclosure

The authors have stated that they have no conflicts of interest.

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