Smoking After a Cancer Diagnosis in Brazil: Divergent Perceptions and Awareness of Tobacco‐Related Harms Among Patients and Caregivers

BACKGROUND: Patients' awareness of tobacco's harms is a key driver for smoking cessation. In Brazil, unique smoking practices-such as straw cigarettes-may influence these views. We hypothesized that cancer patients who continue smoking exhibit an attenuated perception and awareness of tobacco-associated impact on treatment efficacy and survival compared to their primary caregivers. METHODS: Thiscross-sectional study recruited144 active smoker patients with solid cancers and their primary caregivers at a Brazilian public academic hospital. Participants completed a structured questionnaire assessing sociodemographic characteristics, smoking history, perceptions of smoking's impact on quality of life, fatigue and treatment outcomes, and objective awareness of tobacco-related harms. Tumor information was abstracted from medical charts. Groups were compared using chi-square, t-tests, and logistic regression analyses. RESULTS: From 1342 patients approached; 144 (10.9%) active smokers and their caregivers were enrolled. Patients were older (median age 63 vs 51 years), and predominantly male (69%). Among patients, 46% smoked non-manufactured cigarettes (straw, rope, or mixed types). Compared to caregivers, patients exhibited lower scores for both perception (19.8 vs. 23.6; p < 0.001) and awareness (23.0 vs. 25.1; p = 0.02) regarding the harms of continued smoking on both cancer and non-cancer outcomes. Notably, 50% of patients disagreed that smoking adversely affects treatment efficacy, vs. 23% of caregivers (p < 0.001). Only half of both groups reported feeling adequately supported by their medical team to quit smoking. Higher nicotine dependence (Fagerström score; aOR = 2.48, 95% CI: 1.10-5.20) and use of manufactured cigarettes (aOR = 2.36, 95% CI: 1.10-5.10) were independently associated with an improved perception of tobacco harms. CONCLUSIONS: Cancer patients in the Brazilian public health system who continue smoking tend to underestimate tobacco's harms relative to their primary caregivers. Targeted educational interventions and enhanced cessation support are needed to improve cancer care outcomes.