Abstract
PURPOSE: Identifying tobacco products use (TPU) patterns among cancer survivors (CSs) is critical to optimize survivorship care. This study examines exclusive cigarette/e-cigarette, dual (two tobacco-products) and poly (≥ 3 tobacco-products) use among CSs (vs. no cancer history) and its sub-types: smoking-related-cancers (SRCs) vs. non-smoking-related cancers (NSRCs) while also exploring socio-demographic factors. METHODS: The study analyzed 86,551 adults from the 2021-2023 National Health Interview Survey, including 10,846 (9.7%) CSs. Participants were categorized and analyzed based on their CSs status and TPU patterns. Weighted logistic regression models assessed the relationship between TPU and CSs status while adjusting for socio-demographic characteristics. RESULTS: CSs (vs. no cancer history) had a higher likelihood of ever-poly (aOR:1.24, 95%CI: 1.15-1.33), former-cigarette-only (aOR:1.22, 95%CI: 1.13-1.32), and former-dual (aOR:1.21, 95%CI: 1.14-1.29) use. SRC survivors had greater odds of being current-cigarette-only (aOR:2.26, 95%CI: 1.63-3.11), ever e-cigarette-only (aOR:3.41, 95%CI: 1.51-7.70), and ever-poly (aOR:1.32, 95%CI: 1.11-1.57) use than NSRC survivors. Among CSs, being male, single after marriage, or having lower educational attainment was linked to higher odds of exclusive, dual, or poly-tobacco use. CSs aged over 44 years had lower odds of being dual or ever-poly users compared to younger adults. CONCLUSION: Disparities in TPU among CSs particularly between SRC and NSRC survivors calls for proactive cessation support. Oncologists must account for patients' former and current TPU pattern, related perceptions, and socio-demographic barriers in cessation by systematically incorporating tailored and integrated counseling into routine oncology visits. IMPLICATIONS FOR CANCER SURVIVORS: Persistent disparities in tobacco product use requires tailored cessation support in routine oncology visits.