University of Cincinnati
11/06/2025 | Press release | Distributed by Public on 11/06/2025 08:28
Cancer Center experts publish lung cancer research
Cancer Center experts publish lung cancer research
Studies examine post-surgery opioid use and how smoking and declining surgery affect survival rates
By Tim Tedeschi Email TimEmail Tim 513-556-5694
4 minute read November 6, 2025 Share on facebook Share on Twitter Share on LinkedIn Share on Reddit Print StoryLike
November is Lung Cancer Awareness Month, shedding light on the most common cause of cancer diagnoses and death in the United States. The National Cancer Institute estimates more than 226,000 patients will be diagnosed with lung cancer in 2025, with an estimated five-year survival rate of 28.1%.
Researchers at the University of Cincinnati Cancer Center have recently published research examining how smoking cessation before surgery and declining surgery affect overall survival rates and how new protocols affect postoperative opioid use.
ERAS protocol associated with reduced opioid use
Robert Van Haren, MD. Photo/University of Cincinnati.
New research led by the Cancer Center's Robert M. Van Haren, MD, looked at how a multidisciplinary approach to care before, during and after lung cancer surgery affected patients' short- and long-term opioid use. The research was published in the October 2025 issue of The Annals of Thoracic Surgery.
Corresponding author Van Haren said the Cancer Center's thoracic surgery team implemented what is called an enhanced recovery after surgery (ERAS) protocol in December 2022. ERAS protocols have elements that include patient education, nutrition, early ambulation and prioritizing non-opioid pain management options when possible.
"We previously demonstrated that ERAS improved outcomes in our patients," said Van Haren, a Cancer Center thoracic surgeon, associate professor of surgery in the Division of Thoracic Surgery in UC's College of Medicine, and director of the Department of Surgery's Cincinnati Research in Outcomes and Safety in Surgery (OSS) Laboratory. "This study focused on patients that used opioids preoperatively versus those with no pre-op opioid use."
The research team analyzed 371 patients who underwent lung resection surgery at the Cancer Center from 2016 to 2022.
"An ERAS protocol was associated with reduced opioid use in patients undergoing pulmonary resection regardless of preoperative opioid use status," Van Haren said. "However, a subset of naive users, 11%, had new persistent opioid use despite similar postoperative courses. These results demonstrate that strategies are needed to identify risk factors and to individualize pain management in this population."
Screening can save lives
Current guidelines recommend individuals between 50 to 80 years old who haven't quit smoking within the last 15 years and have at least a 20 "pack year" history should be screened for lung cancer.
A pack year is calculated by multiplying the number of packs of cigarettes smoked per day by the number of years they have smoked, with one pack year equivalent to smoking one pack of cigarettes per day for one year or two packs per day for six months. A 20 pack year history would mean smoking one pack a day for 20 years.
For more information, call 513-585-5864 and select option 1.
Surgery should be offered regardless of smoking status
Approximately 40% of doctors require patients to stop smoking before lung cancer surgery, but Van Haren previously published research that found similar postoperative complications between current and former smokers at the time of lung cancer resection.
In an article published June 2025 in the Annals of Thoracic Surgery Short Reports, Van Haren and colleagues examined outcomes of an additional 862 patients enrolled in the National Lung Screening Trial.
"We found that patients that were current smokers had increased complications but similar mortality after surgery," Van Haren said. "The conclusion remains that surgery should be offered to patients regardless of their smoking status and an individualized risk assessment is needed to determine the best treatment option for patients with lung cancer."
Declining surgery leads to worse survival
Researchers reviewed National Cancer Database data for more than 67,000 adult patients diagnosed with stage 1 and 2 non-small cell lung cancer from 2004 to 2020. The research was published May 2025 in the Annals of Thoracic Surgery Short Reports.
Of the 923 patients who declined surgery, 70.6% received no treatment at all. Overall, patients who decline surgery have worse overall survival. There is a critical need to get more patients with lung cancer to treatment. One potential barrier to surgery is a poor patient-physician relationship.
"We have a pilot grant from the Cancer Center looking at improving patient-physician communication as a way to reduce the number of patients who decline surgery," Van Haren said. "We hope that this work will reduce barriers to care, improve communication and allow more patients to receive treatment for lung cancer."
Featured photo at top of Dr. Van Haren. Photo/Colleen Kelley/University of Cincinnati
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- University of Cincinnati Cancer Center
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