Abstract | March 24, 2024

Qualitative Insights on Bladder Cancer Experiences and Smoking Cessation: A Contemporary Analysis via Reddit

Ryan Wong, BS, Medical Student, 2nd Year, Nova Southeastern University Kiran Patel College of Osteopathic Medicine, Fort Lauderdale, FL

Benjamin J Borgert, MD, Department of Urology, PGY1, University of North Carolina at Chapel Hill, Chapel Hill, NC; Richard S Matulewicz, MD, Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY; Adam O Goldstein, MD, Lineberger Comprehensive Cancer Center, Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Kimberly A Shoenbill, MD, Lineberger Comprehensive Cancer Center, Department of Family Medicine, Program on Health and Clinical Informatics, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Marc A Bjurlin, DO, Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC

Learning Objectives

  1. Describe the potential significance of the identified themes and concepts in tailoring effective smoking cessation discussions for bladder cancer patients
  2. Recognize the application of grounded theory as a qualitative research methodology to analyze user-generated content and identify themes and concepts related to smoking cessation experiences

Background/Knowledge Gap: Motivators and barriers to smoking cessation among bladder cancer (BC) survivors is largely understudied. Using internet forums to assess user discourse is a novel approach to identify patient’s lived experiences of BC and their different avenues to quit smoking. “r/stopsmoking”, a Reddit forum with >155,000 users, is for people who smoke to motivate each other to quit smoking. We aim to qualitatively examine smoking cessation in former and current smokers with connections to BC using Reddit.

Methods: All posts on the subreddit “r/stopsmoking” was queried for “bladder cancer” and associated MeSH terms. Threads with anecdotal experiences on BC and smoking were included for analysis. Original post date, upvotes, and years smoked were extracted. Grounded theory (GT) was used to inductively analyze the original posts. Instead of testing a predefined hypothesis, GT recognizes a research context and lays the groundwork for subsequent research. Two independent reviewers arranged original posts into individual excerpts to identified preliminary themes. These themes were then refined to derive emergent concepts.

Results: 16 BC original posts (0.01%, n ≈ 149,139) by former (n=8) and current (n=8) smokers were evaluated. The number of BC original posts increased over time (R2=0.5 p=0.02). The median number of years smoked was 18 (n=7, IQR: 8-25). GT identified six themes: coping with BC, resilience and determination in the face of relapse, managing multiple medical conditions, fluctuating motivators, emotional release, family health history/habits. Newer posts (5/2020 – 3/2022, n=8) had greater mention of coping with BC compared to older posts (8/2010 – 11/2022, n=8). Original posts with themes of coping with BC had higher upvotes compared to those with themes of emotional release (p=0.02). Three emergent concepts were developed from these themes: BC negatively affects quality of life, smoking cessation relies on a strong support network, BC experience is a motivator for smoking cessation.

Conclusions: This study reveals BC experiences without judgment apprehension. The diagnosis of BC and patients’ shared experiences may serve as catalysts to quit smoking. These themes on BC’s impact on smoking can help guide clinicians to have tailored smoking cessation discussions.

References and Resources

  1. Bjurlin MA, Goble SM, Hollowell CM. Smoking cessation assistance for patients with bladder cancer: a national survey of American urologists. J Urol. 2010 Nov;184(5):1901-6. doi: 10.1016/j.juro.2010.06.140. Epub 2010 Sep 17. PMID: 20846679.
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