Smoking cessation in cancer patients

Nov 28 2005

A new report says despite a growing body of evidence that continued smoking after a cancer diagnosis has substantial adverse effects on treatment effectiveness, overall survival, risk of other cancers, and quality of life, up to one-half of cancer patients who smoke continue to do so or relapse after trying to quit.

The report, published in the January 1, 2006 issue of CANCER, a peer-reviewed journal of the American Cancer Society, says smoking cessation is an underutilized tool in cancer management and that healthcare providers often fail to advise smokers to quit.

The health risks of smoking are well understood. Smoking is linked to many primary diseases, such as cancer and respiratory diseases. In patients diagnosed with cancer, smoking is also associated with poor treatment outcomes, according to recent investigations. Despite these risks, up to half of smokers with cancer continue to smoke or relapse. Treatment for this addiction has largely been focused on healthy smokers and is critically dependent on smoker motivation. The diagnosis of cancer, according to research, is a strong motivator for many smokers and thus, provides a window of opportunity to begin treatment for smoking addiction.

Led by Ellen R. Gritz, Ph.D., of The University of Texas M. D. Anderson Cancer Center in Houston, researchers reviewed the scientific literature to provide a comprehensive overview of smoking cessation and cancer, in particular, guidelines and evidence-based treatment for smoking addiction.

They found that the literature provides ample evidence that patients who quit smoking around the time of diagnosis have improved disease outcomes compared to those who continue to smoke. The efficacy of cancer treatments may be reduced in continuing smokers, side effects of treatment may be exacerbated, and survival rates are lower. Quality of life (QOL) is also better in nonsmokers. For example, multiple studies found that compared to nonsmokers, current smokers had significantly worse physical and psychological daily functioning.

Clinical guidelines for generalized smoking cessation intervention strategies from the U.S. Department of Health and Human Services are available, but the diagnosis of cancer presents complex physical and emotional challenges to applying tools in the guidelines to cancer patients who smoke. For example, certain pharmacotherapies may be contraindicated or co-morbidities, such as depression and/or alcohol use, must be taken into account. Targeted interventions have been designed to combine elements of behavioral therapy and pharmacotherapy, but only a few studies exist assessing their efficacy. Another shortfall is that these studies, with one exception, target smokers with smoking-related cancers. The common finding was that the healthcare provider has a significant impact on smoking cessation rates. Interventions may have greater impact if begun soon after diagnosis.

Among the authors' recommendations, future studies should be designed to "determine individual barriers to smoking cessation among cancer patients" and treatment trials should "include patients with non-smoking-related cancers." The authors conclude: "cancer patients who are able to stop smoking and remain abstinent after diagnosis and treatment are likely to reap substantial physical and psychological benefits, including improved QOL and prolonged survival."