Helping Cancer Patients Quit Smoking Should Be a Standard of Care

Graham W. Warren, MD, PhD and K. Michael Cummings, PhD, MPH
Published: Monday, Mar 30, 2015
Overwhelming evidence presented in the 2014 Surgeon General’s Report resulted in the conclusion that smoking causes adverse outcomes in patients with cancer.1 Current smoking increases risk for overall mortality by a median of 51% and increases the risk of cancer-specific mortality by a median of 61%. Smoking further increases the risk of developing a second primary cancer and has strong associations with an increased risk of toxicity from cancer treatment. One or more adverse effects of smoking are noted across virtually all cancer disease sites and for all treatment modalities including surgery, radiotherapy, and systemic therapy.

Andre Goy, MD, MS

Graham W. Warren, MD, PhD

Associate Professor

Vice Chairman for Research

Department of Radiation Oncology

Hollings Cancer Center
Medical University of South Carolina
Charleston, SC

Yet despite these data, most oncologists do not regularly provide evidence-based tobacco cessation support for patients with cancer who smoke.2 Some of the reasons that oncologists do not offer this support include not feeling confident in their ability to assist their patients in stopping smoking, a lack of time, and a lack of available resources.3

However, addressing tobacco use by patients with cancer is not as difficult as some might think. Established evidence-based guidelines are available4 and online resources have been developed specifically for use by clinical oncologists.5 Recent reviews have discussed methods to improve cessation support for patients with cancer that basically rely upon asking patients about tobacco use, advising patients to quit smoking, and assisting patients in quitting smoking using principles of behavioral counseling and pharmacotherapy.6,7 Physicians and other clinical providers can directly assist patients with cessation support or can refer patients to resources such as dedicated institutional tobacco cessation programs, state help line services, or specialized counselors who can be integrated into a busy oncology clinic.

Recognizing the merits of such efforts, leading cancer organizations such as the American Society of Clinical Oncology, the American Association for Cancer Research, and the International Association for the Study of Lung Cancer have advocated for providing cessation support to all patients with cancer who use tobacco.8-10

Hollings’ Model Reaches All Smokers

Clinicians and researchers at the Hollings Cancer Center (HCC) at the Medical University of South Carolina (MUSC) have seized upon these recommendations to develop a dedicated cessation program to provide assistance to all patients with cancer who use tobacco. Prior work demonstrated that an automated referral process for patients to a dedicated cessation program was very well received by patients,11 with more than 90% expressing an interest in participating in tobacco cessation.

K. Michael Cummings, PhD, MPH

K. Michael Cummings, PhD, MPH

Professor

Psychiatry and Behavioral Sciences

Hollings Cancer Center
Medical University of South Carolina
Charleston, SC

Through this platform, patients are screened for tobacco use using a structured tobacco assessment; all patients identified as using tobacco within 30 days of assessment are referred for cessation support, and all patients are followed to ensure that they are using recommended evidence-based cessation treatments and making progress toward quitting. Patients can opt out of the tobacco cessation program, but the service is offered to all patients as a standard of care.

Patients are contacted by a trained cessation counselor who discusses the adverse effects of smoking on their cancer treatment and the need to quit smoking as an important part of their cancer care. Patients are then further assessed for how ready they are to quit using tobacco, what problems they have in quitting, what behaviors they can change, and what medications are needed to help them quit. An individualized tobacco cessation treatment plan is developed, and patients are followed to help ensure that they are able to maintain a successful quit attempt.


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