Peter G. Shields, MD
Deputy Director, The Ohio State University Comprehensive Cancer Center
Thoracic Oncologist, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
Smoking among cancer patients remains a significant and concerning problem that the oncology community has traditionally struggled to overcome. Although the entire medical community recognizes the importance of smoking cessation— both for cancer prevention and cardiopulmonary health—supporting patients in their efforts to cease smoking is generally not done well.
Nationwide, it is estimated that up to 30% of smokers who receive a cancer diagnosis, depending on the cancer type, continue to use tobacco despite all the scientifically backed arguments we throw at them for why ditching the habit is the only logical choice. In my lung cancer practice, about 50% of my patients are still smoking when they begin treatment.
But that is the thing about tobacco use: Choosing to use tobacco is not a decision based in logic. First and foremost, it is important for all of us who treat patients with cancer to acknowledge that tobacco addiction is a real and difficult phenomenon to overcome. For many people, smoking is a lifelong habit that provides comfort and stress relief. We are asking them to abandon this habit—immediately and completely—at one of the most stressful times of their lives: being diagnosed with cancer.
The habit becomes an addiction and to overcome this addiction many smokers will need pharmacotherapy and at least brief counseling to achieve longterm quitting. It also requires a dual commitment of accountability with both the patient and the treating medical team.
This is where the medical community has failed to support patients in eliminating one of the most common causes of preventable death worldwide—and the oncology community has the opportunity to lead changes in practice that could result in thousands of lives being saved each year.Implications for Cancer Treatment
Tobacco-related diseases are the most preventable cause of death worldwide. Smoking cessation leads to improvement of cancer treatment outcomes as well as decreased recurrence and reduced toxicity. It is estimated that more than 25% of the cancer related deaths in the United States will be caused by tobacco smoking.1
In the cancer patient population specifically, science has shown us that smokers with cancer have a high level of dependence and smoking cessation leads to improvement in cancer treatment effectiveness and decreased recurrence. Published data illustrate that smoking influences the metabolism of chemotherapy and certain targeted agents by altering drug clearance time and plasma concentration, which can potentially impact drug efficacy. Smoking is also known to increase the risk of radiation therapy– associated treatment complications and decrease treatment response. The habit is also associated with increased risk of postoperative complications and mortality after surgery, including more pain/fatigue when compared with nonsmokers, impaired wound healing, increased infection rate, and pulmonary complications.2-4New NCCN Guidelines
Recognizing a critical gap in support for patients with cancer and an opportunity to prevent future cancers, the National Comprehensive Cancer Network (NCCN) published the first evidence-based NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Smoking Cessation in a cancer patient population in March 2015.
The intention of the NCCN Guidelines Panel for Smoking Cessation, which I chaired, was to give oncologists a roadmap for successfully supporting patients in their tobacco cessation goals. The guidelines are a strong start, but every institution’s clinical model runs differently. To successfully integrate smoking cessation as an integral component of the care model, oncology teams will need dedicated staff and resources and an operational plan to make the smoking cessation services an easy-to-implement priority versus an afterthought.Cessation Plan Elements