Smoking Cessation for Cancer Patients

By Alanna Kennedy

No Matter Your Cancer, Smoking Isn't Good

So why is it so hard to quit?

By Alanna Kennedy

When most people think about smoking and cancer, lung cancer comes to mind. But how many of us are aware of mounting evidence that illustrates the detrimental effects of smoking on cancer treatment, regardless of a patient's type of cancer?

Smoking during treatment can cause a bevy of complications, says Ellen R. Gritz, a behavioral scientist at the University of Texas M. D. Anderson Cancer Center in Houston. Smoking can cause problems with surgery, such as complications with anesthesia and breathing, she says. It can also hinder the healing of a wound after surgery. "Those risks and complications are always there, but they are higher in smokers," says Gritz.

Smoking can also affect radiation treatment. "A number of studies have shown that [radiation treatment] itself is less effective in smokers, and the toxicities—the side effects—are worse," says Gritz. "There is also evidence that smokers do not do as well in their long-term survival as do people who have quit smoking."

"The bottom line," she says, "is that every patient smoking at the time of diagnosis can do themselves a lot of good ... by stopping." Quitting smoking can also be a way for cancer patients to participate in their own treatment, she adds.

Nevertheless, it can be hard to quit smoking—especially after a diagnosis of cancer. Many cancer patients find it tough because they're addicted to nicotine and they smoke to cope with negative feelings, says Janice A. Blalock, the assistant director of the Tobacco Research and Treatment Program at M. D. Anderson. "To ask them to quit smoking at probably the most stressful time in their lives is challenging," she says.

"Nicotine is a highly addictive drug," says Gritz. By the time you're addicted, "you're not thinking about it or the potential harm that could come." People should never blame themselves for being smokers, she says. Instead, they should focus their energy on quitting.

Kicking the habit is far from easy, but there are options that can improve one's chances of success. Both Gritz and Blalock emphasize the effectiveness of nicotine replacement products such as nicotine patches, gum and lozenges.

Smokers should also consider medication such as the antidepressant Zyban or Wellbutrin (bupropion). Patients shouldn't hesitate to work with their doctors to try these different medications, because they double the likelihood of quitting, says Blalock. For those patients with a particularly strong addiction, combining these therapies may be helpful.

Quitting isn't a task that patients should try to go through alone. Blalock suggests seeking out a support group and using telephone quit-lines. The website can help you find telephone support in your state.

Gritz also points out that health care providers need to be proactive about helping smokers quit. "Every physician should ask every patient at every visit if they are a smoker and assess whether they have tried to quit or not," she says. For patients who are currently smoking or go back and forth, the mere act of a doctor assessing their smoking shows that quitting is really important to them and their treatment.

Thomas J. Touzel, a bladder cancer patient and former smoker, knows this firsthand. During a smoking cessation study he participated in at M. D. Anderson, he received encouragement from Blalock and her colleagues that he cited as instrumental to his success. "I was diagnosed in January and .... I went to M. D. Anderson in June, and that was the first time anyone said to me, ‘You should quit smoking,' " he says. "I decided then that I wanted to quit."

As Touzel discovered, lung cancer isn't the only reason smokers need encouragement to quit. "I knew about lung cancer and for the last 20 years I was [insistent] on getting myself screened [for it]," he says. Meanwhile, he was unaware of the impact of smoking on other cancers.

Assistance from family members is also vital. "If a patient is trying to quit and family members smoke in front of them ... it is really hard for someone to stop," says Gritz. "It would be a great time for everyone to quit together and support each other."  CR endbox