One would think that a diagnosis of cancer is all a smoker needs in order to be motivated to quit. Unfortunately, in many cases this logic would be wrong. Although smoking is responsible for one-third of all cancer deaths, one-half to four-fifths of cancer patients who smoke continue to do so after diagnosis.
As Sonia Duffy, PhD, and colleagues report in a recent review, cancer patients who smoke confront even more barriers to quitting than other smokers. “I think what surprised me when I did the review,” Duffy said, “was the multitude of issues that cancer patients face, and that there are so many variables affecting why they don’t get treatment, and if they do get treatment, why they may not respond. Nicotine addiction, health issues, emotional issues, psychological issues and system level issues are all in the way.” Cancer patients who are unmarried, uninsured, or depressed are particularly likely not to quit.
Unfortunately, cancer patients who smoke often do not get the push they need from their physicians: most oncologists provide no smoking interventions other than advising patients to quit. Oncology nurses, however, may be better positioned to help patients stop smoking. As Duffy et al point out, oncology nurses are skilled educators who have access to patients and considerably more time available than oncologists to offer psychosocial interventions. Additionally, a systematic review of clinical trials found that high-intensity interventions provided by nurses who are directly involved in patient care significantly increases the likelihood of a patient quitting.
Targeting education on tobacco use to a cancer patient’s immediate situation is more effective than providing general information about the health hazards of smoking. Everyone knows that smoking is bad for health, but many are unaware that smoking reduces the effectiveness of cancer treatment, increases the risk of cancer recurrence and secondary cancer, and shortens survival.
Hospitalization is an ideal time to provide smoking cessation intervention because patients may be more motivated while undergoing treatment, are monitored and less liable to skip intervention sessions, and may have temporarily quit because of hospital smoking policy. Intervention programs that begin in the hospital and follow patients for at least a month after discharge have been shown to improve rates of smoking cessation 1 year later. In-hospital stop-smoking programs may be particularly effective in surgical patients.
Community-based programs have also shown some success in helping people who want to quit smoking. Many states have 1-800-QUIT-NOW helplines, which have been shown to significantly improve smoking cessation rates in a real-world setting for periods up to a year, and the American Cancer Society offers a web-based Guide to Quitting Smoking.
Duffy et al offer specific advice to providers to help patients stop smoking. The key educational moment for cancer patients is immediately after their diagnosis. Many patients may assume that because they have cancer, there is little point to their quitting. Teaching them about the improved treatment outcomes, especially improved survival, that they may achieve if they quit smoking can help provide the motivation they lack. Patients with little confidence of success in quitting, and patients who are overconfident that they can quit on their own, should be referred to smoking cessation programs. Interventions should focus on identifying smoking triggers, preparing for high-risk situations, managing withdrawal and quitting-related stress, and setting a quit date. All patients should be evaluated for drug therapy, including nicotine replacement, bupropion, and varenicline, although each drug has contraindications to consider. Regular follow-up, either with the patient’s provider or through a telephone helpline, is essential. If possible, the patient’s family should be part of the process, and encouraged to quit if they too smoke.
Readers, we want to hear from you!
- Do you provide smoking cessation advice to patients?
- Have you been successful in helping patients quit smoking?