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"Enough is enough" at MUSC tobacco conference

Helen Adams | MUSC News Center | November 7, 2014

Sarah Pack

More than 16 million American suffer from a disease caused by smoking. 

There’s a reason Graham Warren, M.D. Ph.D, seemed so passionate during his talk “Addressing Tobacco Use in Cancer Patients” at last week’s Scientific Retreat on Tobacco-Related Research at the Medical University of South Carolina.

The effect of smoking on cancer treatment is clear, he said. “We don’t need to identify the problem anymore. We need solutions.”

That was a recurring theme at the retreat hosted by the South Carolina Clinical & Translational Research Institute. The event included the chief of the American Cancer Society, the head of the Office on Smoking and Health from the Centers for Disease Control and Prevention, a senior representative from CVS (which recently stopped selling tobacco), the senior editor of the 2014 Surgeon General’s Report on Tobacco and other leaders in the fields of tobacco, cancer and addiction research.

Graham Warren 
Dr. Graham Warren said smoking affects how well cancer treatments work. 

Warren, a vice chairman of research in Radiation Oncology at MUSC and a contributor to the latest Surgeon General’s Report, said there is no longer any question that smoking makes costly cancer treatments less effective by increasing treatment toxicity, the rate of cancer recurrence and the risk for second primary cancer (a new cancer unrelated to the original primary cancer).

The 2014 Surgeon General's Report concluded: “Quitting smoking improves the prognosis of cancer patients.”

Two other MUSC researchers also contributed to the Surgeon General's Report. One, Anthony Alberg, Ph.D., is interim director of the Hollings Cancer Center and a professor in the Department of Public Health Sciences. The other, K. Michael Cummings, Ph.D., is co-director of the Tobacco Policy and Control Program at MUSC’s Hollings Cancer Center and professor of psychiatry and behavioral Sciences. Cummings is known as one of the world’s leading authorities on tobacco policy.

Posters at the Tobacco Retreat 
Researchers shared their findings at the tobacco retreat. 

In two other reports published earlier this year in Cancer, the journal of the American Cancer Society, Warren and colleagues called the findings from the Surgeon General’s Report a “paradigm shift” in cancer care, showing the importance of making smoking cessation programs standard practice for cancer patients.

Too many doctors either aren’t hearing that message or are failing to share it with patients. In work published in the November issue of The Lancet Oncology, Warren wrote that while most cancer doctors ask if their patients use tobacco, less than half help patients quit smoking.

Warren, who spoke at the MUSC tobacco retreat as both a researcher and director of the Tobacco Assessment and Cessation Service at the Hollings Cancer Center, said smokers diagnosed with cancer shouldn’t just give up on improving their health and continue smoking. He studied cancer patients who quit using tobacco and found they lived longer than patients who kept smoking.

“It’s not too late to quit. This is something we can do that makes a difference for our patients.”

Warren said that the effects of smoking apply to all cancer patients, not just those with smoking-related cancers.

Audience at tobacco retreat 
William Fulcher of CVS Caremark talks about his company's decision to stop selling tobacco. 

“If you take a look at some of the effects of smoking on overall mortality in people with cancer, current smoking increased overall mortality by a median of 51  percent,” Warren said. “It increased cancer-related mortality by a median of 61 percent.”

The health and financial implications are huge. In South Carolina, an estimated 9,950 people are expected to die of cancer in 2014. Cancer-fighting drugs can cost more than $100,000 per year, with patients picking up part of the cost through copayments through their insurance companies.

So when Warren talked about boosting the effectiveness of cancer treatment by getting tobacco users into smoking cessation programs, he caught the attention of a representative of CVS who was in the audience.

William Fulcher, a medical doctor who serves as CVS Caremark’s vice president of clinical affairs, said CVS might consider cutting copays for cancer medication for patients who quit using tobacco. That could make a big difference for a customer who has a 20 or 30 percent copay on a $100,000 cancer treatment regimen.

“This is exactly what our next step needs to be,” Warren said after the conference. “Gaining the support of a national health care leader like CVS provides an enormous opportunity for us to significantly improve the health outcomes for cancer patients across the nation.”

What follows are other highlights from speakers at the MUSC conference.

William Fulcher, M.D., Vice President of Clinical Affairs, CVS Caremark




"It's depressing that we're not encouraging more smokers to quit."



Fulcher said CVS’s decision to quit selling tobacco products and start promoting smoking cessation programs would cost a billion dollars in revenue – but it was worth it.

Jonathan Samet, M.D., Senior Scientific Editor of the 2014 Surgeon General’s Report, Distinguished University Professor and Chair of the Department of Preventive Medicine at the University of Southern California.

Jonathan Samet  



“Enough is enough. We’ve made progress, but we have to keep at this.”



Samet discussed the history of surgeons general reports from 1964 to 2014. He also called for higher tobacco taxes, less nicotine in cigarettes and public awareness about the potential danger of e-cigarettes.

John R. Seffrin, Ph.D., Chief Executive Officer of the American Cancer Society.

John R. Seffrin, American Cancer Society 




“We must begin to treat the tobacco industry as the convicted racketeers they are.”



Seffrin said the tobacco industry should be outlawed or “regulated absolutely,” calling for “massive and aggressive advocacy.”

Timothy McAfee, M.D., Director of the Centers for Disease Control and Prevention Office on Smoking and Health



“As worrisome as Ebola is, it pales next to 1,000 deaths a day from tobacco.”




McAfee called for the amount of nicotine in cigarettes to be reduced to non-addictive levels. (The five-year-old Family Smoking Prevention and Tobacco Control Act empowers the Food and Drug Administration to institute tobacco control measures as it sees fit, including the reduction of nicotine levels in cigarettes to below addictive levels.) McAfee also said five of his staff members are risking their lives in West Africa to fight Ebola while people in this country “ignore” a much higher death rate linked to tobacco use.

Peter Kalivas, Ph.D., Distinguished University Professor, Research Chairman in the Department of Neurosciences at MUSC’s College of Medicine

Peter Kalivas 


“Their brain has been changed. Can we pharmacologically reverse that? I think we can. We can actually target a key change that is produced by addictive drugs and normalize those synapses."



Kalivas’s speech “Why we can’t stop using drugs” focused on research showing what happens in the brains of people addicted to harmful substances.



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