A relatively new and compelling body of research about the effects of continued tobacco use by cancer patients has a growing number of physicians and researchers calling for increased tobacco screening and smoking cessation treatment as a standard part of care for cancer patients.
The American Association for Cancer Research this week issued a landmark policy statement calling on the oncology community to provide evidence-based tobacco cessation treatment for all cancer and cancer-screening patients and to evaluate tobacco as a complicating factor in clinical trial outcomes.
Graham Warren, M.D., Ph.D., vice chairman for Research in Radiation Oncology at the MUSC Hollings Cancer Center, said it’s one of the first national organizations to specifically address tobacco use in cancer patients. “A lot of organizations have addressed tobacco use in non-cancer patients, but significant evidence suggests that tobacco use is associated with poor outcomes in cancer patients, and I’m very happy that this has been recognized by such a large organization,” he said.
Though many people recognize that tobacco use increases the risk of developing cancer, they probably fail to realize that continued tobacco use by cancer patients increases the risk of death due to cancer and other causes such as heart disease. “Tobacco use also decreases the effectiveness of cancer treatment, increases the toxicity of cancer treatment, and increases the risk of developing a second cancer,” Warren said.
Warren, a member of the association’s subcommittee on tobacco and cancer, was a contributing author on the policy statement published in Clinical Cancer Research, a prominent journal of the American Association for Cancer Research. He also is lead author on a multi-institutional international report published in March in the Journal of Thoracic Oncology that found that while 90 percent of lung cancer physicians believe tobacco use affects cancer treatment outcomes and that tobacco cessation assistance should be provided, only 40 percent routinely provide that help. Reasons for not providing tobacco cessation help included physicians feeling patients would resist tobacco cessation treatment; and physicians not feeling prepared to offer cessation support to cancer patients.
Warren said the finding was interesting, but not unexpected. Clinicians may be too busy or uncomfortable tackling tobacco cessation with patients. He and colleagues in the next few months are developing a structured tobacco assessment and cessation program at MUSC Hollings Cancer Center to identify tobacco use and provide tobacco cessation support for all cancer patients.
|Dr. Michael Cummings|
Michael Cummings, Ph.D., co-leader of Hollings’ Tobacco Research Section, was a co-author on the journal report. “Cancer patients are often faced with a complex treatment schedule over which they have no control. Tobacco cessation is a very important part of treatment that places some of the control back in the patients’ hands.”
Anthony Alberg, PhD, associate director for Cancer Prevention and Control at Hollings, said the association policy statement and the Journal of Thoracic Oncology study are important steps in identifying tobacco use as a crucial factor in cancer treatment and outcomes.
“Tobacco has adverse effects for virtually all cancer patients regardless of the type of cancer,” Alberg said. “Assessing tobacco use and providing cessation assistance is the best chance a patient has for successful treatment and long-term health.”
Warren agrees and adds it’s a way to start changing culture. MUSC is uniquely positioned to be a leader in this area, he said.
“We have a strong concentration of experts in tobacco and addiction here at the Medical University of South Carolina. We have international leaders in tobacco control and cessation. We have an extremely good psychiatry and neurosciences program that deal with addiction – the fundamental biologic mechanisms behind tobacco addiction. We have very good motivation from MUSC as well as Hollings Cancer Center to identify tobacco in all our patients and develop systematic ways to treat tobacco use for everyone who comes through our institution.”
Cancer patients are seen on a weekly or monthly basis, so it’s a perfect opportunity to aggressively help patients stop smoking. “Our common theme is to try to get you to quit using tobacco as soon as possible, provide the behavioral counseling to help you make a decision to quit and, if necessary, provide medications that increase the chances to stop using tobacco.”
An interesting development is growth in the field of understanding addiction. All smokers are not the same, he said, explaining that there are different levels of addictions and possibly co-occurring medical conditions contributing to the addiction that may need to be addressed.
“Tobacco and tobacco-related products such as nicotine affect proteins on every cell in the body. Most people have been addicted to tobacco for years if not decades. It’s extremely difficult to stop something that changes the cellular physiology of virtually all the tissues in your body, especially when you’re diagnosed with cancer. Sometimes there’s a stigma – or people look down on people who smoke. But it’s important to provide every effort we can to help people stop smoking and realize it’s tough to do. It’s an extremely difficult thing that requires a lot of work to get over, but we are working to help every patient succeed.”