A pair of articles from The University of Texas M. D. Anderson Cancer Center makes the case that patients would receive better care if physicians and researchers would address the issue of tobacco use after a cancer diagnosis and monitor tobacco use during clinical trials that test new agents.
One study, to appear in the January issue of the journal Cancer but available online Nov. 28, suggests that the time to help tobacco users quit is the moment they are diagnosed with cancer.
It notes that, without help, up to one-half of cancer patients either continue to smoke after diagnosis or relapse after stopping for a short time.
The other report, a commentary published in October in Cancer Epidemiology, Biomarkers & Prevention, argues that researchers conducting clinical trials should assess whether patients are using tobacco while participating in the study because the detrimental health effects of smoking could negatively influence overall results. The authors are not suggesting that patients who use tobacco should be excluded from these studies, but that smoking should be seen as another critical variable that could have an impact upon study outcome.
Both reports highlight the growing connection between tobacco use after cancer diagnosis and poorer treatment outcome. It has long been known that one-third of all cancers are associated with tobacco use, but new research demonstrates that if patients quit before treatment or participation in a clinical trial, their success rates, quality of life and chances of not developing a second primary cancer greatly improves.
"Tobacco use after cancer diagnosis has now become the elephant in the room, a huge issue in oncology that many in the field are ignoring," says the lead author of both papers, Ellen R. Gritz, Ph.D., professor and chair of the Department of Behavioral Science.
"We now need to realize that it is to the benefit of cancer patients that we address both of these issues by promoting tobacco cessation efforts and collecting data in clinical trials on tobacco use," she says.
In the Cancer study, the researchers say an ideal time to help patients quit smoking is at the time they are diagnosed with cancer. "One thing we want people to realize is that many cancer patients are highly motivated and interested in quitting smoking at diagnosis," says co-author Michelle Cororve Fingeret, Ph.D., a postdoctoral fellow in the Department of Behavioral Science. "This creates a teachable moment in which patients are more receptive to smoking cessation treatment and therefore are more likely to successfully quit."
According to Gritz, the studies she and other researchers have conducted demonstrate that using this "teachable moment" can help up to 70 percent of patients quit using tobacco, whereas the typical success rate for tobacco cessation in the general population is only about 20 percent.
"This demonstrates that the diagnosis of cancer is a wake-up call to many patients, one which demands our support if we want to provide the best outcomes possible," says Gritz.
"Patients want to live, and they want to take an active part in their treatment," says co-author Damon Vidrine, Dr.P.H., a postdoctoral fellow in the Department of Behavioral Science. "This is a way to help them do that and to improve their chance for a better outcome."
Despite such studies, the "teachable moment" that can help patients stop smoking is not being used nearly enough in the service of patient health, Gritz says. While many doctors ask if their cancer patients smoke, "they don't have the resources or the background to do more than to urge the patients to stop."
"Most physicians are not trained in treating behavioral dependencies, and when cancer is diagnosed, doctors and patients are immediately focused on treating the malignancy," she says. "Because smoking is so damaging to patients' health, it needs to be addressed in the treatment plan."
The issue is now vitally important, Gritz says, because research shows that smoking-related complications can be significantly reduced when patients stop smoking before surgery, and that the longer the interval between smoking cessation and initiation of cancer treatment, the better the prognosis.