Smokers with serious illnesses need additional help to quit, study says

Individuals with serious illnesses - including cancer, heart disease and chronic obstructive pulmonary disease - make up a disproportionately high segment of current smokers and are also among the most addicted to tobacco use.

Despite their strong addiction, more than one third of these individuals are likely to give up smoking and remain smoke-free for at least six months if they receive a combination of smoking cessation medications and are allowed to continue taking these medications for a longer period of time, researchers at the University of Medicine and Dentistry of New Jersey (UMDNJ) report.

In their study, the researchers randomly assigned 127 smokers with predefined medical conditions to one of two groups. The first group received nicotine patches for a standard 10-week treatment period. The second group received a combination of nicotine patches, nicotine inhalers and bupropion, an antidepressant medication commonly prescribed for treating tobacco dependence. After 26 weeks, 35 percent of those who received the combination therapy had quit smoking compared to just 19 percent of those who received the nicotine patch alone. The results of this study appear in the April 7 edition of Annals of Internal Medicine .

"Common sense would tell you to quit smoking if you have a serious disease, but more than half of smokers who are newly diagnosed with cancer continue to smoke," said study author Dr. Michael Steinberg, of the UMDNJ-Robert Wood Johnson Medical School and medical director of the Tobacco Dependence Program at the UMDNJ-School of Public Health. "Our research illustrates how terribly addictive tobacco is, but that addiction can be overcome if treated appropriately."

Current product labeling discourages combining nicotine patches with other forms of nicotine replacement and strictly limits the recommended length of time these products should be used. At the same time, treatment for tobacco dependence is not usually reimbursed well by insurance companies. Both are mistakes, Steinberg contends.

"People with serious illnesses who smoke will live longer and have a better quality of life if they receive aggressive treatment for their tobacco dependence," Steinberg said. "Insurance companies will bristle at paying for six months of nicotine therapy, but will turn around and allow benefits for 50 years of prescription statin medications to control cholesterol. Tobacco dependence should be considered like any other chronic illness and, with the right amount of therapy, people can remain tobacco-free for good."

Dr. Steinberg's research was supported by the Robert Wood Johnson Foundation Physician Faculty Scholars program and the Cancer Institute of New Jersey.

The Robert Wood Johnson Foundation Physician Faculty Scholars program aims to improve the nation's health care by developing the careers of young, high-quality physician-scientists. The program annually makes up to 15 three-year awards of up to $300,000 each. The scholars also enhance their skills and productivity via institutional and national mentoring, research experience and protected time in which to acquire that experience.

This program is part of the Robert Wood Johnson Foundation's Human Capital Portfolio, which seeks to attract, develop and retain a high-quality health and health care workforce, with an emphasis on diversity and leadership development.

The University of Medicine and Dentistry of New Jersey (UMDNJ) is the nation's largest free-standing public health sciences university with more than 5,600 students attending the state's three medical schools, its only dental school, a graduate school of biomedical sciences, a school of health related professions, a school of nursing and its only school of public health on five campuses. Annually, there are more than two million patient visits at UMDNJ facilities and faculty practices at campuses in Newark, New Brunswick/Piscataway, Scotch Plains, Camden and Stratford. UMDNJ operates University Hospital, a Level I Trauma Center in Newark, and University Behavioral HealthCare, a statewide mental health and addiction services network.