Although a cancer diagnosis can motivate people to try to quit smoking, a study of British general practitioners finds that physicians are more likely to support smoking cessation in primary care patients with coronary heart disease than those with cancer, and patients with cancer are less likely to stop smoking.
Using electronic primary care records, 12,393 incident cases of lung, bladder and upper aerodigestive tract cancers diagnosed between 1999-2013 were matched 1:1 with incident coronary heart disease cases. At diagnosis, 32 percent of patients with cancer and 18 percent of patients with coronary heart disease smoked. In a retrospective cohort study, researchers found that people with cancer were less likely than controls to have smoking status recorded by their GP (37 percent versus 78 percent), be given advice to quit smoking (23 percent versus 45 percent), or be prescribed smoking cessation medication (12 percent versus 21 percent). Of the 3,706 cancer/heart disease patients who smoked at diagnosis and had at least one smoking status update in the year following diagnosis, 1,359 (37 percent) of patients with cancer and 1,645 (44 percent) of patients with heart disease stopped smoking. Confining the analysis to patients who smoked at the time of diagnosis and to those with a better prognosis did not change these findings except that the difference in prescription of pharmacotherapy was no longer apparent. The frequency of recording of smoking status, advice and pharmacotherapy increased after introduction of incentive payments for GPs to manage smoking but there were no differences in the rates of quitting. The authors call for improvements in the management of smoking cessation by GPs for patients with cancer.