Stop Smoking Now Aids

Smoking After Diagnosis Hurts Care, Research

Doctors Can No Longer Ignore Smoking Effects

Cancer patients who smoke would benefit if their oncologists promoted tobacco cessation efforts and researchers collected data on tobacco use in cancer clinical trials, two journal articles say.

Prompting the suggestions from M. D. Anderson researchers is new research showing the link between poor treatment outcome and tobacco use after cancer diagnosis.

The first article, available online in the journal Cancer, suggests that the time to help tobacco users quit is the moment they are diagnosed with cancer. Without help, up to one-half of cancer patients either continue to smoke after diagnosis or relapse after stopping for a short time, researchers say.

The other commentary, published in the October Cancer Epidemiology, Biomarkers & Preventionjournal, argues that researchers should assess whether patients are using tobacco while in a clinical trial because the detrimental health effects of smoking could negatively influence overall results. The authors are not suggesting that patients who use tobacco be excluded from these studies, but that smoking should be seen as another critical variable that could have an impact upon study outcome.

Tobacco use hurts patients’ recovery

New research demonstrates that if patients quit tobacco before treatment or participation in a clinical trial, it improves:

• Treatment success rates
• Quality of life
• Chances of not developing a second primary cancer

Also, the longer the interval between smoking cessation and the start of cancer treatment, the better the prognosis, says the lead author of both papers, Ellen Gritz, Ph.D., professor and chair of M. D. Anderson’s Department of Behavioral Science. Research shows that smoking after radiation therapy and surgery has been found to:

• Diminish treatment effectiveness
• Exacerbate side effects
• Interfere with wound healing

These adverse effects are found in both patients with smoking-related cancers and nonsmoking-related cancers. Similar adverse effects are likely to occur with chemotherapy, but data are lacking.

Timing is everything in promoting cessation

Immediately encouraging newly diagnosed patients to quit tobacco is key. “Many cancer patients are highly motivated and interested in quitting smoking at diagnosis,” says Cancer article 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% of patients quit using tobacco, whereas the typical success rate for tobacco cessation in the general population is only about 20%.

Problem more difficult to ignore

Despite such studies, the “teachable moment” 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 urge the patients to stop.”

She says that many M. D. Anderson oncologists, especially those treating cancers associated with tobacco use, recommend that patients quit smoking before starting treatment. But that is not the case everywhere.

“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,” Gritz says.

Cessation interventions need not be expensive, nor do they have to rely on the physician. Doctors can refer patients to a hospital-based tobacco cessation program.

Accuracy of clinical trial data in question

The Cancer Epidemiology, Biomarkers & Preventioncommentary discusses how ignoring tobacco use in patients in clinical trials can affect conclusions on the effectiveness of an experimental treatment.

Most oncology clinical trials do not collect data on smoking history and status unless the malignancy is widely acknowledged to be smoking-related, Gritz says.

These data often are collected only when the patient registers for the clinical trial, the researchers say. Subsequent changes in smoking status during treatment or follow-up are monitored in very few trials and are not often reported in discussions about the outcome of the study, Gritz says.

“We can’t ignore the obvious anymore,” she says. “Tobacco use is a critical variable that affects cancer treatment and outcome, and it needs to be addressed.”