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Jacek Jassem
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MTE 25 - Tobacco Control - Practical Issues (Sign Up Required) (ID 574)
- Event: WCLC 2017
- Type: Meet the Expert
- Track: Epidemiology/Primary Prevention/Tobacco Control and Cessation
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 07:00 - 08:00, Room 316
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MTE 25.01 - Smoking after Diagnosis of Cancer (ID 7812)
07:00 - 07:30 | Presenting Author(s): Jacek Jassem
- Abstract
- Presentation
Abstract:
Around one-third of all malignancies are attributable to tobacco smoking. Diagnosis of cancer is a turning point in life and an alarming signal, motivating for smoking cessation. This is particularly true for patients with tobacco-related malignancies, such as cancers of the lung, head and neck, esophagus, pancreas, uterine cervix, kidney, bladder or stomach. Indeed, the quit and quit attempts rates shortly after cancer diagnosis are relatively high, nevertheless a significant proportion of patients continue to smoke or relapse after initial quit attempts. In consequence up to one-third to one-half of cancer patients or cancer survivors continue to smoke, and the smoking rates in cancer survival do not significantly differ from those in the general population[1,2]. Most smoking cessation efforts have been aimed at primary prevention, whereas the importance of stopping smoking in people diagnosed with cancer have been given less attention. In consequence, the provision of tobacco cessation treatment for cancer tobacco users is still not widely available. Patients with tobacco-related cancers feel more guilt and shame resulting from previous smoking, and tend to underreport their current tobacco dependence[3-5]. Many believe that there is no point to stop smoking once being diagnosed with cancer. Additionally, some health care professionals, in fear of increasing patients’ guilt and stress, do not encourage them to stop smoking. Patients who continue smoking experience several adverse effects. Apart from disease site and stage, abstinence from smoking is the strongest and independent predictor of survival in cancer patients who have ever smoked. Several studies have consistently shown that continued tobacco use compromises the effectiveness and increases the complication rates of three main cancer treatments: surgery, chemotherapy and radiotherapy[6]. In patients managed with surgery, continued cigarette smoking is associated with increasing risk of necrosis, slower wound healing, higher surgical site infection rates and prolonged hospitalization[7]. Components of tobacco smoke significantly impact clearance and delivery of many cytotoxic agents, resulting in their decreased efficacy and higher toxicity[8]. Current, compared to former smokers and patients who stopped smoking before starting treatment, have lower response rates to radiation therapy and acerbated radiation side effects, such as oral mucositis, xerostomia, weight loss and fatigue[9,10]. Smoking after a cancer diagnosis results in higher risk of developing secondary cancers, poorer general health and increased all cause mortality[11,12]. In consequence, patients who continue to smoke after cancer diagnosis almost double their risk of dying, compared to those who quit. A deleterious impact of continued smoking on survivorship is particularly high for tobacco-related cancers. Cancer survivors who continue to smoke have also poorer emotional and social functioning, vitality and quality of life[13-15]. In conclusion, quitting smoking and prevention of smoking relapse represent an important opportunity to mitigate cancer treatment complications and to improve survival, general health and quality of life. It also allows avoiding much of the excess risk of secondary cancers and other tobacco-related diseases. Enhanced focus on smoking cessation and its active promotion among cancer patients may increase their motivation to quit. All cancer patients, irrespective of treatment setting, should be screened for tobacco use and advised on benefits of tobacco cessation. Patients who continue to smoke should be offered individualized pharmacologic and behavioral therapy to assist in the quitting process. References Bellizzi KM, et al. Health behaviors of cancer survivors: examining opportunities for cancer control intervention. J Clin Oncol. 2005; 23:8884–93. Burke L, et al. Smoking behaviors among cancer survivors: an observational clinical study. J Oncol Pract. 2009;5:6-9. LoConte NK, et al. Assessment of guilt and shame in patients with non-small-cell lung cancer compared with patients with breast and prostate cancer. Clin Lung Cancer. 2008;9:171-8. Warren GW, et al. Accuracy of self-reported tobacco assessments in a head and neck cancer treatment population. Radiother Oncol. 2012; 103:45–8. Morales NA, et al. Accuracy of self-reported tobacco use in newly diagnosed cancer patients. Cancer Causes Control. 2013; 24:1223–30. Toll BA, at al. Assessing tobacco use by cancer patients and facilitating cessation: an American Association for Cancer Research policy statement. Clin Cancer Res. 2013; 19:1941–8. Sorensen LT, et al. Smoking as a risk factor for wound healing and infection in breast cancer surgery. European Journal of Surgical Oncology. 2002; 28:815–20. O'Malley M, et al. Effects of cigarette smoking on metabolism and effectiveness of systemic therapy for lung cancer. J Thorac Oncol. 2014;9:917-26. Browman GP, et al. Influence of cigarette smoking on the efficacy of radiation therapy in head and neck cancer. N Engl J Med. 1993; 328:159–63. Browman GP, et al. Association between smoking during radiotherapy and prognosis in head and neck cancer: a follow-up study. Head Neck. 2002; 24:1031–7. Stewart BW, et al. Cancer and tobacco: Its effects on individuals and populations, in Robotin M, Olver I, Girgis A (eds): When Cancer Crosses Disciplines: A Physician’s Handbook. London, United Kingdom, Imperial College Press, 2010. Parsons A, et al: Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: Systematic review of observational studies with meta-analysis. BMJ 2010; 340:b5569 Berg CJ, et al. Correlates of continued smoking versus cessation among survivors of smoking-related cancers. Psychooncology. 2013;22:799-806. Garces YI, et al. The relationship between cigarette smoking and quality of life after lung cancer diagnosis. Chest. 2004; 126:1733–41. Duffy SA, et al. Effect of smoking, alcohol, and depression on the quality of life of head and neck cancer patients. General Hospital Psychiatry. 2002; 24:140–7.
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