Tobacco Use in the Oncology Setting: Advancing Clinical Practice and Research

Abstract

While tobacco is a well-established causal agent for many human cancers, less emphasis has been placed on translating this evidence by evaluating the effects of continued tobacco use after a cancer diagnosis. A broad assessment of the effects of continued tobacco use demonstrates that tobacco increases cancer treatment toxicity, recurrence, second primary tumors, and mortality in cancer patients. Few studies report the potential benefits of cessation after a cancer diagnosis, but data suggest improved treatment outcomes in cancer patients who quit smoking. Improving tobacco cessation treatment efficacy and access to cessation support has been sparsely researched in the oncology setting compared with the general population; however, cancer patients are receptive to standard evidence based tobacco cessation guidelines. Several studies demonstrate moderate tobacco cessation success in cancer patients using the general principles of evidence based tobacco cessation support. Several systems level issues and research efforts are needed to standardize tobacco use definitions, increase access to tobacco cessation support, improve tobacco cessation efficacy, understand the time dependent effects of tobacco and cessation on cancer biology, and realize the potential benefits of tobacco cessation for cancer patients.

Does Quitting Smoking Make a Difference Among Newly Diagnosed Head and Neck Cancer Patients?

“…Education programs for health care providers as well as dedicated smoking cessation programs would improve tobacco treatment for cancer patients. 11,60 In 2014, for the first time Surgeon General's report "The Health Consequences of Smoking-50 Years of Progress" 14,61 stated that it is imperative to address smoking among cancer patients. Recent similar reports have been endorsed by the AACR, 62 American Society of Clinical Oncology (ASCO), 63 and NCCN guidelines.…”

“…[3][4][5] Continued smoking following diagnosis is associated with decreased response to radiotherapy and chemotherapy, impaired wound healing, increased infections and circulatory problems, and late complications (eg, severe fibrosis, dysphagia). [5][6][7][8][9][10][11] Conversely, smoking cessation after diagnosis shows several medical benefits, such as decreased fatigue and shortness of breath, increased activity level and quality of life, and improved treatment toxicity. 12,13 The 2014 Surgeon General's report "The Health Consequences of Smoking-50 Years of Progress" (SGR) acknowledged causal relationships between smoking and adverse health outcomes among cancer patients, such as increases in overall mortality, cancer-specific mortality, and second primary cancers.…”

Prevalence and Correlates of Smoking and Cessation-Related Behavior among Survivors of Ten Cancers: Findings from a Nationwide Survey Nine Years after Diagnosis

“…Increasing all survivors' access to cessation support from oncologists, however, will be necessary to translate motivation to actual success in quitting. Prior research indicates that while oncologists do ask about smoking and quitting and are supportive of providing cessation assistance to patients with cancer who smoke, in practice their provision of cessation assistance and follow-up of smoking status is much lower (30,31). Whatever the reasons (e.g., reluctance to address tobacco use in older patients, time constraints), this could be ameliorated by automated systems that screen for tobacco use and provide referrals to available treatments (32), regardless of smoking level or age.…”

AACR Celebrates 50 Years of Tobacco Research and Policy

“…Assessing tobacco use in clinical settings not only facilitates research, but it also is key to identifying individuals in need of cessation therapy (9,18). The AACR has advocated for the integration of tobacco use assessment and intervention into the training of primary and specialty care providers and encouraged cancer centers to offer comprehensive, evidence-based cessation services for their patients and family members (2).…”