Treating nicotine dependence and preventing smoking relapse in cancer patients

Abstract

Introduction Despite the well-documented harmful effects of smoking, many cancer patients continue to smoke. Smoking cessation is critical to address in this population given the associated increase in treatment toxicity, risk of second primary tumors, decrease in treatment response and higher disease-specific and all-cause mortality with continued smoking following a cancer diagnosis. This review seeks to summarize the latest recommendations and guidelines on smoking cessation treatment for patients diagnosed with cancer, and the evidence behind those recommendations. Areas covered We reviewed the latest evidence for smoking cessation treatments for cancer patients and the clinical guidelines and recommendation available for oncologists and health care providers. The unique aspects of nicotine dependence among patients diagnosed with cancer, and key challenges and barriers that cancer survivors and health care providers experience when considering smoking cessation treatments, and available clinical resources, are also discussed. Lastly, the authors summarize future directions in the field of smoking cessation treatment for cancer patients. Expert commentary While there are areas of improvement in research of smoking cessation treatment for cancer patients, critical under-explored areas remain. Nonetheless, providers should adhere to the NCCN guidelines and offer a brief counseling intervention to motivate patients to quit smoking when appropriate resources are not available.

Achieving Equity in the Reach of Smoking Cessation Services Within the NCI Cancer Moonshot-Funded Cancer Center Cessation Initiative

“…These structural changes may have contributed to increased reach by providing more flexible treatment options aligned with patient preferences, and by reducing barriers for oncology clinicians to connect patients with available cessation treatment or provide said treatment themselves. 26,27 Some good news is that there was little evidence of reach inequities among several of the demographic groups assessed, with reach being largely equivalent at both Time 1 and 2 among black/African American, white, Hispanic, and non-Hispanic individuals. Although differences in reach among these groups did not achieve statistical significance, likely due to the low sample size of 22 settings, reach increased meaningfully.…”

Cancer Patients Enrolled in a Smoking Cessation Clinical Trial: Characteristics and Correlates of Smoking Rate and Nicotine Dependence

“…The US Surgeon General concluded that a causal relationship exists between continued tobacco use among cancer patients and poor clinical outcomes, including cancer-specific mortality, an increased risk of disease recurrence, and decreased response to cancer treatment [ 1 ]. Despite these risks, upwards of 50% of those who were smokers when diagnosed continue to smoke or relapse soon after receiving their diagnosis [ 2 , 3 ]. Identifying effective smoking cessation interventions for cancer patients is therefore a priority [ 4 ].…”

“…Identifying effective smoking cessation interventions for cancer patients is therefore a priority [ 4 ]. This requires identifying correlates of smoking behavior, which can serve as intervention targets [ 2 ].…”

Oncologist provision of smoking cessation support: A national survey of Australian medical and radiation oncologists

“…In light of this finding, we suggest a team approach to cessation care where oncologists may be the first to engage with the patient regarding the need for cessation, providing for example; brief motivational advice with information about the individualised benefits of quitting, and formulation of an agreed plan with the patient on the most appropriate referral and support strategy. This should be followed by engagement with adequately resourced, accessible health professionals who understand both cancer treatment and smoking cessation . Multiple practice models could be developed to meet these requirements.…”