With up to 50% of cancer patients smoking upon diagnosis, it is important to understand the large and growing body of evidence indicating that patients are more likely to survive their cancer diagnosis—and their treatment is more likely to be successful and have fewer side effects—if they quit smoking at the time of diagnosis, according to Michael Fiore, MD, MPH, MBA. “However, this evidence has only emerged over the past 5 to 10 years,” says Dr. Fiore, “and therefore many oncologists may not be aware of it, resulting in smoking cessation being an afterthought—as opposed to a core component—of cancer treatment, thanks in part to the chaotic and stressful nature of a cancer diagnosis in which much must be accomplished during a small amount of time.”

“Often, a lot of guilt and shame is associated with a cancer diagnosis,” explains Dr. Fiore. “Many patients feel responsible, particularly those who smoke, and many oncologists are reluctant to add to that. But, we know that cancer patients often welcome help with overcoming their tobacco dependence, particularly when they know it will help overcome their cancer. Patients can feel empowered in confronting a cancer diagnosis by quitting smoking.” To help in doing so, the National Cancer Institute (NCI) and Moonshot Initiative joined forces on the Cancer Center Cessation Initiative to provide funding to NCI-funded comprehensive cancer centers to either develop or expand programs that deliver smoking cessation to presenting patients. “The goal is for every cancer patient who presents to one of these centers to be identified, their smoking status documented in the EHR, and then a plan put in place to help that patient quit based on the best science,” adds Dr. Fiore. “A secondary goal is to take the lessons learned from these centers and disseminate them nationally so that every cancer clinic in every oncology setting will be able to get the best of what’s learned in terms of how to implement smoking cessation programs into their settings.”

In a Perspective published in the New England Journal of Medicine, Dr. Fiore and colleagues sought to shed a light on the initiative and the issue of patients exiting cancer clinics without their tobacco use being discussed, and in turn, having a decreased likelihood of surviving their cancer diagnosis. “While fitting smoking cessation into a busy clinical encounter may appear daunting to some clinicians, it’s only for those who smoke. It’ll dramatically change their outcomes if successful, and it doesn’t have to be delivered by the frontline clinician,” says Dr. Fiore. “That said, even a brief message from a physician to a patient can make a difference. We can use the research we have in terms of how to help patients quit smoking, provide some very brief counseling, use one of the effective medications that have been approved for smoking cessation, and utilize treatment extenders that are available—like state tobacco cessation quitlines or smokefree.gov— to deliver some the cessation care that clinicians may not have the time to deliver during brief clinical encounters. Nothing is going to help the patient more. Even in a busy clinical day, helping cancer patients who smoke to quit is going to make a substantial difference in their oncology outcomes and in their overall health.”

References

Addressing a Core Gap in Cancer Care — The NCI Moonshot Program to Help Oncology Patients Stop Smoking. www.nejm.org/doi/full/10.1056/NEJMp1813913?query=featured_home.