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An Approach to Stopping Smoking
Ernest H. Rosenbaum, MD

Probably the best way to help cancer patients stop smoking is at the time of diagnosis, as they are very susceptible to accepting health promotional changes. In short, they are highly motivated. Although often pre-consultations and programs are available, the best initial approach may be a two- to three-minute speech from the treating oncologist that they should stop smoking, as there are great advantages that can be obtained in helping control their cancer and supporting their treatments.

A psychological assessment of a person's behavior and counseling following the medical teams advice is often very helpful. Stopping smoking can be a significant factor in promoting the effectiveness of treatment and overall outcome for patients with cancer. Additional smoking risks include the fact that before, during and post treatment, cancer cell growth, cell death, and increase in cancer treatment efficacy have been shown. It also may decrease the risk of cancer recurrence and a secondary cancer. It can also increase cancer treatment side effects by complicating chemotherapy, radiotherapy and surgical recovery.

By using this opportune window of opportunity, the few minutes physicians and medical team spend giving recommendations to stop smoking make a difference in a patient's treatment and survival outcome. Continued reinforcement of this message through counseling and supportive care is also vital.

Of note is that doctors who treat head and neck and lung tumors are more aware of the dangers of continued smoking, where general oncologists may be more lax in giving advice, but with the current information known, stopping smoking becomes a vital part of therapy and survival programs. Unfortunately, there's often lack of time, and stopping smoking may not be seen to be a prime goal when therapy is being considered, but it should be considered an integral part of a therapeutic program for those who are smoking. It may be hard to change a lifelong behavioral pattern, but the advantages are becoming more obvious. Programs should be initiated at all places that treat cancer. For example, the M. D. Anderson Tobacco Treatment Program has a therapeutic intervention program, having on staff a psychiatrist, an advanced practice nurse, three PhD clinical and counseling psychologists, This staff is increasing with a higher influx of ex-smokers who want to remain abstinent. Patients seen at the M. D. Anderson get a questionnaire, especially at the Head and Neck Clinic, where they can fill out some limited data and have a form they can register in the Tobacco Treatment Program for smoking cessation. Support is available to help promote the patient's motivation and supportive care for psychiatric problems. Knowing the risks and benefits of smoking cessation can contribute to a more successful program. The M. D. Anderson program is at no cost and promotes the use of various nicotine replacement products, including gums, lozenges, patches, bupropion (Zyban) - an antidepressant that helps people quit smoking - and new drugs, which decrease the desire for smoking. The program also offers support for depression, alcohol abuse, and anxiety disorders.

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First appeared July 11, 2007; update July 12, 2009