The 2014 Report of the United States Surgeon General discussing the health consequences of smoking, confirmed that continued smoking after a diagnosis of cancer is associated with significant increases in all-cause mortality, cancer-specific mortality, and second primary cancers.[1]

The difference in the recovery trajectories noted in former smokers and patients who continue to smoke after diagnosis, confirms the value in promoting cessation among patients with cancer and patients with a history of cancer who smoke, demonstrates the value of smoking cessation in cancer care. [2]

Barriers
Despite repeated arguments to stop smoking, and the understanding that oncologists should play a bigger role in discussing tobacco use, while at the same time actively encouraging and help their patients to stop smoking, not all oncologists have the resources to do so. Furthermore, there are a number of barriers limiting oncologists and other health care providers to talk with their patients about smoking cessation. One of these barriers may be the belief that patients who smoke do not want to quit. Another barrier may be that adding another ‘burden’ by asking these patients to quit smoking is not a good idea…

As a result, over the last 50 years, smoking cessation has not appreciably advanced: far too few smokers were advised to quit and even fewer were offered or received smoking cessation treatment. Many clinicians, including oncologists, neglected to address smoking with their patients.

But despite the understanding that smoking is an effect modifier of cancer treatment, and that not discussing smoking cessation hurts patients’ treatment outcomes, the surgeon general’s report indicated that approximately 40% of smokers are not advised by health providers to stop smoking, even though 70% wants to quit.

A Pillar of Cancer Treatment
But change requires acceptance of smoking cessation as a ‘4th pillar,’ an integral part, of cancer treatment, adding this approach to the practice of evidence-based oncology care, which, for the last 5 decades has largely depended on 3 primary intervention strategies: surgery, radiotherapy, and chemotherapy. [2]

To aid this, consensus standards should be established for minimal levels of cessation care with regard to smoker identification, advice to quit, and offer of and referral to smoking treatment. In addition, a tailored and personalized approach should guide smoker’s ready access to smoking cessation, lowering any barrier to deliver and ‘warm handoffs’ that directly connect patients with smoking treatment resources during a cancer health care visit or hospitalization.[2]

In a cover article published in HemOnc Today, Jennifer Southall interviews a number of experts in behavioral and epidemiology research, psychiatry, and population health sciences.[3] While recognizing that beyond institution-level barriers, cessation can be hard on patients, Southall writes about population-based approaches to connect patients who smoke with smoking cessation services, funding and how changing the mindset in the cancer care community and lead to the successful implementation of cessation programs, and reap real dividends.

A must-read.

Reference
[1] US Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention; 2014. [Report]
[2] Fiore MC, D’Angelo H, Baker T. Effective Cessation Treatment for Patients With Cancer Who Smoke—The Fourth Pillar of Cancer Care. JAMA Netw Open. 2019;2(9):e1912264. doi:10.1001/jamanetworkopen.2019.12264 [Article]
[3] Southall J. Smoking cessation should be ‘pillar’ of the cancer treatment protocol
HemOnc Today, February 25, 2020.[Aticle]