Surprising Hurdles to Quitting Smoking for Cancer Patients

Megan Brooks

November 29, 2012

Why do most cancer patients keep smoking after being diagnosed with cancer? The answer is far from simple, according to a new study.

Dr. Sonia Duffy

The "multitude of issues" that cancer patients face when tackling their smoking habit surprised us, Sonia Duffy, PhD, RN, FAAN, a researcher at the University of Michigan School of Nursing in Ann Arbor, told Medscape Medical News. There are "so many variables affecting why they don't get treatment, and if they do get treatment, why they may not respond," she explained.

"Nicotine addiction, health issues, emotional issues, psychological issues, and system-level issues are all in the way," Dr. Duffy noted.

Other obstacles include lack of access to smoking-cessation programs, doubts about whether they can quit, lack of social support, sleep deprivation, poor nutrition, low activity, and low socioeconomic status. After back-to-back appointments and grueling chemotherapy or radiation protocols, many cancer patients simply lack the time or energy to attend quit-smoking programs, Dr. Duffy said.

Depression is another huge barrier that keeps many cancer patients from kicking the habit. Although depression rates are lower than 10% in the general population, they are as high as 58% in cancer patients.

Dr. Duffy and colleagues conducted a literature review of relevant studies on smoking by cancer patients. The results appear in the November issue of Community Oncology.

This is the first comprehensive review to examine the reasons the very cause of the cancer — smoking — in many cases isn't treated, Dr. Duffy said. She admitted she wasn't prepared to find so many hurdles hindering smoking cessation in cancer patients.

Ducking an Obligation?

"There is a growing consensus about the obligation to provide state-of-the-art smoking cessation interventions for cancer patients," she and her colleagues write. However, research suggests that only 56% of family physicians recommend that their smoking oncology patients quit smoking, and most oncology providers do not provide smoking interventions beyond advice to quit, they note.

"For busy oncology providers, even brief advice coupled with medication therapy (nicotine replacement therapy, bupropion, or varenicline) can help smokers quit," Dr. Duffy told Medscape Medical News.

At the very least, she said providers can refer patients to the 1-800-QUIT-NOW help lines available in all 50 states; they provide telephone counseling and sometimes medications to those without insurance.

Nurses to the Rescue

Nurse-led interventions might be a good option to get more cancer patients to quit smoking. One review concluded that, in general, nurse-administered programs are more effective than nonnursing interventions (Cochrane Database Syst Rev. 2004;1:CD001188).

"Oncology nurses are ideally positioned to deliver cessation interventions," Dr. Duffy and her colleagues point out. Why? Because they are "educated in patient education, psychosocial interventions, and physiological interventions; they have access to and immediate rapport with patients, as well as respect from patients' physicians; they understand the patients' medical conditions, can read their charts, and write nursing notes; and they constitute a much larger workforce than oncology physicians."

In addition, physician time is at a premium, which makes nursing interventions more cost effective.

It is estimated that smoking is behind 30% of all cancer deaths and 87% of all lung cancer deaths, yet 50% to 83% of patients keep smoking after being diagnosed with cancer.

Dr. Duffy said her next project will focus on ways to specifically design smoking-cessation programs for nurses to deliver to cancer patients.

The study was supported by the Department of Veterans Affairs and the National Institutes of Health through the University of Michigan's Head and Neck Specialized Program of Research Excellence (SPORE). The authors have disclosed no relevant financial relationships.

Community Oncol. 2012;9:344-352. Abstract