Quitting Smoking After a Cancer Diagnosis, with Anthony Alberg, PhD, MPH

March 14, 2017
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In today’s podcast, Dr. Anthony Alberg explains why it’s not too late to quit smoking after a cancer diagnosis, including the immediate and long-term benefits during and after cancer treatment. He also addresses common myths around quitting smoking and provides resources for someone who wants to quit.  


ASCO: You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world’s leading professional organization for doctors who care for people with cancer.

Most people are already aware of the benefits of quitting smoking and other tobacco products, but once someone has been diagnosed with cancer, is it too late?

In today’s podcast, Dr. Anthony Alberg explains why it’s not too late to quit smoking after a cancer diagnosis, including the immediate and long-term benefits during and after cancer treatment. He also addresses common myths around quitting smoking and provides resources for someone who wants to quit. 

Dr. Alberg is a Professor of Public Health Sciences and the Associate Director of the Hollings Cancer Center in South Carolina. ASCO would like to thank Dr. Alberg for discussing this topic.

Dr. Alberg: Hello, my name is Tony Alberg, and I'm from the Hollings Cancer Center at the Medical University of South Carolina. And the topic of this podcast is quitting cigarette smoking, particularly focusing on after diagnosis of cancer. And first question that might come up is, why should a patient even consider quitting smoking after being diagnosed with cancer? Isn't it too late? Or are there any benefits? And I think the key point that I would like to make is that it's never too late to stop smoking, that there will always be benefits to stopping smoking, compared to continuing to smoke cigarettes.

The benefits of quitting are very clear, they're direct, and there's even immediate benefits from quitting smoking. In general, we have not done a great job communicating the full range of the harms of smoking, but it's important to understand that cigarette smoking causes harms in every major organ system in the human body. So some of the immediate benefits from quitting smoking that would occur right away would be factors such as reducing inflammation, and inflammation is linked to the risk of progression of many diseases, including cancer.

Quitting smoking will lead to a more fully functioning immune system that works better to fight disease right away. That would include fighting off infections that can be very harmful for cancer patients during their treatment, and the immune system is really thought to be very important to the development of many different diseases other than infections, including cancer and other chronic diseases. Quitting smoking right away increases the non-smoker's antioxidant capacity. Oxidative stress is thought to be harmful to many diseases, including cancer progression and stopping smoking helps the body to fight against this harmful factor. And another system that's improved right away with quitting smoking is wound healing. This can be very important for cancer patients who are going to surgery for their cancer. The non-smokers are more likely to have wound healing without complications than cigarette smokers are. For reasons such as these, patients who smoke—and, in the population, smokers compared to non-smokers, rate their overall health as worse than non-smokers even when they're not feeling sick and in the absence of disease. So stopping smoking leaves one feeling healthier overall. It would be important to recognize that during their first few weeks of quitting, there may be feeling worse but that these benefits will be felt after quitting smoking for several weeks.

That's the immediate benefits, and then in the longer term, there's a whole other set of reasons why it's important for a cigarette smoker to stop smoking after a cancer diagnosis. Cancer patients who smoke continue to experience all the risk of smoking-caused disease and increased death rate, and so that's very important because that all factors in the cigarette smoking significantly shortening survival after cancer. This is due to factors such as increasing the risk of cancer recurrence, increasing the risk of a second primary cancer diagnosis or developing another cancer. The fact that cigarette smoking, in ways that we don't fully understand now, can interact with radiation therapy and chemotherapy to take away from the benefits of those treatments, and as I mentioned before, worse wound healing after surgery. So the goal is survival after a cancer diagnosis and to best improve the chances of survival, it's very important to attempt to stop smoking. Because no one wants to survive their cancer diagnosis, if they're fortunate enough to do so, only to succumb to another smoking-caused disease, such as stroke, chronic obstructive pulmonary disease, or heart disease, to name a few. And those risks all still exist after the cancer diagnosis. So compared to continuing to smoke cigarettes, quitting smoking sooner will significantly improve your chances of survival, and stated plain and simple, after a cancer diagnosis, quitting smoking is one of the most important steps that you can take to prolong your life. So taken together, all this information provides a very powerful argument why quitting smoking is critical for a cancer patient.

Another question that comes up is that maybe there's reasons not to quit smoking, and I'd like to talk about that for a few minutes. So, I think first and foremost, please recognize that smoking cigarettes is not a failing of you as an individual. If you are a smoker, it is not a personal failing. Most adult smokers tried cigarettes when they were young, in childhood or when they were a teenager, usually for social reasons, and from that experimentation, end up with a nicotine addiction that can be very difficult to overcome. So recognize that this is an addiction, that it's not easy to overcome, but can be overcome with effort and with the appropriate help. One argument that I hear often is that quitting smoking is too expensive and that it's hard to afford, that the smoking cessation medications may seem more expensive compared to continuing to smoke cigarettes. That is false; the smoking cessation medications may appear to be more expensive in the short run because the way they're sold looks like more than a pack of cigarettes or a carton of cigarettes would that would be used for the same number of days. But recognize those are for short-term use, and that a successful quit attempt will avoid all the expenses of continuing to purchase cigarettes over the long run. So it's a very prudent and economical short-term investment.

Another argument is that you may have tried to quit before, and either were not able to quit, or you were able to quit smoking for some time, but then you started smoking again. Please recognize that because nicotine addiction is so powerful, this is very common. But the evidence shows that all those quit attempts add up to helping the next quit attempt to be successful. So it's very important to keep trying to quit, to achieve the long-term goal of successfully quitting smoking. My mother used to tell me it's better to have tried and to have failed than never to have tried at all, and that is definitely true when it comes to quitting smoking. All of those quit attempts are adding up, even if they were unsuccessful in the past, will help to add up to successfully quitting smoking in the long run. And I think it's also important to remember that when you tried to quit before, you maybe were not taking advantage of all the support system and the evidence-based approaches that we have to help with smoking cessation today. And taking advantage of those may greatly increase the likelihood of a quit attempt, and I'll talk about those in a few minutes. I think another issue that could come up, is that it's very difficult to smoke if you have loved ones who also smoke, and you're around smoking often or all the time, and that provides a great opportunity after the cancer diagnosis to really address that issue together and to try to quit together and eliminate smoking from the household entirely. And so the motivation to continue to celebrate the precious gift of life should hopefully provide the momentum to overcome any barriers like these that you see in trying to make an attempt to quit smoking.

Another question that arises is what to do first. If you want to quit smoking, how should you approach it if no one's reached out to help you, and whether or not a doctor or healthcare provider is a good place to start. Well, a lot of research shows that the voices of doctors, nurses, and any healthcare provider is very important to helping patients stop smoking. Just hearing it from them, that it's important to address provides another very powerful argument for making a quit attempt. In addition to that positive influence, the doctor or healthcare provider can provide the appropriate referrals for counseling, prescriptions for stop smoking medications that require prescriptions, and be helpful in other ways like that. But often, realize it's not going to be the doctor who's doing the actual smoking cessation but that it would be a referral to someone else who specializes in that area. It's important to recognize that you want to give yourself the best chance that is possible to quit smoking, and so in that regard, there are many stop smoking medications that are now available that are proven to increase the chances of a successful quit attempt.

There are several different kinds of nicotine replacement therapies. So nicotine is the part of cigarettes or other tobacco products that is the addictive component, and the idea behind these nicotine replacement therapies is to replace the nicotine without all of the other poisons that are present in cigarette smoke, and this is a powerful tool. The nicotine can be delivered in different ways, either through a patch, through a gum, a lozenge, an inhaler, and there's been a proliferation in the number of ways that nicotine can be delivered to a patient who wants to stop smoking. Some patients feel that having nicotine as a therapy is just replacing one poison with another. You're just replacing cigarette smoke with nicotine. I want to be very clear that this is not true, that nicotine administered in the doses that are administered in these therapies is safe and is much less harmful and near zero harm, compared to continuing to smoke cigarettes. There are other medications also available, varenicline or Chantix and bupropion, are other non-nicotine medications that also have been shown in clinical trials to increase the chances of a successful quit attempt. And there are other medications as well, either on the market or entering the market, so it's important to know about those.

It's also important to understand that counseling is very helpful. So just to have the chance to interact with a person around smoking, to get their advice, and so on. Counseling can be in-person or it can be through quitlines and administered over the telephone. So if anyone is interested in accessing a quitline, states have their own quitlines, but you can visit the website SmokeFree.Gov. It's all one word S-M-O-K-E-F-R-E-E.G-O-V. Or call the national quitline network at 1-800-Quit Now. That's 1-800-Quit Now. And that will plug you into the services of a quitline that can provide counseling to help you stop smoking. And what evidence has shown is that it's the combination of smoking cessation medication and counseling that provides the very best chance to make a successful quit attempt. So I hope this information has been helpful.

ASCO: Thank you, Dr. Alberg. More information on stopping tobacco use after a cancer diagnosis can be found at www.cancer.net/tobacco. And for more expert interviews and stories from people living with cancer, visit the Cancer.Net Blog at www.cancer.net/blog.

Cancer.Net is supported by the Conquer Cancer Foundation, which is working to create a world free from the fear of cancer by funding breakthrough research, sharing knowledge with physicians and patients worldwide, and supporting initiatives to ensure that all people have access to high-quality cancer care. Thank you for listening to this Cancer.Net Podcast.