Tobacco use is a well-established cause of cancer, contributing to about 1 in 3 cancer deaths annually. Whereas detrimental effects of smoking are well recognized, the harms of continued smoking after the diagnosis of cancer are underappreciated. Smoking continuation by cancer patients and survivors causes adverse treatment outcomes, including increased overall mortality, cancer related mortality and risk for second primary cancer, and considerably increases cancer treatment toxicity. The clinical effects of smoking after the diagnosis of cancer also has a substantial effect on increased cancer treatment costs. Smoking cessation after the diagnosis of cancer can improve treatment outcomes, but most cancer patients who smoke at the time of diagnosis persist in their smoking habit during treatment. Unfortunately, healthcare providers often do not proactively cooperate with their patients to help them to quit by providing tobacco cessation assistance for their tobacco using patients. Surveys among IASLC members demonstrate that although most healthcare professionals recognize that smoking causes adverse outcomes, approximately 90% ask about tobacco use and 80% advise patients to quit, only few offer direct assistance with quitting. There is a clear and unmet need to address tobacco use in cancer patients. The diagnosis of cancer is “the teachable moment”, allowing health care professionals the best opportunity to discuss with patients their nicotine addiction and shared decision-making. An enhanced focus on smoking cessation at the time of a cancer diagnosis and active intervention may increase patients’ action to quit.
Recognizing the critical importance of smoking cessation after cancer diagnosis, the IASLC recommends implementation of the following:
· All cancer patients should be screened for tobacco use and advised on the benefits of tobacco cessation.
· In patients who continue smoking after diagnosis of cancer, evidence-based tobacco cessation assistance should be routinely and integrally incorporated into multidisciplinary cancer care for the patients and their family members.
· Educational programs regarding cancer management should include tobacco cessation training, empathetic communication around history of tobacco use and cessation and utilization of existing evidence- based tobacco cessation resources.
· Smoking cessation counseling and treatment should be a reimbursable service.
· Smoking status, both initially and during the study, should be a required data element for all prospective clinical studies.
· Clinical trials of patients with cancer should consider designs that could also determine the most effective tobacco cessation interventions.