Study to Explore Smoking Cessation After a Cancer Diagnosis

NEW YORK--People often continue to smoke even after a diagnosisof cancer, Jamie Ostroff, PhD, said at a symposium on tobaccocontrol at the Third World Congress of Psycho-Oncology.

"We hear time and time again from these patients, why shouldI bother quitting? I already have cancer," she said. "Clearly,these perceptions and myths about the lack of benefit of smokingcessation after a cancer diagnosis persist in patients, families,and even some health care personnel."

Dr. Ostroff pointed out that continued smoking after a cancerdiagnosis is associated with a higher risk of disease recurrence,second primary tumors, numerous treatment complications, and mortality.The increasing survival rates in many cancers further underscorethe need for intervention among the newly diagnosed, she said.

Looking for a 'Teachable Moment'

Dr. Ostroff and her colleagues at Memorial Sloan-Kettering CancerCenter are planning a prospective study of recently diagnosedcancer patients to determine if there is a "teachable moment"for smoking cessation.

"Health care personnel commonly ask if we should strike whilethe iron is hot or wait until patients are more comfortable anda little less overwhelmed by their disease," she said.

The upcoming study will seek to answer that question by exploringa number of different issues: What are the patterns of smokingcessation after diagnosis? Which patients are most likely to continuesmoking? How long is the teachable moment? Does the teachablemoment also apply to smokers within the patient's social and familynetwork?

To set up the study, Dr. Ostroff and her colleagues looked atthe barriers and facilitators to smoking cessation in the contextof a diagnosis of lethal cancer. These patients have very highlevels of psychological stress, and the coping demands of eventhe highest functioning patients are clearly challenged. And,as mentioned above, many patients have a strong pessimism aboutquitting after a diagnosis of cancer. There is also variabilityin the way people perceive the severity of their disease and theirrole in health care. "Last, but certainly not least, is thefact that those who are diagnosed with a tobacco-related diseaseare usually heavy, long-standing smokers," she said.

Despite these barriers to smoking cessation, a large number ofsmokers with cancer do manage to stop. A retrospective study ofhead and neck cancer patients who had curative surgery indicatedthat 65% never resumed smoking. "It's the 35% who continuesmoking that we are interested in," Dr. Ostroff said.

Surveys from Memorial Sloan-Kettering seem to indicate that thevast majority of cancer patients who smoke have made multipleattempts to quit, generally without any formal or informal assistance,which seems to reflect that most smokers prefer to quit on theirown, Dr. Ostroff pointed out.

"It seems that people need to be reminded that they needto practice quitting," she said. "Those who have quitsmoking many times are more likely to be successful than thosewho have never attempted to quit."