Mind and Body

Many cancer patients continue smoking after being diagnosed



A diagnosis of cancer doesn’t necessarily deter some from giving up their smoking habits.

A research team led by Dr. Elyse Park from the Massachusetts General Hospital/Harvard Medical School in Boston took a look at how many lung and colorectal cancer patients stop smoking once they were diagnosed and which ones were more likely to do so. The researchers found a substantial minority of patients still keep up the habit, and colorectal cancer patients were even less likely to quit than lung cancer patients.

Once patients receive a diagnosis for cancer, most of their treatment solely centers on fighting the disease.  But Park said that her team’s findings highlight the need for more than just a pharmacological approach.

“Any cancer patient who’s a smoker who comes into a clinic should be assessed and receive behavioral and pharmacological treatment, and very few cancer patients actually receive that,” Park said.  “It’s important because there are many studies that indicate that continuing to smoke has negative effects on cancer treatment outcomes.  So you will do better in the long run if you stop.”

Park and her team tested 5,338 lung and colorectal cancer patients, comparing their smoking rates at the time of diagnosis and five months after diagnosis.  Initially, 39 percent of lung cancer patients and 14 percent of colorectal cancer patients were smokers.  Upon second look five months later, 14 percent of lung cancer patients and 9 percent of colorectal cancer patients still hadn’t kicked the habit.

“The message that we receive from this is that oncology clinicians should screen for smoking, and consider treating it as a part of comprehensive cancer care,” Park said.

There was a diverse amount of factors and traits that predicted whether or not certain patients would continue smoking versus others.  For lung cancer patients, continued smokers tended to have pre-existing factors such as having public health insurance, a lower body mass index, and low emotional support, among other factors.  Colorectal cancer patients who kept smoking tended to have completely different characteristics such as being male, lower education levels, and being uninsured.

“It’s a multifaceted issue,” Park said regarding what keeps smokers smoking.  “I think that there’s a perception that cancer patients are stressed and have a lot to worry about, which keeps them smoking.  And there is some skepticism on the part of clinicians and family members that these patients who haven’t quit before now are not going to be able to quit.  So there’s some reluctance to add new treatments.”

But Park said these deterrents to quit smoking are critical to address moving forward.  For her, it’s just as important to treat the physical trouble as it is to treat the mental road blocks.

“Almost all smokers want to quit smoking, but they don’t have the tools they need to quit and stay quit,” Park said.  “All the programs that are out there are for cancer prevention, so it can be isolating for people once they have a cancer diagnosis.  There’s also a hesitancy to join a smoking cessation group when you already having cancer.”

In order to test the effectiveness of behavioral treatment on cancer patients, Park is looking to conduct a lengthier study in the near future with a more diverse group of cancer patients.

“We’ll be assessing integrating behavioral and pharmacological treatments in cancer care settings with four types of diagnoses,” Park said.  “This is special because there hasn’t been any large scale, longitudinal randomized-clinical trial integrating both styles of treatment.  It’s really an area that needs more attention.”