Why It’s Worth It and How to Do It
by Anthony J. Alberg, PhD, MPH
Why quit smoking after you’ve been diagnosed with cancer? The damage is already done, right? Isn’t it too late to worry about quitting now? Besides, you’ve got more pressing matters to deal with, like cancer treatment. Quitting smoking should be low on your priority list, don’t you think?
WRONG. These old ways of thinking have been transformed by evidence that clearly shows the substantial benefits of smoking cessation among cancer survivors. In fact, if you’re a cancer survivor who smokes cigarettes, quitting smoking is one of the most important things you can do to prolong survival and improve your quality of life.
Why does quitting smoking matter? What are the benefits of smoking cessation in cancer survivors?
The full range of harms caused by cigarette smoking is so broad that it is difficult to grasp. Cigarette smoking harms every major organ system in the human body, which is a big reason why cigarette smoking is a leading cause of preventable disease and premature death in the U.S.
Most smokers actually do want to quit.
What does this mean for people with cancer? Well, the 2014 Surgeon General’s Report, The Health Consequences of Smoking – 50 Years of Progress, judged the evidence to be sufficient to infer that, in cancer survivors, smoking caused adverse health outcomes, led to poorer prognosis, increased mortality from all causes and from cancer, and increased risk of second primary cancers. The evidence also suggested a causal relationship between cigarette smoking and the risk of recurrence, poorer response to treatment, and treatment-related toxicity.
One barrier to quitting smoking is having other smokers in the home and in your broader social environment. So, quitting cigarette smoking may be an issue that will affect not just you but also your family and your broader social network. Caregivers can play a vital role in helping a loved one quit by providing added motivation to quit smoking. If caregivers also smoke cigarettes, now is the perfect time to celebrate the precious gift of life and work together to eliminate smoking from the household entirely.
Quitting smoking has clear, direct benefits for cancer survivors. Cigarette smoking is a major source of inflammation, immune system dysregulation, and oxidative stress – all factors that lead to diminished health status in the near term and that greatly contribute to the progression of many diseases, including cancer. And these effects last, and may even compound, for as long as a person continues smoking. Quitting cigarette smoking, on the other hand, almost at once significantly reduces inflammation and results in a more fully functioning immune system to better fight off infections. In addition, compared with smokers, nonsmokers have better wound healing capability after surgery and a reduced risk of surgical complications. Moreover, people who quit smoking consistently report a better self-rated health status than do those who continue to smoke.
The value of quitting smoking is further enhanced by its longer-term benefits. Cigarette smoking is an established cause of 13 different kinds of cancer. Smoking not only increases your risk of cancer recurrence, but it also heightens your chances of being diagnosed with a new primary cancer. It is also a major contributing factor in several other leading causes of death, including heart disease, stroke, and chronic obstructive pulmonary disease. Consequently, cancer survivors who continue to smoke experience significantly shorter survival than those who quit smoking.
How do I go about quitting smoking?
Given these powerful reasons to stop smoking, the question becomes not whether to try to quit but how to try to quit. Although, let’s be honest: nicotine addiction makes it difficult to quit.
Most smokers started smoking when they were teenagers, usually heavily influenced by smokers in their social environment, and then quickly became addicted. However, when they reach adulthood, most smokers actually do want to quit. Even so, the powerful addictiveness of nicotine is difficult to overcome and can make quitting successfully seem out of reach. Just know that quitting smoking is a challenging goal to achieve. Having difficulty quitting is common and is not a personal failing.
Cancer survivors who continue to smoke experience significantly shorter survival than those who quit smoking.
Give yourself the best chance to quit. Coupling your personal effort with the right kind of help allows you the highest probability of success. The recommended evidence-based approach to quitting involves counseling combined with proven stop-smoking medications.
Counseling gives you the opportunity to talk through the difficult issues that will arise while making a quit attempt, with people trained in addressing these issues. Counseling can be in person, or it may take place via telephone calls such as those used by Quitlines like 1-800-QUIT-NOW. Having someone to talk with can make a significant difference in your effort to quit.
A diverse suite of smoking cessation medications has been carefully tested and shown to be effective in randomized controlled trials. These include various forms of nicotine replacement therapy, Chantix, and Bupropion. Surprisingly, some smokers avoid nicotine replacement therapy because they feel that it is “replacing one poison with another.” This is far from the case. Nicotine replacement therapy replaces the heavy nicotine from cigarettes with nicotine at much lower doses and without all the other poisons and toxins. Nicotine replacement can be delivered in several ways: through the skin (via a patch), orally (via gum or a lozenge), and through the respiratory tract (via inhaler).
So, if you want to maximize your chances of quitting smoking, your best bet is to combine counseling with stop-smoking medications. However, if using both strategies is not right for you, remember that even just doing counseling alone or stop-smoking medications alone significantly increases the likelihood of a successful quit attempt.
If you are a cancer survivor who smokes, now is the time to focus on breaking your nicotine addiction. Quitting smoking is one of the most important steps you can take to prolong your life. It is never too late to reap health benefits from quitting smoking. And no matter how you choose to try to stop smoking, the important thing is that you try.
Dr. Anthony J. Alberg is a professor and chair of the Department of Epidemiology and Biostatistics at the University of South Carolina’s Arnold School of Public Health in Columbia, SC, as well as chair of the American Society of Clinical Oncology’s Cancer Prevention Committee.
This article was published in Coping® with Cancer magazine, May/June 2018.