Dr. Len's Cancer Blog

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Dr. Len's Cancer Blog

The American Cancer Society

Smoking And Cancer Treatment: Danger Ahead

by Dr. Len January 23, 2009

You’ve been diagnosed with cancer.  You are either being treated for cancer, or you have completed your treatment, survived and have moved on with life.  Naturally, you will do everything you can to improve your chances that your treatment will be successful and that the cancer won’t recur.  And, that you will do what you can to reduce the odds of developing another cancer somewhere in your body.


Not so fast.  If you are a smoker, a recent study published in the Journal of Oncology Practice suggests that if you follow the above scenario, you are the exception and not the rule.


You may be among those who think that once someone has cancer, we should let them alone to deal with their disease and its treatment and stop harping about stopping smoking.  But the medical evidence doesn’t support that notion.


We have known for years that continued smoking during cancer treatment can interfere with the success of that treatment.  And, longer term, it can lead to an increased risk of developing other cancers.


Research has shown that smoking after a cancer diagnosis interferes with chemotherapy, surgery and radiation therapy according to the study.  It can slow wound healing after surgery, increases the risk of side effects from radiation therapy, and decreases the response to radiation therapy.  It may also decrease the effectiveness of chemotherapy.


The authors of this report note that if the doctors make a point about cancer patients stopping smoking and provide services to help those patients, then between 25% to 70% of the patients will indeed quit.


In the current study, the researchers surveyed patients who had a variety of cancers either recently diagnosed and treated, or long term survivors who were diagnosed more than 10 years previously.  Most were white, and 85% had graduated from high school and 26% had some college education.


52% of the patients were either current or former smokers, and 39% of the patients were actively smoking when they were diagnosed with cancer.


44% of the patients were able to stop smoking after their diagnoses, while 56% continued to smoke.  Of the continuous smokers, 58% had thought of quitting smoking, while 42% had not.


One sad commentary in this study is that of the patients who were current smokers at the time of their cancer diagnosis, only 44% were advised by any member of their health care team that smoking was harmful to their treatment, and only 62% were told by their health care professionals that they should stop smoking.


So what do we take away from this study?


We know that smoking is harmful to your health.  But we also know it is even more harmful if you are being treated for cancer.


We know that one of the most important motivators in getting people to do something is if their health care professional tells them the importance of what they need to do.  You would think that having cancer would be one heck of a motivator to get someone to quit, but it obviously is not enough.  And if your doctor doesn’t talk to you about it and doesn’t offer you the opportunities to get help to quit, then that makes the situation even more difficult.  What you don’t know certainly can hurt you when it comes to smoking and cancer treatment.


For its part, the American Society of Clinical Oncology—which publishes the Journal of Oncology Practice—indicated in an article that appeared in the same issue as this study that cancer specialists could do more to address the issues of smoking cessation with their patients.  They pledged to increase awareness of this issue among their members, and to provide the information and resources to enable doctors and other health professionals to address their patients’ need to stop smoking.


The diagnosis of cancer and the rigors and side effects of the treatment are well-known to many of us.  Perhaps what is not as well known is that is sometimes the seemingly “small stuff” that can make a huge difference in the outcome of cancer treatment.  And, it isn’t “small stuff” when you survive your cancer yet continue to smoke, increasing your risk of another cancer years down the road.


When I was a younger physician in training we used to marvel at the patients with head and neck cancer who would continue smoking through a tracheotomy site, or other patients with end-stage lung cancer who would continue to smoke even as they were receiving intensive treatment.


And maybe those are simply situations where we would all end up leaving well enough alone.


But if you are a patient with a curable cancer, say colon or breast cancer, and you are undergoing surgery and/or radiation, then continuing to smoke could well cause severe complications if you get an infection or a bad reaction to the radiation treatment.


Maybe it’s time all of us paid more attention to the problem, and helped our patients and their families understand that even in these most difficult of circumstances, looking past the cigarettes just isn’t the right thing to do.

Filed Under:

Cancer Care | Tobacco | Treatment

Moving Forward With True Early Detection of Cancer

by Dr. Len January 08, 2009

An article in the current issue of Wired Magazine nicely details how the hope of new breakthroughs in the diagnosis and treatment of cancer run headlong into the realities that inevitably occur.  It also points out how perseverance and optimism—appropriately focused on the issue at hand—may take us to success as we pursue our dreams of reducing in incidence and burden of cancer.


The article, titled “The Truth About Cancer: Don’t Try to Cure It. Just Find It:  Inside the Science of Early Detection” and written by Thomas Goetz (a deputy editor for Wired), outlines in large part the work of the Canary Foundation, an organization founded by Don Listwin from California to pursue the question of how we can find cancers at the earliest moment possible when the chances for cure are greatest.


Mr. Listwin’s search was inspired by the experience of his mother, who was diagnosed with advanced ovarian cancer and died from her illness a year later.


He asked the question why it took so long to diagnose the cancer until it was so far advanced and beyond hope of cure.  He found out what many of us unfortunately are very familiar with: many cancers, like ovarian and pancreatic cancer, are advanced at the time of diagnosis.  They are truly silent, because it is their spread that eventually produces the signs and symptoms that lead to their discovery.  And then it is too late to do much about the disease.


There has been a tremendous amount of interest over the past several years in trying to find some way to make the diagnoses of these cancers earlier.  Scientists have been working hard to find what we call “molecular markers” which are early signals in the blood that may say to us that a cancer is present long before it even becomes visible. (In the interests of full disclosure, the American Cancer Society and the Canary Foundation have collaborated in the funding of several of these researchers.)


We have screening tests available for some of the common cancers that have enabled us to find cancers reasonably early in their course.  Screening for these cancers has resulted in real improvements in treatment and survival over the past years.  Such cancers include breast cancer, colorectal cancer and cervical cancer (the jury on prostate cancer screening is still “out” until we get solid evidence that the PSA test actually makes a difference in whether men with prostate cancer have an improved outlook and survival with early detection).


But those tests are actually fairly crude, when you consider that there are probably proteins or other markers circulating in the blood that could find cancers well before they are otherwise visible with the types of machines we have today such as mammograms, CT scans and ultrasound.


The good news is that we are making progress, as reflected in the article.  The bad news is that the progress is slow, moving forward in fits and starts, with some unfortunate detours along the way.  For example, some tests that have been promoted as being able to diagnose ovarian cancer through blood tests have been discredited on more careful investigation.


But hope remains, and the Canary Foundation is moving that research agenda forward. 


What’s unique in a very real respect is the approach used by the Foundation, which is not unlike that of a number of other “entrepreneurially directed” ventures.  More and more, there are businessmen who are taking the reins of directing research programs trying to cross the void between the traditional scientific methods of research and the more disciplined, goal-directed efforts of the typical business where you scope out an opportunity and move forward, changing directions and emphasis as you go learn from your successes and your mistakes.


The article points out the dilemmas faced by the researchers engaged in trying to solve this early detection problem when it comes to figuring out whether or not the various discoveries actually are clinically relevant.  That is no small matter, and sticking to the fundamental premise that proof of effectiveness is key to credibility in this field.  Otherwise we may end up with some fancy technology that really doesn’t measure what it is supposed to measure.


I recently wrote a blog which questioned the value of many of these new tests and technologies that are being promoted to either screen, diagnose or otherwise aid the treatment of cancer.  As I mentioned, there is a lot of hype, not infrequently little validation of these tests, and then massive marketing efforts to get a particular technology or test adopted in patient care. 


The sad reality is that there is no independent professional organization that has looked carefully at the utility and value of many of these tests, leaving it to patients and doctors to make their own assessments.  Unfortunately, neither are well equipped to make these judgments, relying frequently on manufacturers and promoters who create a “buzz” about a particular new test or technology.


As noted by the article’s author:


“For a disease like cancer, so often seen as a death sentence, early detection promises a trade-off.  At first, it makes things more complicated.  It introduces more doubt and complexity into an already complicated equation.  But in return, early detection promises that this doubt can be quantified, that these new variables can be broken down into metrics, analyzed and factored into our health decisions. Early detection proposes that the result of this calculation—complicated and ambiguous as it is—will yield better results for individuals and for their families.  In exchange for a modicum of doubt, it offers a maximum opportunity for hope.”


We don’t know how long it is going to take to get the benefits of research efforts into molecular markers and the very early detection of cancer.  Maybe it will be five years, maybe ten years, maybe longer.


But with persistence, dedication, and commitment such as that demonstrated by the Canary Foundation, I have no doubt we are going to get there.


About Dr. Len

Dr. Len

J. Leonard Lichtenfeld, MD, MACP - Dr. Lichtenfeld is Deputy Chief Medical Officer for the national office of the American Cancer Society.