Some Smokers Diagnosed with Cancer Don’t QuitMar 7, 2012
For many smokers, a cancer diagnosis is a wake-up call that motivates them to quit. But researchers at Massachusetts General Hospital report that a “substantial minority” of lung and colon cancer patients are still smoking 5 months after their diagnosis. The researchers chose those two cancers to study because smoking is known to be a strong risk factor> for lung cancer, but is a less well-known risk factor for colon cancer. That difference may affect how important patients and doctors think it is to quit.
The study, published in the journal Cancer, involved 2,456 patients with lung cancer and 3,063 patients with colon cancer. At the time they were diagnosed, 39% of the lung cancer patients and 14% of the colon cancer patients were current smokers (although a much higher portion had a history of smoking). Five months after their diagnosis, 14% of the lung cancer patients and 9% of the colon cancer patients still smoked. Though more lung cancer patients smoked overall, they were also more likely to quit.
Why quitting matters
Research suggests that quitting smoking after a lung cancer diagnosis improves the effectiveness of treatment, reduces the chances of secondary tumors, and increases the chances of survival. How smoking affects colon cancer treatment outcomes has not been as well studied. But we do know that long-term smokers are more likely than non-smokers to develop and die from colon cancer.
Continued smoking after a diagnosis of other types of cancer may also affect treatment and survival, although this area requires more study, according to the researchers.
Why some don’t quit
Even among people who want to quit smoking, some people have a much harder time quitting than others. The researchers found several factors that made it more likely that someone would continue smoking.
Lung cancer patients who continued smoking were more likely than those who quit to be unmarried, to not have private health insurance, to report higher levels of depression and poorer health, and to be heavier smokers. Colon cancer patients who continued smoking were more likely to be male, to have no insurance, to report higher levels of depression, and to be heavier smokers. Patients in both groups who kept smoking were less likely to have undergone surgery to treat their cancer. This may be because many surgeons insist patients stop smoking before surgery to aid wound healing, according to the researchers.
The researchers conclude that cancer patients who smoke after their diagnosis either try to quit but fail, or don’t think quitting will help. Lung cancer patients, who are more likely than colon cancer patients to quit, are probably more likely to associate their diagnosis with smoking. Another possibility is that doctors are more likely to talk to lung cancer patients about quitting.
Patients who had advanced stage lung cancer had higher rates of smoking after diagnosis. This may reflect a sense from patients or doctors that quitting would not affect chances of survival.
Many patients with lung and colon cancer quit around the time of diagnosis, resulting in a significant group of cancer patients who are relatively new former smokers vulnerable to relapse.
The researchers recommend that doctors take a more assertive role in asking cancer patients whether they smoke, and referring smokers to quitting programs. They say doctors should have this conversation by the 2nd medical visit, whether or not the patient has an established smoking-related cancer. Research shows the closer to the time of diagnosis the patient receives quitting assistance, the greater the likelihood of success.
For help in quitting, see the American Cancer Society’s Guide to Quitting Smoking.
A Snapshot of Smokers After Lung and Colorectal Cancer Diagnosis. Published online Jan. 23, 2012 in Cancer. First author: Elyse R. Park, PhD, MPH, Massachusetts General Hospital, Boston.