Quitting smoking after a cancer diagnosis can add years to patients’ lives

Quitting smoking within six months of a cancer diagnosis adds an average of two years to a patient’s life.

With this information in hand, all cancer centers have an obligation to offer evidence-based smoking cessation to all patients, said Graham Warren, MD, Ph.D., Vice Chair for Research in the Department of Radiology. She is also the Mary Gilbreth Endowed Chair of Oncology, a MUSC Hollings Cancer Center investigator and senior author of a new paper demonstrating a broad survival benefit of using evidence-based smoking cessation to help patients quit smoking as soon as possible after cancer diagnosis.

This is a survival benefit that we can achieve now. It’s not something we have to wait 10 years for test results. If we’re missing patients now, well, they’ve lost the benefit they’re going to get from it. So there is an urgent responsibility to make this work. It is important to ensure that we provide everyone with evidence-based care specifically to help them improve survival. This is not optional.”

Graham Warren, MD, Ph.D., Vice Chair for Research, Department of Radiology, MUSC

It is known that smoking after a cancer diagnosis reduces the effectiveness of treatment and increases the likelihood of certain side effects or complications. And some previous work has looked at the survival benefit of smoking cessation in specific subgroups of cancer patients, such as lung cancer patients.

In this paper, published in JAMA OncologyWarren and colleagues at MD Anderson Cancer Center were able to use data from the Tobacco Research and Treatment Program (TRTP) at MD Anderson to examine long-term survival in more than 4,500 patients with a wide variety of cancers.

Records from this program were valuable because they regularly note the patient’s current smoking status and use of a structured, evidence-based tobacco treatment program. Too often, Warren said, cancer centers ask about a patient’s smoking status at diagnosis but don’t follow up throughout treatment to update the electronic health record.

With the detailed records from the TRTP, the researchers were able to divide patients into three groups: those who quit within six months of diagnosis, those who quit between six months and five years after diagnosis, and those who quit longer from five years after diagnosis. . Quitting smoking after a cancer diagnosis improved survival across all cancers overall, with the greatest benefit among patients who quit within six months of diagnosis.

David Marshall, MD, chairman of Radiation Medicine and medical director of the Office of Clinical Trials at Hollings, said the clear benefit of smoking cessation after diagnosis in all types of cancer underscores the need to improve clinical treatment approaches for all patients. Marshall’s expertise is in prostate cancer and clinical trials, and he noted the impact of smoking on outcomes in prostate cancer.

“Most prostate cancer patients don’t die of prostate cancer. It’s often smoking-related conditions that contribute to patient deaths,” he said.

Smoking cessation even in patients with cancers not related to smoking may be one of the biggest contributors to improved overall survival.

Warren said these data likely represent the new gold standard establishing a survival benefit to support smoking cessation programs at cancer centers. Unfortunately, he said, while up to 90% of patients are asked about smoking, only about 40% of centers provide help to stop smoking.

“It’s not like developing a new targeted agent. You don’t need new protocols or buy new drugs,” he said. “If you understand the importance of this, you can start doing it this afternoon. The evidence is there. The treatments are there. It’s just a matter of getting clinicians to put it into practice and patients getting evidence-based treatment.”

Raymond N. DuBois, MD, Ph.D., director of the MUSC Hollings Cancer Center, noted the importance for all types of cancer.

“This research shows in a very clear and unambiguous way what clinicians have often observed – that their patients who continue to smoke do worse than those who are able to quit,” DuBois said.

“This is an important finding for people facing any type of cancer diagnosis, not just lung cancer, and for their doctors. We also know that continued smoking after a cancer diagnosis weakens the immune system, making it harder for the body to fight cancer cells”.

K. Michael Cummings, Ph.D., a Hollings colleague with an extensive background in tobacco research who has collaborated with Warren on other projects but not on this paper, said the work shows the clinical necessity of offering cessation programs of smoking.

“Patients and family members need to be educated about the benefits of smoking cessation,” he said. “Furthermore, patients who smoke must receive real help to quit smoking, recognizing that quitting is not easy. Cigarette addiction is a chronic relapsing disorder, so one-time interventions for patients are insufficient.”

Tobacco Treatment Program at MUSC Health

Founded in 2014, MUSC’s tobacco treatment program offers the type of evidence-based intervention that can help people quit smoking.

Patients are assigned to a trained smoking cessation counselor who can assist with pharmacotherapy to address the physical need for nicotine and behavioral counseling to address mental burden. They meet regularly, usually over the phone, so counselors can help patients stay on track.

It is important that this work touches every cancer patient who smokes.

“Thanks to the work of Dr. Warren and others, since 2021 Hollings Cancer Center has implemented a smoke cessation treatment program where every patient visiting a Hollings outpatient oncology clinic (now up to 52 clinics in South Carolina) is regularly screened for smoking status assessment and referral automatically enroll current smokers in the telepharmacy-assessed tobacco treatment program, where patients can receive behavioral and smoking cessation support to help them on their journey to quit smoking,” Cummings said.

With the support of the Department of Radiology at MUSC and Hollings, Warren has collaborated with cancer centers in the US and Canada to create smoking cessation programs. Through the Canadian Partnership Against Cancer, for example, he helped increase smoking cessation programs in Canada from 26% of cancer centers in 2015 to 95% of cancer centers by 2023.

He also worked with the American College of Surgeons Committee on Cancer on the Just ASK and Beyond ASK Smoking Cessation initiatives, which addressed smoking in more than 700 cancer centers in the United States.

But there is more work to be done, and smoking cessation may be one of the most effective methods for improving survival in the US and internationally. He expects this study to provide unequivocal evidence about the importance of smoking cessation programs in cancer centers.

“We now have a good estimate of how smoking cessation improves survival in cancer,” Warren said. “This really shows us that if we provide an intervention, we improve survival.”