Does your doc ask you about smoking history?


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If not, that may change. At the annual meeting of the American Association for Cancer Research, a committee of oncology thought leaders dedicated to examine the effects of tobacco and cancer, released a statement that calls for medical professionals to ask about tobacco use and provide easier access to cessation treatment for patients. This isn't to create an even further stigma against patients with cancers that may be attributed to smoking, but to try to help patients quit and to better understand the effects of tobacco in cancer treatment. Roy Herbst, who leads the AACR Tobacco and Cancer Subcommittee, says the conversation between physician and patient about tobacco use should be routine. "We always take a smoking history. It's very important to make sure that the patient doesn't feel any guilt or shame that they've smoked... but it's important to know."Unfortunately, the message isn't getting through to patients. In one study, although 90 percent of medical professionals believe tobacco cessation should be a standard part of patient care, only 40 percent discuss and provide cessation support. In a survey to National Cancer Institute-designated cancer centers, only 38 percent record smoking as a vital sign and less than half of the institutions have designated staff to help patients with smoking cessation. This is in comparison to 78 percent of centers having dedicated nutrition personnel. While we can agree that both are very important to treatment and survivorship, why the gap in care? Herbst explained some physicians don't ask their patients about smoking history or provide treatment because of various reasons, including not wanting to put additional strain on the patient. However, he says it is imperative physicians start the conversation because smoking can impact certain cancer treatments, comorbidities and surgery recovery. The AACR statement also calls on the research community to ask about smoking history of clinical trial participants and evaluate subsequent effects on experimental treatments. The committee explained in its report that although most studies are not designed to examine the effects of tobacco use on these investigational therapies, "direct and indirect negative effects of tobacco use have the potential to confound the results of clinical research."Of the 155 NCI cooperative group studies, fewer than a third actually record tobacco use and under 5 percent assess tobacco use at follow-up. Herbst says that is a lost opportunity for research and to help the patient, most of whom want help in quitting."It's incredible that this data is not recorded, and there's no intervention," he says. In his own practice, once he's able to identify patients who want help, he refers them to a dedicated staff at Yale that counsels patients about smoking cessation and provides treatment and counseling--something he hopes can be expanded to many other centers across the nation. Benjamin Toll, who directs the Smoking Cessation Service program at Yale, says that first visit may be challenging, especially when understanding that the person may have just been diagnosed with cancer. "I try not to use the word 'quit' in the first meeting because it can be daunting. Instead, I say 'change.' The goal of the first meeting is to come back."You can read a summary of the policy statement here: "Assessing Tobacco Use by Cancer Patients and Facilitating Cessation: An American Association for Cancer Research Policy Statement". Unfortunately, the full statement is under a paywall. You can also read the AACR release here.

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