Renewed Focus on Smoking Cessation

CURE, Summer 2013, Volume 12, Issue 2

Experts call for medical professionals to engage patients in conversations about tobacco cessation.

At the annual meeting of the American Association for Cancer Research (AACR) in April, a group of oncology thought leaders released a statement calling for medical professionals to ask patients about tobacco use and to provide the patients easier access to cessation treatment.

Roy Herbst, who leads the AACR Tobacco and Cancer Subcommittee, says the conversation between physicians and patients about tobacco use should be routine. "We always take a smoking history," says Herbst, who is chief of medical oncology at Yale Cancer Center and Smilow Cancer Hospital at Yale-New Haven in New Haven, Conn. "It's very important to make sure that the patient doesn't feel any guilt or shame that they’ve smoked," but doctors need to know the information.

In a survey of National Cancer Institute (NCI)-designated cancer centers, only 38 percent of the 58 surveyed centers record smoking as a vital sign, and less than half of the institutions have designated staff to help patients stop smoking.

Herbst says some physicians don't ask their patients about smoking history or provide cessation treatment for various reasons, including not wanting to put additional strain on the patient. However, he adds, it is imperative that 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 to evaluate its impact on experimental treatments. 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," the committee reported.

Of the 155 NCI Cooperative Group studies surveyed, less than a third actually recorded tobacco use, and less than 5 percent assessed tobacco use at follow-up.

"It's incredible that this data is not recorded, and there's no intervention," Herbst says. In his own practice, he refers patients who want help to a dedicated staff at Smilow Cancer Hospital. The staff counsels patients about smoking cessation and provides treatment—something he hopes can be expanded to many other centers nationwide.

Benjamin Toll, who directs the Smoking Cessation Service program at Smilow Cancer Hospital, says that the first visit may be challenging, especially when understanding that the person may have just received a cancer diagnosis. "I try not to use the term 'quit' in the first meeting because it is very daunting for a patient," he says. "I talk about the change process and changes they may be willing to make. My goal from the first meeting is to get them to come back and get them to engage in treatment."