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Wednesday, November 28, 2012

You’ve Got Cancer? Why Are You Smoking?

By Heather Millar


I must admit that I’ve not always been the most understanding person when these two questions have come up in the past. When I’ve seen benches and courtyards outside cancer hospitals filled with smokers, some pulling oxygen tanks or IV poles along, I’ve shaken my head and wondered how so many people could be so stupid. When I was first diagnosed, I got in trouble with a family member for getting on my high horse about her smoking. It probably wasn’t a good idea to post about that on Facebook. If I remember correctly, I was full of tragic, righteous indignation at the time.

In my defense, almost every single health story I have written in the last 20 years could include the sentence, “This gets worse if you smoke.” My Dad, who smoked two packs a day for 40 years, died of lung cancer.

So why don’t people get it? Why don’t they at least quit smoking when they must face cancer? Isn’t it obvious that smoking interferes with treatment, that smoking brings death faster?

A new study in the journal Community Oncology set out to examine why the very cause of many cancers, smoking, so often goes untreated. The authors say this is the first comprehensive review of the problem.

It’s kind of amazing that more research hasn’t been done, considering these statistics: Smoking causes 30 percent of all cancer deaths and 87 percent of all lung cancer deaths. Yet, roughly 50 percent to 83 percent of cancer patients keep smoking after a cancer diagnosis, through treatment and beyond, says Sonia Duffy, a University of Michigan School of Nursing researcher and lead author on the paper, “Why Do Cancer Patients Smoke and What Can Providers Do About It.” For patients who quit on their own, nearly 85 percent will start smoking again, a rate no better than that in the general population.

It’s easy to dismiss smoking as a lack of discipline or a disregard for one’s own health. I made those assumptions for years.

But Duffy says it’s a much more complicated picture for these patients. She says she wasn’t prepared to find so many hurdles blocking a cancer patient who wants to quit smoking.

“I think what surprised me when I did the review was the multitude of issues that cancer patients face, and that there are so many variables affecting why they don’t get treatment, and if they do get treatment, why they may not respond,” Duffy says. “Nicotine addiction, health issues, emotional issues, psychological issues, and system-level issues are all in the way.”

Other obstacles include limited access to programs to help patients quit, little social support, sleep deprivation, and poor nutrition. Many cancer patients have just lost hope that they can quit; and a growing body of research seems to show that addiction has as many roots in environment, hormones, nerve signaling, and body chemistry as in self-discipline.

Add all that to the rigors of cancer treatment—back-to-back appointments and grueling chemotherapy or radiation protocols—and it becomes less and less surprising that many cancer patients simply lack time or energy to quit smoking, Duffy says.

Here’s the last tidbit that blew my mind: Only 56 percent of family practitioners encourage their cancer patients to stop smoking. Most oncologists will advise patients to stop smoking, Duffy’s research showed, but their priority is cancer treatment, not nicotine addiction.

Duffy suggests that nurses could run smoking cessation programs for cancer patients, but most nurses aren’t trained to do that. In her next project, she’ll work on figuring out ways to design such programs.

In some ways, this is just another reminder that silos exist everywhere in medicine: Docs will treat your broken arm, but many will skirt around the depression that led you to jump off that roof. They’ll treat your liver disease, but may look the other way to avoid the alcoholism that caused it. Modern medicine tends to be spectacularly bad at treating chronic, systemic, socially driven conditions like addiction.

We also labor against American ideas of freedom: Many of us believe that patients should be free to drink, or smoke, or whatever, even if it’s killing them. My Dad used to call his cigarettes “coffin nails.” Maybe people should be free to be unwise, but after readying Duffy’s paper, I bet most of those smoking cancer patients don’t want to die because of their habit; they just don’t know how to quit.

Not seriously addressing smoking when someone’s lungs are being irradiated for lung cancer? Surely, we must do better than this. Do you smoke? Would you like to quit? If not, then why not? If so, what would help you quit?

Photo: Ingram Publishing

Posted by: Heather Millar at 1:00 am


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