Smoking Cessation after Diagnosis of Lung Cancer
My question is about terminal lung Cancer. What are the benefits of smoking cessation if the patient is terminal? I am wondering if the stress of withdrawal will reduce their quality of life. If you know of any references that could help me out, I would appreciate it since I have not been able to find any journal articles.
Mitchell Machtay, MD, Radiation Oncologist, responds:
Is smoking cessation an important part of supportive care of the cancer patient, or an example of "too little, too late"? As noted by the questioner, there are few studies dealing with the pros and cons of aggressively trying to get patients with metastatic lung cancer to defeat the addiction that more than likely landed them in the oncologist's office in the first place.
It is generally agreed that for patients with a potentially "curable" cancer, smoking cessation is crucial to having the best possible outcome. For example, a study in patients with head and neck cancer showed that patients who continued to smoke had a 27% lower chance for cure than those who did not smoke throughout treatment [Browman, 1993]. A good article on smoking cessation in patients with head and neck cancer was written by Harari et al. in the International Journal of Radiation Oncology, Biology, Physics, 1995 [Harari, 1995]. Similar findings of improved cancer outcomes and fewer side effects from therapy have been reported for patients receiving definitive therapy for lung cancer with curative intent.
It is not entirely clear whether there are any benefits to smoking cessation for patients with "terminal" cancer (meaning cancer that has metastasized or spread throughout the body, with an expected survival of 6 months or less). I too have not had any success finding any scientific articles on this topic. Nicotine addiction is a serious illness, and nicotine withdrawal can cause or worsen many symptoms, including anxiety and depression. Certain medications, such as anti-depressants and/or nicotine replacement therapy, can help cancer patients to decrease or eliminate their tobacco intake and should be strongly considered. While smoking cessation is unlikely to prolong life expectancy for people with very advanced cancer, there are some potential "short term" benefits even with a limited life-span. These might include:
- Less strain on the heart and overall circulatory system.
- Decreased chance of pneumonia and other respiratory complications.
- Improved appetite.
- Decreased heartburn and/or other gastrointestinal symptoms.
- Increased ability to tolerate radiation therapy and/or chemotherapy if these therapies are needed.
Finally, it is not unusual for patients with advanced lung cancer to require home oxygen therapy to relieve symptoms. Continued smoking in this setting is, of course, extremely hazardous both to the patient and his/her family.
People make a conscious decision (albeit irrational and unduly influenced by the tobacco industry) to start smoking. However, it is not possible to simply "decide" to quit this terrible addiction. Patients with cancer have free will and may decide to attempt to quit. Whether they do or do not, it is the duty of their physicians to make honest recommendations and support their patients' decisions. In my practice, I recommend to all patients (and their family members) to stop smoking if they can. However, in people with a very limited life expectancy (particularly if less than 6 months), I stress quitting less than I do for patients who are potentially curable.