Supportive Care, Tobacco Cessation Program Can Help Cancer Patients Quit Smoking

Quitting smoking can be hard for patients, particularly after a cancer diagnosis, says Dr. Graham Warren, a board-certified radiation oncologist and vice chairman for research in the Department of Radiation Oncology at MUSC Health. “The stress of diagnosis often makes people want to smoke more,” he says. “We have to remember that patients are smoking because cigarettes are designed to be highly addictive, and it can take several attempts to quit.”

We talked with Dr. Warren, who is internationally recognized for his work to increase access to evidence-based tobacco cessation support for cancer patients and holds the Mary Gilbreth Endowed Chair of Clinical Oncology in MUSC’s Hollings Cancer Center. He is an adviser for the Canadian Partnership Against Cancer (CPAC) and works with the National Institutes of Health to implement strategies to address tobacco use across cancer care. Dr. Warren also was a contributor to the 2014 and 2020 Surgeon General’s Report on Tobacco, demonstrating that smoking caused adverse cancer treatment outcomes and that smoking cessation after a cancer diagnosis improves survival in cancer patients.

Read below to find out what strategies are most effective, and how quitting smoking can improve outcomes for patients diagnosed with cancer.

Q. What are the strategies that address tobacco use across cancer care? A. Some of the most useful strategies are to accurately identify ALL patients who should receive evidence-based care, inform them of the harmful effects of tobacco on cancer care and the benefits of quitting and provide them help to quit smoking. These core principles of asking, advising and assisting are at the heart of most national and international efforts to provide care to ALL patients and reduce disparities in care.

Q. How effective are these strategies? Which one is most effective?

A. One size does not fit all, and we must be ready to help patients quit by using strategies that will work for them. Patients and providers can stigmatize smoking in a way that prevents people from quitting, so we should minimize any stigmatization. It is key to discuss the importance of quitting smoking to achieve the best outcomes for cancer treatment in an understanding, empathetic manner.

Providing accurate, empathetic and supportive care and referring them to our dedicated cessation program is the best chance patients have to quit smoking.

Q. Do certain programs or methods work better than others?

A. Anyone can have a significant addiction to smoking, and everyone should have equal access to evidence-based care. It is important, however, to remember that patients can have vastly different resources and support systems. Some patients may respond better to quitting when meeting in person, while others may respond better by phone. In practical terms, many patients may have limited ability to travel, so phone or telehealth resources may be key to their response to counseling and support.

Q. What factors make someone more responsive/open to trying to quit smoking?

A. Clear communication about the link between smoking and health outcomes is critical to convincing patients to quit smoking. Patients faced with a new cancer diagnosis must understand that smoking will have a significant, negative effect on cancer treatment outcomes. Smoking increases the risk of recurrence or cancer-related death by more than 60%. Patients who continue to smoke after they complete cancer treatment have twice the risk of dying. Quitting smoking is absolutely the best method we have right now to prevent these adverse outcomes.

Q. How does smoking affect other health conditions?

A. Smoking is bad for cancer and non-cancer health conditions such as heart disease, lung disease, stroke, etc. Quitting smoking is unequivocally the best method for reducing or eliminating these risks and improving quality of life.

Q. Please describe the tobacco treatment programs that you have helped develop for cancer patients.

A. I have had the privilege to work with thousands of people internationally to address smoking in cancer care. We have developed several institutional programs, most notably at Roswell Park Cancer Institute and here at the Medical University of South Carolina. Our program at Roswell Park not only increased access to care, but also improved survival in patients who participated in the phone-based program.

At MUSC Health, our cessation program has reduced readmissions and costs associated with hospitalization. We also worked with the Michigan Oncology Quality Consortium to implement cessation efforts using State Quitlines across community oncology practices in Michigan. This was the largest effort demonstrating that quitlines can provide evidence-based care in a diverse set of oncology clinics, including small and large clinical settings.

We played a significant role in the development of the Cancer Moonshot Initiative through the Cancer Centers Cessation Initiative (C3I). This is a $30 million National Cancer Institute effort to implement clinical cessation programs across 52 NCI Designated Cancer Centers. The C3I helped deliver support to more than 76,000 patients across the United States through 2021.

We have also worked extensively with the Canadian Partnership Against Cancer (CPAC) to implement cessation as a standard of cancer care over the past decade. The initiative had increased access to evidence-based care at 87% of cancer centers across Canada by 2020.

These initiatives have led to profound progress in helping patients quit and significant improvement in the education of providers and patients about the importance of quitting smoking after a cancer diagnosis.

We continue work with these national initiatives and have started working with the American College of Surgeons Commission on Cancer to develop the Just Ask program, which is expanding implementation of smoking and smoking cessation opportunities across more than 1,500 accredited sites. These sites represent more than 70 percent of newly diagnosed cancer patients annually.

In parallel with these initiatives, we have worked with several major cancer organizations, including the American Society for Clinical Oncology, American Association for Cancer Research, International Association for the Study of Lung Cancer, and others to develop specific advocacy and guidelines for addressing smoking in cancer care. These initiatives have increased awareness of the importance of addressing smoking in cancer care; collectively these initiatives have touched the lives of hundreds of thousands of cancer patients.

Q. What clinical trials are available for cancer patients who want to quit smoking?

A. The Department of Radiation Oncology spearheaded development of the Hollings Cancer Center Cessation Program in 2013, which has been merged into the MUSC Health Tobacco Treatment Program developed by Dr. Michael Cummings and led by Dr. Benjamin Toll. Overall, MUSC Health’s Tobacco Treatment Program has helped support investigators and attracted more than $14 million in research funds. Clinical trials are available to help patients quit smoking as a part of cancer screening and treatment, and ongoing research is aimed at identifying optimal methods to help patients quit smoking.

Q. What other research activities are ongoing in the Department of Radiation Oncology?

The department has expanded access to clinical trials by screening more than 80 percent of all cancer patients for trial eligibility over the past eight years. We have also led novel development of yogic breathing as an adjunct to cancer care and overall health.

We recently recruited a national leader in clinical trials design. Several faculty members are opening nationally funded clinical trials. We continue working to develop highly integrated data resources linking radiotherapy care to the tumor registry, medical records and patient-reported outcomes. We are also working with industry partners to spearhead development of a comprehensive digital transformation platform that links real-time patient-reported outcomes, symptom tracking, wearable devices and operations with in-depth analytics and artificial intelligence.

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Dr. Warren practices at MUSC Health University Medical Center, 171 Ashley Avenue. To make an appointment, call 843-792-9300.