Why do cancer patients smoke and what can providers do about it?

Purpose: Despite the wide-spread dissemination of the health risks associated with smoking, many cancer patients continue to smoke resulting in decreased quality of life, increased probability of cancer recurrence, and decreased survival time. To better assist cancer patients to quit smoking, this review will describe the unique issues related to smoking and quitting smoking among cancer patients. Methods: Literature searches were done electronically though MEDLINE and PUBMED. The most recent evidence from scientific literature was considered. Results: Cancer patients are particularly vulnerable to smoking as they have high levels of nicotine dependence, lack of access to cessation services, and high relapse rates. Cancer patients often have a low perceived risk of smoking, a large social network of other smokers, elevated psychological distress, problem drinking, low intake levels of fruits and vegetables, and low levels of physical activity. There are several barriers to providing smoking cessation to cancer patients such as lack of education of providers, hesitancy to upset patients, and scheduling conflicts. System-wide interventions that include brief advice from physicians followed by intensive cessation interventions and state supported telephone quit lines have been shown to enhance quit rates. Conclusion: Efficacious interventions are available to assist cancer patients to quit smoking, yet smoking cessation interventions are often not implemented. Joint actions by clinicians, administrators, insurers, and purchasers can encourage a culture of health care in which tobacco cessation interventions are implemented consistent with evidenced-based standards of care. Implementing efficacious tobacco cessation interventions can reduce morbidity and mortality among cancer patients.