The National Comprehensive Cancer Network (NCCN) published new guidelines this year addressing smoking cessation.1 In this document, some startling evidence was cited, namely that:
There is a link between smoking and increased risk of cancer recurrence, overall poor treatment response, and increased treatment-related toxicity.
Cytochrome P450 enzymes may be altered with smoking such that the metabolism of some chemotherapy and targeted therapies may result in alterations of drug clearance and plasma concentration, potentially impacting the efficacy of certain drugs in patients who smoke (i.e., erlotinib [Tarceva], irinotecan [Camptosar]).
Radiation-related treatment complications may be heightened when patients smoke and treatment response may be decreased.
Smoking may impair wound healing following oncologic surgery and increase infection rates, pulmonary complications, and promote longer postoperative hospitalizations.
Smoking cessation appears to have benefits of improved survival, treatment outcomes, and health-related quality of life as well as decreased toxicity and surgical complications.2, 3
Of note is that only 50% of oncologists advise patients to stop smoking and few offer guidance how to do it.4 Citing time as a barrier by practitioners, NCCN established a brief assessment strategy and treatment algorithm that included a two-question initial risk determination:
Have you ever smoked cigarettes?
Do you currently smoke cigarettes or have you smoked in the past 30 days?
The algorithm then offers questions to assess readiness to quit and treatment. Clinical recommendations include the following:
The two most effective pharmacotherapy agents are combination nicotine replacement therapy and varenicline (Chantix).
Combining pharmacologic therapy and counseling is most effective and evidences the best results in smoking cessation.1
A cautionary reminder is that it may take more than one quit attempt to achieve long-term cessation. Additionally, there is no current evidence that the use of e-cigarettes enhance smoking cessation. The NCCN guidelines provide an evaluative overview to determine readiness to quit smoking, risk for smoking relapse, pharmacotherapy guidelines, and resources for health professionals in their efforts to help smokers quit.1
National Comprehensive Cancer Network (2015). NCCN clinical practice guidelines in oncology – smoking cessation. (Version 1.2015).
Kotz D, Brown, J, West R. (2014). ‘Real World’ Effectiveness of Smoking Cessation Treatments: A Population Study. Addiction, Mar;109(3):491-9.
O’Malley M, King AN, Conte, M, et al. (2014). Effects of Cigarette Smoking on Metabolism and Effectiveness of Systemic Therapy for Lung Cancer. Journal of Thoracic Oncology, Jul;9(7):917-26.
Shields PG (2015). New NCCN Guidelines: Smoking Cessation for Patients With Cancer. Journal National Comprehensive Cancer Network, May;13(5 Suppl):643-5.
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