Wednesday, June 15, 2011

Smoking Cessation

Cigarette smoking continues to be the leading cause of preventable morbidity and mortality in the United States, causing approximately 443,000 premature deaths annually. Recent estimates show that about 20.6% of U.S. adults (46.6 million people) are current smokers. Smoking accounts for at least 30% of all cancer deaths and 87% of lung cancer deaths. Yet each day in the United States, approximately 3,450 young people between 12 and 17 years of age smoke their first cigarette, and an estimated 850 youth become daily cigarette smokers. This is unfortunate given that smoking is linked to a broad array of cancers including nasopharynx, nasal cavity and paranasal, sinuses, lip, oral cavity, pharynx, larynx, lung, esophagus, pancreas, uterine cervix, kidney, bladder, stomach, and acute myeloid leukemia. In addition, an estimated 8.6 million people suffer from smoking-related cerebrovascular disease, stroke, chronic bronchitis, emphysema, and gastric ulcers. On average, smokers die 13 to 14 years earlier than nonsmokers. The benefits of quitting smoking are tremendous:

Within 20 minutes - your heart rate calms down

Within 8 hours - there is more oxygen in your blood and mucous begins to clear out of your lungs, which makes breathing easier

Within 48 hours - things smell and taste better

Within 3 months - your blood circulation improves and your body is better able to fight infection

Within 9 months - less sinus congestion, wheezing, and shortness of breath

Within 1 year - your risk of dying from a heart attack is cut in half

After 5 years - you have much less of a chance of having a stroke

After ten years - your risk of developing lung cancer is cut in half

Moreover, the mathematics of quitting are clear: 365 days/year x $5.00/pack = $1825.00 for a pack per day smoker for a year 365 days/year x $10.00/pack = $3650.00 for a two pack per day smoker for a year 10 years = $18,250.00 for a pack per day smoker or $36,500.00 for a 2 pack per day smoker It is especially important that cancer patients and survivors quit smoking. A recent meta-analysis showed that 14-58% of cancer patients who were smoking at the time of diagnosis continued smoking after treatment. This is alarming because quitting smoking after initial diagnosis can:

Positively impact response to treatments (therapeutic radiology, chemotherapy, and surgery)

Decrease the likelihood that patients will develop second malignancies

Increase rates of survival

Importantly, there are several effective smoking cessation treatments. First line drug therapies include: nicotine replacement therapy (patch, gum, lozenge, nasal spray, and inhaler), bupropion SR (Wellbutrin XL, Zyban), and varenicline (Chantix). Of note, there is recent convincing research that dual nicotine replacement therapy (e.g., patch + lozenge) is a very safe and effective treatment regimen. It is essential that drug therapies be combined with counseling. There is a dose response curve for the amount of counseling time and the number of counseling sessions, such that a higher amount of contact time and a higher number of sessions are related to higher rates of abstinence from smoking. There is a new Smoking Cessation Service at Smilow Cancer Hospital at Yale-New Haven. This service provides individual counseling combined with a first line medication treatment. All care is highly personalized and tailored to the needs of the patient. After a thorough assessment, patients are typically followed for 4 to 9 individual sessions with multiple follow-up phone calls. Every effort is made to schedule smoking cessation treatment sessions so that they coincide with pre-existing cancer treatment appointments. Please feel free to contact the Smoking Cessation Service with patient referrals or any questions at (203) 688-1378.