Smoking cessation in cancer patients
Stopping smoking after a cancer diagnosis improves survival, reduces treatment complications and second cancers, and is the single most effective supportive intervention that oncology services still routinely fail to deliver.
Continued smoking after diagnosis increases all-cause and cancer-specific mortality (2014 Surgeon General's report: about 50% higher risk of death in lung and head and neck cancer), impairs wound healing and radiotherapy response, increases chemotherapy toxicity and treatment interruptions, and raises the risk of second primary cancers. Quitting within months of diagnosis of early lung cancer improves survival by around a third in cohort studies and a randomised trial of intensive cessation support in the ELCAP and Moscow cohorts (Annals of Internal Medicine 2021) showed better survival. Evidence-based treatment is varenicline or cytisine plus behavioural support, which doubles or triples quit rates. Despite this, fewer than half of cancer centres systematically assess and treat tobacco use; the NCI Cancer Center Cessation Initiative (C3I) and the UK's opt-out 'Cure' model demonstrate that embedding cessation into oncology pathways lifts treatment rates from single digits to over 50%.
How it works
Removing ongoing carcinogen exposure and hypoxia-inducing carboxyhaemoglobin improves radiotherapy oxygen enhancement and drug metabolism, halts field cancerisation, and lowers cardiovascular competing risk.
- Large survival effect in lung and head and neck cancer
- Cheap, effective drugs available
- Opt-out models are proven to raise uptake
- Under-delivered: most patients never offered treatment
- Stigma and fatalism among patients and clinicians
- Reimbursement gaps for cessation pharmacotherapy
Latest papers
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