To commemorate the 50th anniversary of the US Surgeon General’s report on the dangers of tobacco, the AACR published a policy statement on tobacco use by cancer patients to coincide with its 2014 annual meeting. Scientific evidence shows that tobacco use in cancer patients leads to poorer outcomes by compromising response to therapy, increasing treatment-related toxicity, increasing the risk of recurrence and second primary tumors, and hastening earlier death. Yet a certain proportion of patients continues to smoke.
The policy statement emphasizes the need to integrate evidence-based tobacco-dependence treatment into all healthcare delivery. At the present time, there is a scarcity of dedicated cessation treatment programs available at oncology practices.
The statement emphasizes that the “5 As” program developed by the US Department of Health and Human Services is a proven method of increasing rates of successful quitting. This model relies on the following steps: ASK about tobacco use at every clinic visit; ADVISE to quit; ASSESS interest in quitting; ASSIST by providing counseling and pharmacotherapy; and ARRANGE follow-up. Although the “5 As” model lacks an evidence base for patients with cancer, following this model could be instrumental in helping cancer patients to quit smoking.
Surveys of oncologists and other healthcare providers show that smoking cessation is rarely offered to patients, even though most agree that tobacco affects cancer outcomes and should be part of cancer care. In one survey of members of the International Association for the Study of Lung Cancer, more than 90% of respondents said this was important, yet only 40% discussed medications or provided any type of cessation support. Many respondents indicated the perceived inability to get patients to quit using tobacco as well as patient resistance to intervention programs were the main barriers to offering cessation support.
AACR made 2 recommendations: (1) Patients with cancer who use tobacco or who have quit within the past 30 days should be provided with evidence-based tobacco-cessation assistance, ideally within or associated with the oncology practice; and (2) Tobacco use should be comprehensively and repeatedly documented for all patients so that the confounding effects of tobacco on cancer treatment, disease progression, comorbid events, and survival can be evaluated in clinical trials and in all cancer settings.
Toll BA, Brandon TH, Gritz ER, et al; Writing Committee for the AACR Subcommittee on Tobacco and Cancer. Assessing tobacco use by cancer patients and facilitating cessation: an American Association for Cancer Research policy statement. Clin Cancer Res. 2013;19(8):1-8. http://www.aacr.org/Uploads/DocumentRepository/LegAffairs/Tobacco/AACRStatement_TobaccoUseCancerPatients_2013_CCR.pdf. Accessed April 16, 2014.