Title: Tobacco Use and Treatment among Cancer Survivors

Authors: Chineme Enyioha , Graham W. Warren , Glen D. Morgan and Adam O. Goldstein 

Publication: 6 December 2020 (International Journal of Environmental Research and Public Health


Tobacco use is causally associated with the risk of developing multiple health conditions,
including over a dozen types of cancer, and is responsible for 30% of cancer deaths in the U.S [1,2].
Smoking by cancer patients and survivors causes adverse health outcomes [3]. Smoking at the time of
a cancer diagnosis increases the risk of overall mortality by approximately 50% and cancer-related
mortality by approximately 60% across cancer disease sites and treatments [3]. Smoking further
increases the risk of developing a second primary cancer and has strong associations with increased
toxicity from cancer treatment [3]. Almost half of patients diagnosed with cancer who smoke may
either continue to smoke while in treatment or relapse after successfully quitting, both of which
complicate cancer care [4]. The annual costs of additional cancer treatment incurred by continued
smoking are conservatively estimated at USD 3.4 billion in the United States [5]. However, quitting
smoking after a cancer diagnosis is associated with improved overall survival [2] as well as improved
cancer control and quality of life [6–14]. Despite evidence that demonstrates the harms of smoking,
large surveys have shown that while approximately 90% of oncologists ask about tobacco use and
over 80% advise patients to quit, few provide assistance with quitting [15,16]. A survey of 58 National
Cancer Institute Designated Cancer Centers in 2009 demonstrated that most physicians did not provide
structured approaches to addressing tobacco use [17]. Few Cooperative Group clinical trials have
assessed tobacco use, even though smoking can affect overall and cancer-related survival, which serve
as the primary or secondary outcomes of clinical trial designs [18]. Predictive barriers to providing
cessation support include a lack of time, education and resources [19,20], but, until recently, there was
little national coordination of efforts specifically designed to implement clinical cessation initiatives for
cancer patients in the United States.

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