Introduction
Overview
Smoking as a Primary Risk Factor
Poorer Treatment Response in Cancer Patients
Smoking as a Secondary Risk Factor
Effects of a Cancer Diagnosis on Quitting Smoking and Remaining Abstinent
Smoking Intervention in Cancer Patients
Treatment
Get More Information From NCI
Changes to This Summary (11/14/2008)
Questions or Comments About This Summary
About PDQ

Introduction

This patient summary on smoking cessation and continued risk in cancer patients is adapted from a summary written for health professionals by cancer experts. This and other credible information about cancer treatment, screening, prevention, supportive care, and ongoing clinical trials is available from the National Cancer Institute. This brief summary describes smoking and the risks that continued smoking have on cancer patients.

Overview

This summary briefly covers smoking as a primary risk factor for cancer, but the main focus is on the effect of smoking on cancer recurrence and diagnosis of a second primary cancer; patterns of quitting and continued smoking in cancer patients; and recommendations for cancer patients to quit smoking. Information on cancer prevention and quitting smoking in healthy people is readily available elsewhere. The information presented in this summary is related to smoking, rather than using other forms of tobacco, such as snuff or chewing tobacco.

Smoking as a Primary Risk Factor

It has been known for almost 50 years that tobacco use can be linked to cancers of the lung and head and neck. Eighty-five percent of the cases of head and neck cancer found each year are associated with tobacco use. Long-term smoking that begins before age 30 also increases the risk for developing colorectal cancer. Smoking contributes to cancer development by causing mutations in genes, impairing lung function, and decreasing the effectiveness of the immune system. (Refer to the PDQ summary on Lung Cancer Prevention ¹ for more information.)

Poorer Treatment Response in Cancer Patients

If cancer is diagnosed in a smoker, studies have found that quitting smoking will still be helpful. Even recent quitters are more likely to recover from cancer than smoking patients are. Continuing to smoke may decrease the effectiveness of treatment and may worsen treatment side effects. For example, patients who have received radiation therapy for laryngeal cancer are less likely to regain satisfactory voice quality if they continue to smoke. Also, wound healing following surgery will be more difficult if one continues to smoke.

Smoking as a Secondary Risk Factor

Whether a patient has a cancer that is smoking-related or nonsmoking related, he or she is at increased risk of developing a second cancer at the same or another site, if smoking is not stopped. The risk of developing a second cancer may persist for up to 20 years, even if the original cancer has been successfully treated.

Patients with oral and pharyngeal cancers who smoke also have a high rate of second primary cancers. The risk decreases significantly, however, after 5 years of not smoking.

Effects of a Cancer Diagnosis on Quitting Smoking and Remaining Abstinent

Most people who have a smoking-related cancer stop smoking or make serious efforts to quit when cancer is diagnosed. Patients who do not immediately stop smoking may be motivated to quit in the future. Some studies have shown that patients who have less intensive treatment are more likely to continue smoking, and if they quit, are more likely to start smoking again.

Smoking Intervention in Cancer Patients

Although smoking cessation research has been conducted in other patient groups, especially heart patients, few studies have involved cancer patients. These studies have shown the importance of involvement of physicians and other health care professionals in helping patients to stop smoking. The ASK, ADVISE, ASSIST, and ARRANGE model was developed in the late 1980s for health care providers and their patients who smoke. Using this model, the physician asks the patient about smoking status at every visit, advises the patient to stop smoking, assists the patient by setting a date to quit smoking, provides self- help materials, recommends use of nicotine replacement therapy (for example, the nicotine patch), and arranges for follow-up visits.

Not all smokers are motivated to stop smoking. Physicians should help patients become motivated to quit smoking. It is common for first time quitters to start smoking again once or many times. Quitters should be taught to anticipate stressful situations in which they will want to smoke, and to develop strategies for handling them. It may take more than a year for even motivated smokers to stop smoking. The National Cancer Institute booklet, Online Guide to Quitting ² may help patients understand reasons for smoking and the best ways to quit.

Treatment

The drugs bupropion and fluoxetine have been found to be successful in helping healthy people stop smoking. They have not, however, been studied in people with cancer.

Nicotine products, such as nicotine inhalers, nicotine gum, and nicotine patches, may help with the withdrawal symptoms that one experiences when trying to stop smoking. Several precautions should be considered, and a physician should be consulted before beginning any form of treatment.

Get More Information From NCI

Call 1-800-4-CANCER

For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

Chat online

The NCI's LiveHelp® ³ online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

Write to us

For more information from the NCI, please write to this address:

NCI Public Inquiries Office

Suite 3036A

6116 Executive Boulevard, MSC8322

Bethesda, MD 20892-8322

Search the NCI Web site

The NCI Web site ⁴ provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use our “Best Bets” search box in the upper right hand corner of each Web page. The results that are most closely related to your search term will be listed as Best Bets at the top of the list of search results.

There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.

Find Publications

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator ⁵. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

Changes to This Summary (11/14/2008)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.

Questions or Comments About This Summary

If you have questions or comments about this summary, please send them to Cancer.gov through the Web site’s Contact Form ⁶. We can respond only to email messages written in English.

About PDQ

PDQ is a comprehensive cancer database available on NCI's Web site.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site ⁴. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

A clinical trial is a study to answer a scientific question, such as whether one method of treating symptoms is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. Some patients have symptoms caused by cancer treatment or by the cancer itself. During supportive care clinical trials, information is collected about how well new ways to treat symptoms of cancer work. The trials also study side effects of treatment and problems that come up during or after treatment. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients who have symptoms related to cancer treatment may want to think about taking part in a clinical trial.

Listings of clinical trials are included in PDQ and are available online at NCI's Web site ⁷. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Glossary Terms

A substance that is used to treat depression, and to help people quit smoking. It belongs to the family of drugs called antidepressants.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.

Having to do with the colon or the rectum.

The process of identifying a disease, such as cancer, from its signs and symptoms.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

A drug used to treat depression. It is a type of antidepressant.

Monitoring a person's health over time after treatment. This includes keeping track of the health of people who participate in a clinical study or clinical trial for a period of time, both during the study and after the study ends.

The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein.

The complex group of organs and cells that defends the body against infections and other diseases.

Having to do with the larynx.

One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.

Any change in the DNA of a cell. Mutations may be caused by mistakes during cell division, or they may be caused by exposure to DNA-damaging agents in the environment. Mutations can be harmful, beneficial, or have no effect. If they occur in cells that make eggs or sperm, they can be inherited; if mutations occur in other types of cells, they are not inherited. Certain mutations may lead to cancer or other diseases.

The National Cancer Institute, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. The National Cancer Institute conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the National Cancer Institute Web site at http://www.cancer.gov. Also called NCI.

An addictive, poisonous chemical found in tobacco. It can also be made in the laboratory. When it enters the body, nicotine causes an increased heart rate and use of oxygen by the heart, and a sense of well-being and relaxation. It is also used as an insecticide.

A chewing gum that contains a small dose of nicotine, which enters the blood by being absorbed through the lining of the mouth. This helps stop nicotine cravings and relieves symptoms that occur when a person is trying to quit smoking. A prescription is not needed for nicotine gum.

A device used to inhale (breathe in) small doses of nicotine through the mouth. The nicotine is absorbed through the lining of the mouth and goes into the blood. This helps stop nicotine cravings, and relieves symptoms that occur when a person is trying to quit smoking. A prescription is needed for nicotine inhalers.

A patch that sticks on the skin and contains a small dose of nicotine, which enters the blood by being absorbed through the skin. This helps stop nicotine cravings and relieves symptoms that occur when a person is trying to quit smoking. A prescription is not needed for nicotine patches.

A type of treatment that uses special products to give small, steady doses of nicotine to help stop cravings and relieve symptoms that occur when a person is trying to quit smoking. These products include nicotine gum, nicotine inhaler, nicotine nasal spray, nicotine lozenges, and nicotine patch. They do not contain any of the other chemicals found in tobacco products.

By or having to do with the mouth.

PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.

The hollow tube inside the neck that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). The pharynx is about 5 inches long, depending on body size. Also called throat.

Medical doctor.

In medicine, action taken to decrease the chance of getting a disease or condition. For example, cancer prevention includes avoiding risk factors (such as smoking, obesity, lack of exercise, and radiation exposure) and increasing protective factors (such as getting regular physical activity, staying at a healthy weight, and having a healthy diet).

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.

Cancer that has recurred (come back), usually after a period of time during which the cancer could not be detected. The cancer may come back to the same place as the original (primary) tumor or to another place in the body. Also called recurrent cancer.

Something that may increase the chance of developing a disease. Some examples of risk factors for cancer include age, a family history of certain cancers, use of tobacco products, certain eating habits, obesity, lack of exercise, exposure to radiation or other cancer-causing agents, and certain genetic changes.

Checking for disease when there are no symptoms. Since screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (breast), colonoscopy (colon), Pap smear (cervix), and PSA blood level and digital rectal exam (prostate). Screening can also include checking for a person’s risk of developing an inherited disease by doing a genetic test.

Refers to a new primary cancer in a person with a history of cancer.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of supportive care is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called comfort care, palliative care, and symptom management.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

A plant with leaves that have high levels of the addictive chemical nicotine. The leaves may be smoked (in cigarettes, cigars, and pipes), applied to the gums (as dipping and chewing tobacco), or inhaled (as snuff). Tobacco leaves also contain many cancer-causing chemicals, and tobacco use and exposure to secondhand tobacco smoke have been linked to many types of cancer and other diseases. The scientific name is Nicotiana tabacum.

A break in the skin or other body tissues caused by injury or surgical incision (cut).