Why Cancer Patients Can't Quit Smoking

Getting through the surgery is their first priority

FRIDAY, May 3 (HealthDay) -- One out of four patients who undergo disfiguring head or neck surgery for smoking-related cancers still can't kick the habit.

That's the disturbing conclusion of a new study from the VA Ann Arbor Healthcare System in Michigan.

So, if smoking caused their illness in the first place, why don't they quit?

Many of these people desperately want to, says lead researcher Sonia Duffy, but getting through the cancer surgery is often their main priority. And, ironically, she adds, smoking helps provide many with a coping mechanism.

Head and neck cancer patients undergo painful operations that can affect their appearance and way of speaking. More than 30,000 Americans are diagnosed with these forms of cancer every year. And 85 percent of the time, these cancers can be traced back to tobacco use, according to the American Cancer Society.

A recent study of 202 heart-transplant patients at the University of Pittsburgh showed similarly distressing smoking rates. Seventy-one percent of those patients were regular smokers before their transplant, and 27 percent started lighting up again as soon as they'd made it through the first stage of recovery.

"Physicians are aware of addiction issues," Duffy says. "They may refer patients to a smoking clinic, a substance abuse clinic, or a psychiatric clinic."

But Duffy thinks these referrals can be daunting for the patients. "It's hard to get bounced around like that when you're dealing with a life-threatening diagnosis," she adds.

Duffy polled 81 patients with head and neck cancer from the Ann Arbor VA and the University of Michigan hospitals. Most of the patients were white and male, and all responded to a questionnaire about their smoking and drinking habits, as well as their psychological outlook and their quality of life.

The results, published in the current issue of the journal General Hospital Psychiatry, show that 23 percent of the patients continued to smoke regularly after surgery, while 35 percent admitted to having smoked at some point in the six months preceding the survey.

And more than half of the group (46 patients) continued to drink alcohol, though the combination of drinking and smoking is known to increase the risk of head and neck cancers. Smoking and drinking were also associated with poor physical functioning and a lower quality of life.

In addition, 44 percent of the group reported symptoms of depression.

"Smokers generally use nicotine to calm and soothe themselves," says Marlene Maheu, an expert on nicotine addiction at the California School of Professional Psychology in San Diego. "This is the coping mechanism they're going to fall back on when they have to deal with a medical emergency."

Adds Alison Ross, an expert on how people cope with illness, "It's not logical to smoke if you've got a cancer diagnosis. But what drives people to light up isn't logic, it's emotion."

"People use smoking for all kinds of reasons -- to put up a barrier between themselves and others, as a food substitute, as a means of self-medicating [for anxiety and depression.] It takes a comprehensive program to help the hardcore smoker give it up. Some may need the help of a trained therapist," says Ross, an adjunct professor of psychology at Beth Israel Medical Center in New York City.

Duffy is testing a new program to help cancer patients deal with nicotine addiction and improve their quality of life.

"We provide medication to help patients kick the smoking habit," she says. "If necessary, we offer medications for depression. We also have an educational program that shows people how to make behavioral changes."

She believes the success of such interventions is based on quick and easy access. "Our goal is one-stop shopping -- to provide these services at the same place patients get their cancer treatment," she says.

What To Do

An estimated 47 million Americans smoke, according to the American Cancer Society, despite evidence that smoking is related to one in five deaths and has been linked to both cancer and heart disease.

If you want to quit, you'll find a guide to anti-smoking programs at The Centers for Disease Control and Prevention, or the American Lung Association.

SOURCES: Sonia Duffy, Ph.D., R.N. researcher, VA Ann Arbor Healthcare System and the University of Michigan; Marlene Maheu, Ph.D., California School of Professional Psychology, San Diego; Alison Ross, Ph.D, adjunct professor of psychology at Beth Israel Medical Center, New York City; April 2002 General Hospital Psychiatry
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