? about smoking thru treatment

[Irisheyes]

Just returned from a week long visit with my Dad that ended up being 5 days in the hospital because of severe pain Dad was having.

He is set to start Chemo this Tuesday and Radiation on Wed. My Dad is still smoking, news to me and lied to his physicians all week long. I have a couple of questions...

He obviously did not smoke these past five days in the hospital and was down right parinoid to the degree of there was some type of conspiracy going on. Even said he thought the ER was using placebos, Morphine didn't work very well for him, ended up on Ativan and pain patch. Could this be due to Nicotine withdrawl or the drugs or both? Dad is a 2-3 pack smoker.

Also, how is his smoking going to effect his treatment? We had a knock down drag out argument because he lied to me and his doctors. Would sneek in the back of the house and come out smelling up a storm and deny it. I can accpet that he won't stop, just want him to be upfront about it to the people that are trying to heal him.

Thanks so much..sorry to be so long.

[Irisheyes]

..still learning

[Kasey]

Hi Shannon,

I remember you from your previous posts. Sorry you return with this news. I am not sure about the effects of cigarette withdrawal and the symptoms you describe. I do know that the research I have read states that stopping smoking is a very good thing to do - treatments go better or can produce better results. It was something like that. However, I would not expend lots of energy arguing with Dad about this. Don't think it will help very much. So just do what you can to support him.

Hopefully once these treatments start there will be better news to report. Until then, many of us will be thinking of youo.

Kasey

[Laura Ann]

Smoking after diagnosis affects outcomes and research

Source: (cancerfacts.com)

Tuesday, November 29, 2005

HOUSTON – Nov. 28, 2005 – A pair of new studies show that many patients continue to use tobacco after a cancer diagnosis and that such use during therapy may thwart better outcomes.

The information is of particular importance for clinical trials that test new agents, which might show greater effectiveness in populations that are tobacco-free during the trial.

"Tobacco use after cancer diagnosis has now become the elephant in the room," says the lead author of both papers, Dr. Ellen R. Gritz, professor and chair of the Department of Behavioral Science at University of Texas, M.D. Anderson Cancer Center. "It is a huge issue in oncology that many in the field are ignoring."

One study, scheduled to appear in the January issue of the journal Cancer, but was published online in an early-release, Nov. 28, suggests that the time to help tobacco users quit is the moment they are diagnosed with cancer.

The other report, an editorial published in the October issue of the journal Cancer Epidemiology, Biomarkers & Prevention, suggests that researchers conducting clinical trials should assess whether patients are using tobacco while participating in the study because the detrimental health effects of smoking could negatively influence overall results.

Both reports highlight the growing connection between tobacco use after cancer diagnosis and poorer treatment outcomes, however, the authors stop short of suggesting that patients who use tobacco should be excluded from these studies. Rather, they emphasize that smoking should be seen as another critical variable that could have an impact upon study outcome.

In the Cancer study, the researchers say an ideal time to help patients quit smoking is at the time they are diagnosed with cancer. It notes that, without help, up to one-half of cancer patients either continue to smoke after diagnosis or resume smoking after stopping for a short time.

"One thing we want people to realize is that many cancer patients are highly motivated and interested in quitting smoking at diagnosis," says co-author Dr. Michelle Cororve Fingeret. "This creates a teachable moment in which patients are more receptive to smoking cessation treatment and therefore are more likely to successfully quit."

It has long been known that one-third of all cancers are associated with tobacco use, but new research demonstrates that if patients quit before treatment or participation in a clinical trial, their success rates, quality of life and chances of not developing a second primary cancer greatly improves.

According to Gritz, the studies that she and other researchers have conducted demonstrate that using this "teachable moment" can help up to 70 percent of patients quit using tobacco, whereas the typical success rate for tobacco cessation in the general population is only about 20 percent.

"This demonstrates that the diagnosis of cancer is a wake-up call to many patients, one which demands our support if we want to provide the best outcomes possible," she says.

Evidence from research studies cited in the article also demonstrates that for two of the major cancer treatment modes - radiation therapy and surgery - smoking has been found to diminish treatment effectiveness, exacerbate side effects and interfere with wound healing. These adverse effects are found both in patients with smoking-related cancers and in those with nonsmoking-related cancers. Similar adverse effects are likely to occur with chemotherapy, but few studies have looked at this.

Despite such studies, the "teachable moment" that can help patients stop smoking is not being used nearly enough in the service of patient health, Gritz says. While many doctors ask if their cancer patients smoke, they don't have the resources or the background to do more than to urge the patients to stop.

"Most physicians are not trained in treating behavioral dependencies, and when cancer is diagnosed, doctors and patients are immediately focused on treating the malignancy," she says. "Because smoking is so damaging to patients' health, it needs to be addressed in the treatment plan."

The issue is now vitally important, Gritz says, because research shows that smoking-related complications can be significantly reduced when patients stop smoking before surgery, and that the longer the interval between smoking cessation and initiation of cancer treatment, the better the prognosis.

In the Cancer Epidemiology, Biomarkers & Prevention article, the researchers show how ignoring tobacco use in patients participating in a clinical trial can affect conclusions on the effectiveness of an experimental agent or treatment.

"Now that we know that smoking produces detrimental effects on treatment outcomes, it makes sense that this is a contributing factor that could affect the success of a clinical trial," says Gritz.

But despite the critical relevance of smoking to cancer outcomes, most oncology clinical trials do not collect data on smoking history and status unless the malignancy is widely acknowledged to be smoking related, she says.

These data often are collected only when the patient registers for the clinical trial, the researchers say. Subsequent changes in smoking status for all patients during treatment or follow-up are monitored in very few trials and are not often reported in discussions about the outcome of the study, Gritz says.

"We can't ignore the obvious anymore," she says. "Tobacco use is a critical variable that affects cancer treatment and outcome, and it needs to be addressed."

Copyright © 2001, 2002, 2003, 2004, 2005 NexCura, Inc. All rights reserved. Republication or redistribution of cancerfacts.com content, including by framing or similar means, is expressly prohibited without the prior written consent of NexCura. NexCura® is a registered trademark and cancerfacts.com™ is a trademark of NexCura, Inc. or its affiliates. Copyright © 2001, 2002, 2003, 2004, 2005. All rights reserved. This information is for educational purposes only.

[dadstimeon]

Shannon,

If I was in your shoes I would encourage your father in a positive way to at least be upfront with his doctor. See what he or she says--what is the impact, what can be done etc. Good luck.

Rich

PS: When it comes to lung cancer I tell my doctor everything. I at least owe her that respect and courtesy, after all she is the one helping me.

[Calintay]

My mom also lied to me although the fact of her smoking did make me upset the lying was worst. But I believe it takes time for them to acknowledge and not to mention now that we are open about it she admits how ashamed and embarassed she is of it. I believe that she is not doomed just because she still smokes but she may or may not get a reoccurence. Be patient with him. My moms doctors also did not "know" she was still smoking but they are not stupid. My mom pulled through all treatments fine but with usual side effects. Take care and best of luck to you.

[Irisheyes]

I can't imagine how hard it is to stop smoking after 35+ years. My dad has always preached personal responsibility to me growing up so I was upset that he was wasting his energy compaining about what he thinks are "catty" nurses and that he doesn't trust them then goes home and smokes non-stop. But these are not normal times, where we all react as we would otherwise.

My dad and I are two peas in a pod so I asked him to put himself in my shoes. In the future I will handle the sittuation differently but my philosophy now is "no regrets".

Thanks again for the advice.

[cindi o'h]

Shannon..

Absolutely adore your family picture. It is obvious how much the two of you love each other.

Poor guy. He is ashamed that he hasn't been able to stop smoking.

Prayers for successful treatment.

Cindi o'h

[gerbil runner]

Shannon, you've already covered the most important part - love and support your dad no matter what.

For some people, to quit smoking is a Herculean task. My mother also underwent huge psychological difficulties when she quit smoking. In the early 80's, she quit for 9 months. The cravings were gone, but she was depressed, angry, combative and paranoid.

She did quit for good after diagnosis - she had a bleeding lung tumor, and was terrified she would cough and bleed to death (a very real risk).

Your dad needs to be upfront about the smoking - there are medications (antidepressants, not just patches) which can help if he wants to try to quit. Anyone who has severe psychological symptoms with quitting needs an understanding and well-versed doctor to help.

[Don M]

Shannon; in the final analysis, you have to be supportive. But in my view it is of paramount improtance that your dad quit smoking if he wants get evry edge possible in beatin the cancer. Of course, your dad already knows this, so the only thing you can really do is to be supportive.

Don M

[barbaraSanAntone]

Thanks very much for the article Laura Ann. I am a smoker, have been for 52 years+. I am 73, stage 3b NSCLC, no symptoms, will begin Carbo/Gemzar Chemo on 1/4/06. I still smoke, I am totally addicted, and when I tried to quit(many times) several years back, a doctor said nicotine is a natural antidepressant and is harder to kick than heroin or cocaine. He was going to put me on an antidepressant for 3 weeks and then use the patch and antidepressant, but I decided to keep on smoking.

All my docs (internist, pulmonologist, oncologist and thoracic surgeon) know I smoke, and dont yell at me because they know I am addicted. It makes sense that treatment and health would be better with no smoking, however I felt the article was a little misleading, because MDA, a teaching-research institute did not factor into the results equation of whether the participants in studies continued to smoke during treatment (which also skewed their results). Anyway folks, its hard as heck to have a smoke anywhere you want to nowadays

[barbaraSanAntone]

Thanks very much for the article Laura Ann. I am a smoker, have been for 52 years+. I am 73, stage 3b NSCLC, no symptoms, will begin Carbo/Gemzar Chemo on 1/4/06. I still smoke, I am totally addicted, and when I tried to quit(many times) several years back, a doctor said nicotine is a natural antidepressant and is harder to kick than heroin or cocaine. He was going to put me on an antidepressant for 3 weeks and then use the patch and antidepressant, but I decided to keep on smoking.

All my docs (internist, pulmonologist, oncologist and thoracic surgeon) know I smoke, and dont yell at me because they know I am addicted. It makes sense that treatment and health would be better with no smoking, however I felt the article was a little misleading, because MDA, a teaching-research institute did not factor into the results equation of whether the participants in studies continued to smoke during treatment (which also skewed their results). Anyway folks, its hard as heck to have a smoke anywhere you want to nowadays

[Guest akmaryann]

I know what you feel. My husband has had a lung removed, didn't require oxygen after his surgery but continued smoking and now requires oxygen 6 months later. He still lies to everyone and gets angry with me if I tell anyone that he is still smoking. To say the doctors aren't stupid isn't true! They really don't believe that someone would opt to smoke after their diagnosis, it doesn't even cross their minds. When I told one doctor he said "I thought he quit". I said "can't you smell it, can't you tell on your tests"...and they look at you with this blank look. I hope for your dad's sake that he does decide to quit because this is painful to watch.

[Leslie221]

Your dad's dx is still so fresh, I'm sure he's still reeeing from the news and that awful feeling of suddenly having no control over the most important thing in your life -your body! If there was ever a time a person who'd spent a lifetime relying on nicotine to reduce stress would be MOST likely to want/need a smoke, it would be now! Bad timing, but true.

Hopefully, as your dad starts to get used to all this and his anxiety levels go down to something manageable (it happens, just takes time) he'll be able to confront the issue of smoking and see quitting as something he can control and do for himself.

Can the docs give him an anti-depressent - some also really help with smoking cessation (I think Wellbutrin is one.) Give his brain another source for anxiety reduction?

Keping you in my thoughts and hoping for things to ease up in your corner of the world,

Leslie

[dchurchi]

My husband Alan still smokes and all his Dr.'s know he still smokes. I decided some time ago (hard as it was) not to be a nagging voice in his ear. I have

never smoked so I am not going to pretend I know

how hard it is to quit.

I want to enjoy what time we may have left together

and my Nagging him was not going to change our

situation. (or his smoking habits)

so I love him, hold him and just make the best out

of every second we spend together.

[PamS44]

Shannon, I know how hard your dad is fighting. I couldn't "just" quit either. I would sneak a puff here and there. It took me a year of struggling, enbarressment, sneaking, lying, and hiding. Thank God - my husband, son and daughter "played" along. They kept telling me how proud they were. It gave me that much more determination to finally quit those little addictive sticks. Please do not humiliate your dad by telling him that you know he is lying.( he feels bad enough that he is lying) Instead, put your arm around his shoulders. Let him know that he can do anything he puts his mind to. Tell him that you love him and that you are proud of him. He is fighting two battles right now. A cancer and an addiction. I pray that he will win both fights.

[slinaresholz]

Hello Shannon!

Maybe your Dad could try gradually quitting so he wouldn't have such bad withdrawl symptoms. I read about a four step program, where you cut your cigarette consumption in half, then after two or three days in half again and so on till you are down to no cigarettes. Or he could try one cigarette every half hour at first, for a few days, then 45 minutes and make the intervals between cigarettes longer and longer till he is free. My sister said she quit smoking so gradually that she didn't have any symptoms of withdrawl. She smoked about two packs a day. Some doctors will have him take Welbuterin for two weeks and then quit. He probably couldn't take the patch because if you decide to smoke you have to take it off and wait six hours or you could have a stroke. Believe me, I empathize with him and have fallen off the wagon. I am trying the gradual approach myself and hope I can be successful. Praying for both of you!

Sharon

[Irisheyes]

Thank you everyone for your advice and kind thoughts and prayers. Sorry to reply so late but I was in StLouis visiting Dad and he has the slowest dial up on earth!

Anyway, I let it drop and did not put any pressure on him about his smoking. I know he is ashamed and I do not need to add to it, however, I would IF I thought it might help.

He is not eating and has lost 25lbs in the past two weeks, right now that is the battle we will fight. He only weighs 141 and I am so afraid I am losing him. He believes he is dying and is also afraid.

His doctors did put him on an antidepressant when he told the doctor all the other patients seemed to be doing so well and asked why he wasn't getting better. Heartbreaking. I am back in Atlanta for a week trying to still earn a paycheck and make sure my family knows who I am. Then will go back up for another week. I ordered a weight gain powder supplement and am ready to get serious about his weight. He has to skip chemo this week due to it.

Thanks again, it is amazing how people you have never met can bring such comfort to your life!

[mhutch1366]

Nicotine is an appetite suppressant. I'm sure that doesn't help. I know it's one of the reasons I don't eat much.

I had been struggling to quit before diagnosis, and prior to surgery was down to 3-4 a day after a year of smoking/not smoking. After 21 days in the hospital I didn't smoke for 9 months then I got so depressed I didn't care.

After much wrestling internally, the beast and I worked out a compromise to feed the addiction and keep my lungs relatively clean.

I smoke 2-3 cigarettes a day, in the car on my way to and from work. I don't smoke in front of the kids, only in the car. The rest of the time I chew nicotine gum. It's a miserable habit but nowhere near as awful as a 2 pack a day habit.

Some weekends I don't smoke at all, or only 1. I breathe pretty well, considering.

I am not up to another major fight given the limited strength the "new normal" has brought. After 27 years of 2 packs a day, quitting was a roller coaster for real. I don't know how much it was compounded by the growth of the cancer, which was of a type to affect behavior and mood, among other things.

Support your dad as best you can, and maybe just maybe this post will help someone to trade off on the gum and spare the lung damage.

I'm not proud, but it works.

XOXOXOx

MaryAnn

[ellakc2]

Hi Irisheyes,

I dont't know how it will effect his treatment, but the cancer will never go into remission if he's still smoking. My dad smoked to the day he died of

panreatic cancer. There not to much you can do if he won't stop. Take care and good luck.

[joanie55]

Dear Irisheyes,

One of the things you say "my dad thinks he is dying" hit me in the eyes. Why would he want to stop smoking when he thinks he's dying anyway. Maybe there is some way you could get him to see that he is going to live. If he knows that, he will see the logic of stopping. Its not just for the lung cancer, but stopping will help him not get other cancers that smoking contributes to. Being a former smoker who was totally addicted, I found the withdrawal was really a 3 day physical ordeal. After that it was mental.

Wishing you and your dad the very very best.

Joan

[Guest akmaryann]

My husband is not a co-operative patient but saying things like, "You could beat this thing if you wanted to" actually makes him think occasionally that he has some control over the situation and does boost his spirits. Quitting smoking is not easy but if I could do it...anyone can. I smoked from the time I was 13 years old and just quit when my husband was diagnosed which was 36 years later. He still hasn't quit and I don't think he every will...however, stranger things have happened.

[aceking]

I will say that cancer sucks!!!!! My father was an extremely heavy smoker all my life, and never quit entirely until the day he died. He actually died from colon cancer that metastasized to the liver , but it was always lung cancer that i feared because of his respiratory problems and constant coughing. DConstant I left the proverbial family nest prior to realizing that it may be an emotional issue for all./

[ErinC1973]

My dad smoked through treatment. My mom kept it from me for 8 months, until he was diagnosed with brain mets. He always said, "It's already got me, it's going to kill me, so what's the difference? The damage is done." My dad had a pretty negative attitude throughout it all, I will say. He tried to put up a positive front for me, but he didn't want to really go above and beyond to help himself.

My mom...now, she is a different story. My mom had the BEST attitude. Sure, she got down once in a while, but her will to survive was a lot stronger than this thing. She quit smoking the day she had her lumpectomy in 1999--7 weeks after losing my dad. I really kept on her in every aspect--and it was right in my face because she lives with us. I didn't miss a trick. My mom had absolutely ZERO desire to smoke from the moment she awoke from her lumpectomy on. Lung cancer still grabbed hold, though, almost five years to the day she would have been declared NED of BC.

Anyway. What I'm trying to say is that in my experience, having seen both ends of the spectrum, I truly believe that attitude is EVERYTHING. My dad had nothing but down days, pain, constipation, misery and pretty much bad news for 9 months from diagnosis till death. He lost weight (A LOT) and kept losing because the tumor was pressing on his esophogus. My mom had good days, with a few sprinkled with bad in between, felt generally good on chemo, and kept plugging along even when she'd crash at dialysis or wake up and have to vomit after her chemo. Even at the end she was in good spirits. She was a very petite person to begin with, but since she had other issues (kidney, for one) she got weighed 3x a week and maintained her weight with just a small loss at the beginning. We incorporated renal-friendly and cancer-fighting foods into our diet to encourage her. She had a series of good scans and we had a great summer together. I'll always hang onto that memory now that she's gone.

It's very hard to keep someone positive when they feel they have little to be positive about. I cried on my husband's shoulder a LOT. My mom and I saw a counselor at Cancer Treatment Centers of America, where she received treatment, and she told me that I needed to realize that I could not completely control my mother's life. This hit me HARD. I had to step back and let her do what she wanted to. I knew she was tired. I had seen what LC did to my dad and it scared the hell out of me. I had spent YEARS trying to get my mom to quit smoking. I can remember in high school I used to ration her cigarettes out to her. I kept them in my room and when she wanted one she'd have to come and ask me. But all the hounding I did was really no good, because when my mom was ready, I learned, she'd do it herself. It's hard for me to stand by and watch helplessly because I am quite honestly a control freak. But I did what I could, supported my mom every day through this, and in the end, that's what I realize kept her going.

It's hard. Maybe the hardest thing ever. I do have regrets and I know I will for a long time. I regret not demanding that my mom get that CT scan way back when because she was a smoker and pay for it out of her own pocket. But there were a lot of "rights" in this whole thing too. Someday I will be able to sort it all out.

Good luck to you. I will be praying with everything in me.

[Fay A.]

Erin,

I am so sorry for the loss of your Mom, Dear One.