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Is there a value in quitting smoking after diagnosis?

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Is there a value in quitting smoking after diagnosis? For radiation, yes.

http://blog.lungevity.org/2011/11/06/sm ... teraction/

November 6th, 2011 - by Dr Loiselle

I was in a check out line at my local warehouse grocery store last year when I noticed that the man behind me in line had no shopping cart. After glancing over my shoulder again, I sensed that he was fairly approachable, so I half-jokingly said, “It appears you are missing your cart, sir.” He looked down, sighed, then looked at me: “No, I’m just here for cigarettes.”

“Have you ever tried to quit?” I asked.

“Sure, many times,” he said, with a bit of a chuckle.

“Smoked for many years?” I asked.

“Oh, fifty years… You don’t understand – my quitting smoking is like you trying to stop drinking water.”

“I do understand.” I said.

I see many patients who have been lifetime smokers, many expressing that quitting seems an impossibility. Sometimes when faced with a smoking-related cancer, such patients are able to find a way to quit. Often, patients that have been smokers all their life want to know: “will it really make a difference at this point, after a lifetime of smoking, to quit?”

The answer is a resounding YES: it makes a difference. In fact, it is one of the most proactive, cancer fighting actions that a patient can take. Quitting smoking also rapidly reduces the risk of heart attack and stroke, as well as reduces the risk of second cancers. The benefit is similar for patients with lung cancer, head and neck cancer, bladder cancer, and gynecologic cancers.

Smoking particularly inhibits the effectiveness of radiation therapy. Most types of therapeutic radiation depend on oxygen free radical mechanisms — that is, the effectiveness of the radiation to break the DNA of the cancer cells relies on the presence of oxygen in the target tumor. Smoking cigarettes and other forms of tobacco reduces blood’s capacity to carry oxygen, so less oxygen is availability to interact with radiation.

The effect of smoking while undergoing radiation treatment was recently examined by physicians at The Mayo Clinic in Scottsdale and a group from Luebeck Germany. Dr. Dirk Rades and colleagues published a 2008 analysis in the International Journal of Radiation Oncology, Biology, Physics, which looked at 181 patients treated with radiation therapy for non-small cell lung cancer, and found that local control of lung cancer at one year was 46% among currently smoking patients versus 71% among patients that were not currently smoking. This was actually statistically significant when all other factors where taken into account (i.e. multivariate analysis).

Also very important ant relevant in that study is the fact that the amount patients smoked prior to undergoing radiation therapy did not impact the effectiveness of the treatment. Thus, for those patients that have smoked their entire life, now facing lung cancer, the data show that quitting during treatment can impact the outcome of treatment significantly, if one is able to stop smoking during treatment. It is never too late.

As the man in the store highlighted with his analogy to water deprivation, I do understand that it can be extraordinarily difficult to quit. But it can be very worthwhile by making a big difference in the treatment outcome, representing something patients can do for themselves in a time when much feels outside of our control.

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