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Smoking Cessation

Lung cancer is the most common cause of cancer death because it is usually found too late to remove it surgically and other treatments like chemotherapy or radiation are less effective for this disease than other types of cancer. Therefore, prevention offers the best chance to limit this common killer.

95% of lung cancer patients smoke--an activity linked to this disease. Therefore, promoting smoking cessation offers one of the best ways to reduce lung cancer deaths. In addition, smoking has been linked to other cancers like colon, lung, stomach and esophagus. Life-threatening conditions like emphysema and heart disease are also caused by smoking.

Nicotine addiction is a frustrating problem for patients who want to quit and for the physicians who care for those patients. Some doctors become pessimistic when many patients fail to stop their habit even after a life-threatening disease develops. It is a sobering statistic that 50% of current smokers will die from this habit if they do not quit.

The good news is that about half of all patients will eventually quit although it may take many attempts. Doctors are learning to become more persistent in encouraging patients. This is because half of smokers will quit eventually, although it may require many attempts to kick the habit. Medications and behavior therapy can help double quit rates.

Recently, devices to deliver nicotine have caused the greatest increase in smoking cessation since the Surgeon General's report. One of these, the nicotine patch, is most responsible because it became available without a prescription. Nicotine gum is used for times of craving along with the patch. Earlier concerns about nicotine overdose or adverse cardiovascular problems caused by high nicotine exposure do not seem to be supported by studies of patients combining these delivery mechanisms in moderate levels. Smoking while wearing the patch seems to be relatively safe as well but patients with possible heart disease should consult their physician. Other devices available by prescription are the nicotine nasal spray and nicotine inhaler. These are effective but the long term effects are still being studied.

Bupropion (Wellbutrin TM) has been shown to increase cessation rates, particularly if combined with nicotine. This drug has some side effects and requires a prescription; however, the side effects are usually minimal. This drug is usually started about a week before the planned quit date.

In summary, providing encouragement to smokers increases their chance of quitting from 5% to 10% if just good advice is given. 15% quit if behavior therapy is used (a psychosocial treatment usually offered by local groups). The addition of medications doubles each of these percentages to yield a cure rate as high as 30%. While not a sure thing, this is 6 times better than patients who attempt to quit on their own. More information on this topic can be found by visiting your family physician or local cancer screening center.