Let’s face it. There’s a lot of guilt that goes along with smokers who have lung cancer. Every week my patients tell me “I tried to quit” or “Why should I bother quitting now?” Most lung cancer patients don’t seem to get a lot of sympathy. You don’t see people wearing the white ribbon for lung cancer like the pink ribbon for breast cancer. I don’t see a lot of Hollywood celebrities lining up to go to bat for lung cancer patients. Where are all the 5K runs for lung cancer?
With all that said, many cancer specialists give little more than lip service to telling patients to stop smoking once diagnosed. Why beat them up even more psychologically when we, as their doctors, are asking them to undergo surgery, chemotherapy and radiation? But two major studies may change all that. In the first study, Dr. Meredith Shiels and her colleagues at the National Cancer Institute found that stage I lung cancer patients who survived their first lung cancer but continued to smoke were more than twice as likely as “never smokers” to die (J Clin Oncol 2014: 32; 3989-3995). That’s a big number.
In the second key study, Dr. Yoshikazu and co-workers critically looked at 1,649 patients with locally advanced lung cancer harboring the EGFR mutation. Once again, the conclusion was that survival was significantly better in “never smokers” than in patients with a history of smoking. All is not lost though. All patients with advanced lung cancer, regardless of smoking or not, benefited from chemotherapy (The Oncologist 2015:20; 307-315).
As a cancer specialist who meets with early stage and advanced stage lung cancer patients every day, these remarkable studies tell me that I need to be ever more mindful about getting my patients to stop smoking. Mere lip service is not going to cut it. I know, deep down, that I do the patients and their families no favors if I just ignore their smoking. And it’s just not the doctor’s concern. It will take a group effort with all cancer care providers, family doctors, nurses, technologists and even care takers. Just like chemotherapy and radiation, my lung cancer patients may not like it, but “stop smoking” will be part of the survivor plan.