Smoking Should Be Assessed in Cancer Trials

Smokers Experience Poorer Cancer Survival Rates

Thomas Touzel had smoked for 52 of his 65 years when he saw a flier in the cafeteria of a cancer center where he was receiving treatment for bladder cancer. The paper urged patients to attend a tobacco cessation program that was to start in 20 minutes, so Touzel, who had tried to quit numerous times, thought he would make another attempt.

"Doctors had told me for years that I should stop, and I knew I should, but developing cancer was a big wake-up call," the Montreal resident says.

He signed up for an innovative program led by researchers in M. D. Anderson's Department of Behavioral Science that used palm-size computers. The devices emphasized smoke-free messages and personal goals to help reduce nicotine cravings over a six-week period. He also took an anti-depressant commonly used in smoking cessation called bupropion (Wellbutrin SR). It worked Touzel has been cigarette-free for more than a year.

"I could not have stopped smoking without that program, and I appreciate the interest that M. D. Anderson has in making and keeping me healthy," Touzel says. "The fact that my cancer center wanted to help me made the effort much more credible."

M. D. Anderson offers numerous smoking cessation programs, and more are planned for next year.

But experts say cancer centers throughout the country need to be doing a great deal more to to help current and future cancer patients who smoke. It is critically important to collect smoking data in clinical trials to further understand the role of smoking in cancer treatment and outcome, according to a commentary published in the October 2005 issue of Cancer Epidemiology, Biomarkers and Prevention.

Tobacco raises risk of developing a multitude of diseases

"We recommend that a patient's smoking habits be collected in all cancer clinical trials at the time of diagnosis, trial registration and throughout treatment and follow-up to long-term survival or death," says commentary co-author Ellen Gritz, Ph.D., chair of M. D. Anderson's Department of Behavioral Science and an internationally prominent tobacco researcher.

"Collecting this information will increase our knowledge about the adverse effects between the interactions of tobacco smoke, including nicotine and cancer treatment drugs." The data also will enable doctors to better individualize patient cessation efforts.

The recommendation was made in an article co-authored by Carolyn Dresler, M.D., a thoracic surgical oncologist who is currently head of the tobacco and cancer group at the International Agency for Research on Cancer, and Linda Sarna, D.N.Sc., (Doctor of Nursing Science), a registered nurse and professor at the University of California-Los Angeles School of Nursing.

Most cancer clinical trials do not collect data on smoking history and status during or after treatment unless the disease is considered to be smoking related, such as lung or head and neck cancer, Gritz says. According to the American Cancer Society (ACS), tobacco causes 87% of lung cancer deaths and 30% of all cancer deaths.

Tobacco use increases the risk of cancer of the:

• Lung
• Head and neck
• • Mouth
  • Nasal cavities
  • Larynx
  • Pharynx
• Esophagus
• Stomach
• Liver
• Pancreas
• Kidney
• Bladder
• Uterus (Endometrium)
• Cervix
• Colon and rectum
• Myeloid leukemia

At M. D. Anderson, roughly one-third of patients receive treatment for tobacco-related cancers, Gritz says, and research shows that smokers have poorer cancer treatment outcomes and survival than nonsmokers: "Studies suggest that tobacco use before, during and after treatment could affect cell growth, cell death and tumor density, hindering the effectiveness of cancer treatment."

Tobacco use is the single largest preventable cause of disease and premature death in the United States, according to the ACS. Tobacco use accounts for approximately 440,000 premature deaths related to smoking and 38,000 deaths in nonsmokers from second-hand smoke, the U.S. Surgeon General says.

The commentary authors write that the failure thus far to assess, analyze and report smoking data has limited cancer researchers' ability to investigate the effect of smoking on cancer treatment and survival. They conclude: "The time has come to integrate data about the single most important lifestyle risk factor in cancer prevention into cancer treatment and survivorship trials."