Highlights tobacco cessation can improve outcomes and survival in patients with cancer
An American Association for Cancer Research (AACR) statement released in April calls on the oncology community to provide evidence-based tobacco cessation treatment for all cancer patients and to evaluate tobacco as a confounding factor in cancer clinical trial outcomes.
Tobacco use is the single largest preventable cause of cancer in the U.S., and smoking cessation treatment has long been regarded as a key cancer prevention strategy, but research has shown that tobacco cessation services are often lacking in oncology settings. A survey of National Cancer Institute (NCI)-designated cancer centers indicated that only 38 percent of the responding centers record smoking as a vital sign, and less than 50 percent have dedicated tobacco cessation personnel. This is unfortunate, as evidence shows that continued tobacco use during and after cancer treatment leads to more adverse side effects, poorer treatment outcomes and higher overall mortality from all causes. “We have made great strides in treating cancer, and people are living for decades after a cancer diagnosis,” stated Margaret Foti, Ph.D., M.D. (h.c.), AACR chief executive officer. “If, however, we do not address a patient’s tobacco use then we leave them at risk for new malignancies or premature death from cardiovascular disease. With this statement, we call on all oncology professionals to take responsibility for identifying tobacco users at every visit and ensuring that these patients get the treatment and support they need.”
In addition to compromising their treatment and overall health, continued smoking by cancer patients can complicate the interpretation of clinical trial outcomes. “Tobacco, like other drugs, has adverse side effects and can interfere with the efficacy of treatments,” stated Roy Herbst, M.D. Ph.D., chair of the AACR Subcommittee on Tobacco and Cancer and chief of medical oncology at Yale Comprehensive Cancer Center. “We have to get to a point in clinical trials where we factor a patient’s tobacco use into how we evaluate patient outcomes, just like we do with other drugs or comorbidities. Right now, the field is not doing that with any regularity,” said Herbst, referring to an evaluation of 155 NCI Cooperative Group trials that showed that as few as 29 percent of registered trials assessed any form of tobacco use in patients at enrollment, and less than 5 percent of registered trials assessed tobacco use later in the trial.
In the statement, the AACR calls for universal tobacco use assessment and documentation at every patient visit in all clinical cancer settings. “Whether they are being treated in a community oncology setting or as part of a cancer clinical trial, we must help patients end their tobacco addiction, but we can’t do that unless the patient has been identified as a tobacco user,” stated Benjamin Toll, program director, Smoking Cessation Service Smilow Cancer Hospital at Yale-New Haven and chair of the writing committee charged with developing the AACR policy statement.
AACR’s policy statement was developed by the Tobacco and Cancer Subcommittee of the AACR Science Policy and Government Affairs Committee and follows a 2010 policy statement that addressed a broader spectrum of tobacco control and research issues.