For National Non-Smoking Week, Dr. Renelle Myers, Thoracic Interventional Respirologist at BC Cancer, discusses her work on smoking cessation and why quitting is so important, even after a cancer diagnosis.
When a doctor refers a patient to BC Cancer for a lump in their chest, the first person they may see, if they live in British Columbia, is Dr. Myers.
Dr. Myers performs lung biopsies and helps to stage cancers of the lung, head and neck. She also provides smoking cessation counselling and is currently working on the development of a program that will screen and assist all BC Cancer patients that smoke.
But if a person already has cancer, what benefit is it to them to quit? Why go through the hardship?
Dr. Myers: Simply put, it's the best treatment option. Patients that quit smoking live longer, they live better, they have less chance of their cancer coming back and they also have less chance of getting a second primary cancer later in life.
Evidence also shows that patients that quit smoking have fewer treatment complications or side effects to radiation therapy if they stop smoking, and that their chemotherapy, in certain circumstances and in response to certain drugs, will be more effective if they stop smoking.
How many BC Cancer patients smoke?
We are currently looking at some preliminary research on this topic. We know that approximately 60 per cent of people that present to BC Cancer have been smokers in the past, but current smokers are less than that. We think that it's around 20 per cent but we don't know.
We're currently developing a smoking cessation program within BC Cancer specifically for patients that smoke, and part of that program will be data tracking so that we can get some hard numbers in order to see if this program makes a difference.
We hope to ask every person who comes to BC Cancer if they smoke and, if they do, they will receive personalized advice on how quitting would benefit their treatment. For example, if they are receiving radiation, they might get a pamphlet explaining how quitting can reduce side effects. Our goal is that every single patient is asked, advised and referred for help.
How does smoking interfere with treatment or make cancer worse?
With radiation, for example, we know that you have a 20 per cent increase of complications secondary to your radiation if you continue to smoke. That's thought most likely to be a result of hypoxemia. Tissues that have a lack of oxygen are more susceptible to the damage of radiation, and when you're smoking your tissues are more hypoxemic.
There are also studies showing that for certain targeted therapies, only 50 per cent of the drug is found circulating in the blood of smokers versus non-smokers. So if you smoke you're likely not getting an effective dose of your medication.
What resources are available to patients that are smokers?
Nicotine replacement therapies, including the patch, inhaler, gum and lozenges, are all free of charge with your care card in B.C. You can get these nicotine replacements from your local pharmacist. I make sure my patients are aware of this, and can also provide them with prescriptions for certain smoking cessation medications, like Champix or Ziban.
I also refer patients to QuitNow, which is a telephone counselling line with Professional Quit Coaches that provide counselling services in more than 150 languages. They can also receive motivational text messages, or a combination of texts and phone calls. We know that it's effective: smokers have two times greater chance of quitting with a telephone quit line.
What should an oncologist tell a patient who is a smoker?
The best thing that they can do for themselves and their cancer treatment is to stop smoking, and we can help them do that. We understand that it's difficult journey to undertake and at a very difficult juncture in their lives, but we have the tools and the resources to help them.