Can’t quit: Nearly 10 percent of cancer patients still smoke

Nearly nine years after diagnosis, bad habits die hard, and some say ‘What’s the point?'
Nearly 10 percent of patients continue smoking years after a cancer diagnosis but the rates are higher for some cancers. More than 17 percent of bladder cancer survivors still smoke as do nearly 15 percent of lung cancer survivors and 11 percent of ovarian cancer survivors, the study found. Jeff T. Green / Getty Images

Nine years after being diagnosed with cancer, nearly 10 percent of survivors still smoke cigarettes – and more than 80 percent of them light up every day.

That’s according to a new study from American Cancer Society researchers who say the findings underscore the tenacity of tobacco cravings and the need for better long-term help.

“Quitting smoking is really difficult,” said Dr. Lee Westmaas, director of tobacco research at the cancer society. “I think we tend to underestimate the power of addiction.”

Better screening of smoking habits and referral to cessation programs are needed, not just right after a cancer diagnosis, but years later, the study published Wednesday in the journal Cancer Epidemiology, Biomarkers & Prevention found.

Westmaas and his team analyzed data from patients in 11 state cancer registries, targeting those with the 10 most common kinds of cancer. They analyzed results from 2,938 survivors who answered a survey between January 2010 and December 2011, about nine years after they were diagnosed.

Overall, some 9.3 percent of cancer patients still smoked, the study found. But the rates jumped higher for different kinds of cancer: more than 17 percent for survivors of bladder cancer, nearly 15 percent for lung cancer and more than 11 percent for ovarian cancer.

(Other cancers included in the study were breast, prostate, uterine, skin melanoma, colorectal, kidney and non-Hodgkin lymphoma.)

Survivors were more likely to smoke if they were younger, had less education and income, and drank more alcohol, the study found.

15 daily cigarettes

Most of the current smokers – some 83 percent – lit up every day and smoked an average of nearly 15 cigarettes a day. Forty percent of the daily smokers puffed more than 15 cigarettes each day, the study found.

That’s not surprising, said Dr. Jonathan Bricker, a clinical psychologist and expert in smoking cessation with the Fred Hutchinson Cancer Research Center’s Public Health Sciences Division.

“You’d think it’s logical that a cancer diagnosis would be a wake-up call to people,” Bricker said. “But it’s not true.”

In fact, years of work with the Fred Hutch Cancer Prevention Program have shown him that it’s common to continue to smoke despite the disease.

“People may be blocking it, in a sense compartmentalizing the cancer from the behavior,” he said. “In general, when you get a specific medical diagnosis, the level of lifestyle change is very mild.”

The figures in the new study are lower than other estimates of smoking among cancer patients, which have shown that between 15 percent and 18 percent of continue to smoke after diagnosis, Westmaas said.

But the explanation for that is likely a grim one, he explained. Previous studies had looked at cancer patients who quit smoking shortly after diagnosis, not nearly a decade later.

“Nine years out, it’s quite possible that those survivors who had continued smoking had suffered a recurrence and had passed away,” he said.

‘What’s the point?’

The crucial question – why would someone with cancer still smoke? – is a tough one, the experts said. Part of it may be denying the link between the cigarettes and the disease, but part of it may be a kind of fatalistic view of life after cancer.

“The perspective some people have is ‘What’s the point?’” Bricker said. “The worst that can happen has happened. It’s too late. It doesn’t matter.”

In fact, quitting smoking does matter, even among the older cancer patients in the study, who had a mean age of 65. Health benefits of kicking the habit start almost immediately: Within a month, the heart rate returns to normal; within a year, wound healing improves and the overall quality of life gets better.

Still, convincing a long-term smoker is difficult, Bricker conceded. “They’re a tough nut to crack,” he said.

Nearly half of the smokers in the study said they planned to quit, and, of those, about 40 percent intended to stop within the next month. “The motivation is there,” Westmaas said.

Part of the problem is that many cancer patients who smoke don’t know where to turn for help. Some don’t know that there are free stop-smoking services, such as 1-800-Quit-Now, a national number that routes patients to local resources.

Bricker is also recruiting adult volunteers nationwide for a Fred Hutch smoking-cessation study called WebQuit.

Getting formal help has been crucial to Kelly Johnson, 43, a longtime smoker who was diagnosed with breast cancer in the middle of a move this summer from Wisconsin to Washington. When she got to Seattle, her diagnosis was confirmed, she was scheduled for a mastectomy – and enrolled in a smoking cessation program offered by Seattle Cancer Care Alliance.

Both Johnson and her husband, Stephen Johnson, 42, quit smoking on July 13, she said. It’s been doable, but Johnson said she completely understands why someone would keep smoking years after a cancer diagnosis.

“The conscientious brain knows it’s time to quit smoking, but the heart still wants to smoke,” she said.

There’s a tendency in society to stigmatize cancer patients who continue to smoke, but that may actually backfire, triggering stress that leads to more smoking, said Bricker, who advocates compassion and treatment.

“The blame and the judgment are not helping,” he said. “It’s adding kerosene to the fire.”

Have you tried to quit smoking? Tell us about it on the Fred Hutch Facebook page here. 

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JoNel Aleccia is a former staff writer at Fred Hutchinson Cancer Research Center. From 2008 to 2014, she was a national health reporter for NBC News and Prior to that she was a reporter, editor and columnist for more than two decades at newspapers in the Northwest.

Solid tumors, such as those of lung, breast and prostate, are the focus of Solid Tumor Translational Research, a network comprised of Fred Hutchinson Cancer Research Center, UW Medicine and Seattle Cancer Care Alliance. STTR is bridging laboratory sciences and patient care to provide the most precise treatment options for patients with solid tumor cancers.

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