How to Cope - Survivor Why Should I Quit Smoking Even After a Cancer Diagnosis?

cigarette in a question markAlthough most people know that smoking is the most preventable cause of illness in the United States, there is considerably less awareness about the risks of continued smoking and the benefits of quitting for those diagnosed with cancer. Many smokers assume that quitting smoking after a cancer diagnosis won’t really make a difference. “Why bother? I already have cancer,” they say. “After all, the damage is done, right?” 

Wrong. Persistent smoking can significantly affect cancer outcomes. According to the U.S. Surgeon General’s most recent report on smoking, The Health Consequences of Smoking – 50 Years of Progress, individuals undergoing active cancer treatment, as well as survivors, who continue to smoke are more likely to have worse health outcomes. 

Continuing to smoke after a cancer diagnosis not only increases your risk of cancer recurrence, but it can also cause treatment complications, decrease your quality of life, reduce the effectiveness of your cancer treatments, and increase your risk of developing a second cancer. Furthermore, smoking has been shown to cause (and worsen) other chronic health conditions, including diabetes, heart disease, stroke, respiratory problems (such as COPD and asthma), erectile dysfunction, rheumatoid arthritis, inflammation, blindness, and impaired immune function.  

On the flipside, quitting smoking can actually improve your health. Evidence shows that quitting smoking helps radiation therapy and chemotherapy treatments work better, improves wound healing, and reduces your risk of infection following surgery. In addition, cancer survivors who are able to quit smoking during cancer treatment often report significantly reduced treatment side effects. 


FDA-Approved Stop-Smoking Medications

Nicotine Patch
How to get it: Over the counter
How it works: The nicotine patch is a nicotine replacement medication that is placed on the skin and delivers a small and steady dose of nicotine over a 24-hour period.

Nicotine Gum
How to get it: Over the counter
How it works: Nicotine replacement gum is chewed until a tingling feeling is produced and then is parked between the cheek and gums to allow the nicotine to be absorbed.

Nicotine Lozenge
How to get it: Over the counter
How it works: Nicotine replacement lozenges are like hard candies that dissolve in the mouth and are moved from side to side to allow the nicotine to be absorbed.

Nicotine Inhaler
How to get it: By prescription only
How it works: A nicotine inhaler is a mouthpiece, resembling a cigarette, that holds nicotine-containing cartridges. As you puff on it, a dose of nicotine is absorbed in the mouth and upper airway.

Nicotine Nasal Spray
How to get it: By prescription only
How it works: Nicotine nasal spray is sprayed in the nostril to deliver a dose of nicotine, which is absorbed in the nasal passageway. 

Bupropion (Zyban)
How to get it: By prescription only
How it works: This non-nicotine pill, which is taken by mouth, helps to reduce nicotine cravings and withdrawal symptoms.

Varenicline (Chantix)
How to get it: By prescription only
How it works: This non-nicotine pill, which is taken by mouth, helps reduce nicotine cravings and withdrawal symptoms. It also makes smoking less enjoyable by blocking the effects of nicotine in people who continue to smoke.

What’s more, quitting smoking can reduce your risk of cancer coming back, as well as your risk of developing new cancers. It can also have a significant positive impact on your quality of life. You will likely feel better emotionally, have less stress, and see improvements in your self-esteem, appetite, sleep quality, and energy levels after quitting smoking. And perhaps more important, quitting smoking can increase your life expectancy – even after a cancer diagnosis. 

OK, you’ve convinced me to quit, but I don’t know how. You’re not alone. Despite growing awareness of the risks of smoking, as many as two-thirds of people who are current smokers at diagnosis either continue to smoke or relapse following a prior quit attempt. Quitting smoking is hard, and staying smoke-free is even harder. Couple that with the distress of cancer, not to mention the guilt you may be feeling over the prospect that your smoking may have contributed to your diagnosis, and it’s easy to see why cancer survivors can have a hard time giving up cigarettes.
Quitting smoking can reduce your risk of cancer coming back, as well as your risk of developing new cancers. And perhaps more important, quitting smoking can increase your life expectancy – even after a cancer diagnosis.Though the statistics may seem unpromising, there is some good news. Safe and effective ways of quitting smoking do exist. And becoming smoke-free is a reachable goal for cancer survivors – before, during, and after treatment. However, to be most successful, your tobacco cessation program must address both the behavioral and the physiological aspects of tobacco dependence. 

Behavioral counseling can help you learn practical ways to cope with the urge to smoke. It can also help you strengthen your coping skills for handling the daily life stressors that may trigger your urges. For those who want to stop smoking but aren’t yet ready to quit completely, a certified tobacco treatment specialist can provide tips and strategies to help you reduce smoking in preparation for eventual quitting, and help you get motivated to do so. 

The physiological component of tobacco dependence, or nicotine addiction, is best treated with FDA-approved stop-smoking medications. (See sidebar for a list of available options.) Not only do these medications help to reduce cigarette cravings, but they also help to decrease or eliminate the physical withdrawal symptoms that come with tobacco cessation. And for those who are not quite ready to set a quit date, these medications can help to reduce the total number of cigarettes smoked daily in preparation for a future quit attempt. 

There are two types of FDA-approved stop-smoking medications available: nicotine replacement therapies and non-nicotine pills. Both help to reduce nicotine cravings and withdrawal symptoms, making it easier for smokers to break their nicotine addiction. These medications can be used alone or in certain cases in combination. At present, there is limited evidence to support the use of alternative treatments (such as hypnosis, acupuncture, laser treatment, electronic cigarettes, and other electronic vapor inhalation devices) to quit smoking. 

Quitting smoking is difficult for anyone, and maybe even more so for cancer survivors. Not only do you have to contend with breaking the physical addiction to nicotine, but many cancer survivors also encounter stigma and criticism from family, friends, and even healthcare providers, who can be judgmental and unsympathetic about the strength of nicotine addiction, even in the face of cancer. 

But there is hope. You can quit smoking – for good. By working with an experienced tobacco treatment specialist who combines FDA-approved stop-smoking medications with a behavioral change program, you can quit successfully and stay tobacco-free. 


Suhana de Leon-SanchezSuhana de Leon-Sanchez is a board-certified psychiatric nurse practitioner and tobacco treatment specialist at Memorial Sloan Kettering Cancer Center in New York, NY.

Dr. Jamie OstroffDr. Jamie Ostroff, a clinical health psychologist, is the director of the Tobacco Treatment Program and chief of the Behavioral Sciences Service in the Department of Psychiatry & Behavioral Science at MSKCC.

This article was published in
Coping® with Cancer magazine, July/August 2019.