The reasons cancer patients keep smoking after a cancer diagnosis are much more complicated than a lack of discipline or a disregard for one’s own health.

Smoking causes 30% of all cancer deaths and 87% of all lung cancer deaths. Yet, roughly 50% to 83% of cancer patients keep smoking after a cancer diagnosis, through treatment, and beyond, according to Sonia Duffy, PhD, RN, University of Michigan School of Nursing researcher. For patients who quit on their own, the relapse rates, similar to the general population, are as high as 85%. Yet, Duffy explained, continued smoking severely hampers cancer treatment, increases cancer recurrence, and decreases survival.

“Ours is the first comprehensive review study to examine reasons why the very cause of the cancer, namely smoking, in many cases isn’t treated,” said Duffy, who said she wasn’t prepared to find so many hurdles hindering smoking cessation in cancer patients.

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“I think what surprised me when I did the review was the multitude of issues that cancer patients face, and that there are so many variables affecting why they don’t get treatment, and if they do get treatment, why they may not respond. Nicotine addiction, health issues, emotional issues, psychological issues, and system level issues are all in the way.”

Other obstacles include limited access to smoking cessation programs, little social support, sleep deprivation, poor nutrition, lack of confidence in being able to quit, and socioeconomic status. After back-to-back appointments and grueling chemotherapy or radiation protocols, many cancer patients simply lack time or energy to attend smoking cessation programs, Duffy says.

Depression is another big barrier to quitting smoking, and among cancer patients it is as high as 58%, compared with 10% in the general population, she says. While most lung cancer patients understand the relationship between smoking and their diagnosis, head-and-neck-cancer patients often do not make the connection.

Surprisingly, Duffy’s research suggests that only 56% of family physicians urge their cancer patients to quit smoking. Most oncology providers suggest quitting, but the oncologist’s main focus is on cancer treatment. Duffy’s paper suggests that nurse-administered smoking cessation interventions may be the best way to reach cancer patients who smoke, yet many nurses are not trained to conduct cessation interventions. Duffy’s next project will examine ways to specifically design quit-smoking programs for nurses to administer to cancer patients.

This review paper was published in Community Oncology (2012;9(11):344-352).