Challenges: Tobacco Use During Cancer Care
Tobacco use is rarely addressed during cancer treatment despite evidence that continued use is associated with many negative cancer outcomes (e.g., poor wound healing, complications, cancer recurrence, new cancers, higher death rates) and that quitting tobacco use can benefit patients in all stages of cancer care and help people live longer (U.S. National Cancer Institute, 2022).
Many factors may contribute to this undertreatment. Some of these are also challenges in other care contexts, such as lack of clinician time, lack of clinician confidence, lack of efficient and sustainable workflows, and pessimism regarding patient receptivity or tobacco treatment effectiveness. Some are heightened in the context of cancer, such as stigma, fatalism, patient stress, and treatment toxicity.
Case studies in this guide provide examples of ways cancer programs met these challenges and successfully integrated effective tobacco treatment in cancer care. Although no program convinces 100% of their patients to quit using tobacco, these programs help many patients with cancer quit and reduce their harm from tobacco use (D’Angelo et al., 2022; Ramsey et al., 2022).
Tobacco use is a chronic, relapsing condition. Although many patients quit using tobacco soon after learning of their cancer diagnoses, about half continue to use tobacco after diagnosis, and many who quit at diagnosis eventually relapse to tobacco use (U.S. National Cancer Institute, 2022). Treating tobacco effectively requires system changes to support chronic or repeated cycles of tobacco treatment care.