by Steven Chang, MD

What is it?

Tobacco dependence

• Nicotine is the drug in tobacco & it produces physical & emotional dependence to it
  • Because of this dependence, when you quit you may experience sadness, sense of loss/grief, frustration/impatience, anger/irritability, anxiety/worry, restlessness/boredom, trouble concentrating, which can make it more difficult to quit
• Survival:
  • Continued tobacco use reduces your chances of survival from head and neck cancers in half. But quitting improves your chances of living; your survival approaches that of non-smokers at 2 years post-diagnosis
• Cancer recurrence:
  • Continued tobacco use quadruples risk of cancer recurrence compared to non-smokers
  • Continued tobacco use is also associated with 5 times increase in risk of a second primary cancer

How common is it among head and neck cancer patients?

Tobacco use/smoking in cancer survivorship

• Of the 53,000 cases of head and neck cancers each year, 85% are associated with tobacco use (NCI)
• 26-61% of patients who are diagnosed with head and neck cancer currently use tobacco (including cigarettes, smokeless tobacco, cigars).
• It is estimated that 35% of head and neck cancer survivors either return to or continue tobacco use after treatment.

What are the signs and symptoms?

• Because of this dependence on nicotine, when you quit you may experience sadness, sense of loss/grief, frustration, impatience, anger, irritability, anxiety, restlessness/boredom, or trouble concentrating which can make it more difficult to quit
• Continued tobacco use is associated with prolonged mucositis during radiation, reduced likelihood of regaining satisfactory voice quality, reduced effectiveness of treatment, disease recurrence, second primary cancers, and decreased length of survival

How is it treated?

• Successful quit plans include multiple strategies from below & include behavioral strategies
• Planning for success:
  • Consider your reasons for quitting – write these down
  • Decide on a plan
    • Set a quit date – mark it on your calendar & tell your friends & family
    • Will you use over the counter nicotine replacement therapy (e.g., patches, gum, lozenges) or prescription medications (e.g., Chantix/varenicline or Wellbutrin/bupropion)?
    • What behavioral support will you use?
    • Think about past quit attempts – what worked, what didn’t, why did you return to smoking?
  • Strategies for quitting:
    • Remove all cigarettes, ashtrays, & lighters from your house, car, & work
    • Ask friends/family who smoke not to smoke around you, to refuse any requests for cigarettes, & to no leave cigarettes out where you can see them
    • Stock up on oral substitutes – gum, hard candy, straws, toothpicks, carrot sticks
    • Set up a support system – people you can call or is willing to help you quit
    • Make a list of things you can do to distract yourself through the urge to smoke & post this list somewhere visible so you can reference it easily during cravings (e.g., walking, exercise, computer/phone games, drinking water, deep breathing, other activities or hobbies)
      • Urges last 10-15 mins & distracting yourself through the urge to smoke can be helpful
    • Smoking is a strong habit & daily events can trigger the urge to smoke. Change up your daily “schedule” (e.g., instead of sitting at table after meal, get up & go for walk/do dishes/brush teeth, drink tea instead of coffee, eat in different place, take different route to/from work, etc.) can help break the link between the trigger & smoking
    • Decrease or avoid alcohol
    • Consider behavioral or supportive therapy as it can boost success rates higher than medications or nicotine replacement alone
      • Workplaces & hospitals have stop-smoking programs led by professionals
      • Contact the American Cancer Society at cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/ or 1-800-227-2345 to find out what support services might be available where you live

When should I call my doctor?

• Talk to your doctor about quitting smoking. Your doctor will be able to help you plan for success and will be able to discuss medications to help you.

Where can I learn more?

• www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/index
• www.cdc.gov/tobacco/data_statistics/fact_sheets/cessation/quitting/index.htm
• www.cancerresearchuk.org/about-cancer/causes-of-cancer/smoking-and-cancer/how-to-stop-smoking
• www.cancer.gov/about-cancer/causes-prevention/risk/tobacco