With an objective to meet the individual needs of patients who are smokers at the time of cancer diagnosis, the National Comprehensive Cancer Network® (NCCN®) released the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Smoking Cessation. The NCCN Clinical Practice Guidelines were presented on March 13, 2015 at the NCCN 20th Annual Conference: “Advancing the Standard of Care”.
Tobacco-related deaths are the most preventable cause of death worldwide. According to the American Cancer Society, out of the 1,71,000 of the estimated 5,89,430 cancer deaths that occur in the United States, more than 25% are caused by tobacco use. Apart from cancer, tobacco use is directly linked to several other diseases such as heart disease, stroke, diabetes, lung diseases (including emphysema, bronchitis, and chronic airway obstruction).
Smoking is a chronic, relapsing condition and the success or failure to stop this long-term habit depends on several factors. Research shows that smokers with cancer have a high level of dependence. Smoking cessation programs can lead to improvement in cancer treatment outcomes as well as reduced recurrence. It is estimated that about 20-30% of cancer patients smoke out of which around 50% are active smokers.
According to an expert who was involved in developing the new NCCN guidelines, the United States lacks systematic and consistent mechanisms to promote cessation in cancer patients in healthcare institutions. These new guidelines aim to establish proper standards of care and fill the gaps that exist in the existing guidelines.
The main proposals put forward by the NCCN are as follows:
- Treatment modalities for smokers living with cancer should include behavior therapy, evidence-based pharmacotherapy and close follow-up with retreatment as required
- Combination nicotine replacement therapy (NRT) and varenicline are advised as the two most effective pharmacotherapy agents which can be combined as needed
- High-intensity behavioral therapy with multiple counseling sessions is advised and a minimum of brief counseling is highly recommended
- Smoking status should be documented in patient health records and updated at regular intervals
- Healthcare providers should discuss relapse and provide patients with adequate guidance, as it may take multiple quit attempts with the same therapy to achieve long-term cessation
As the new guidelines address the physical and behavioral impact of cigarette smoking dependency, they can help oncologists to effectively support their patients in achieving their smoking cessation goals.