December 2018
By Sanjay Agrawal, Consultant Respiratory Intensivist
As specialists with an interest in thoracic oncology, we want our patients to have the best outcome whether that’s as a result of screening, early diagnosis, surgery, radiotherapy, chemotherapy or some combination. One of the treatments that can make a big difference to our outcomes is the treatment of tobacco addiction as approximately 40% of our patients still smoke at the time of diagnosis and many continue to smoke despite their diagnosis and planned treatment. It is not surprising that many people continue to smoke despite their diagnosis as their tobacco addiction is powerful and often starts in childhood and is based on the dopaminergic pathways of satiety and reward in the central nervous system.
Multiple studies have shown that treating tobacco addiction improves the outcomes of patients with lung cancer including overall survival, reduced recurrence rates, reduced new primaries and a reduction in post-operative complications. The meta-analysis by Paul Aveyard published in the BMJ in 2010 has shown this quite clearly.
A recent report by the Royal College of Physicians called Hiding in Plain Sight; treating tobacco dependency in the NHS has highlighted the most effective ways of helping our tobacco addicted smokers to quit. The combination of pharmacotherapy – specifically dual nicotine replacement therapy or varenicline (Champix) – combined with behavioural support doubles the quit rate compared to either modality alone. The most popular quit aid for patients are e-cigarettes that have also helped many people quit smoking altogether. In my lung cancer clinic I routinely ask smoking status and treat tobacco addiction and commence treatment or refer for treatment. The Lung CAST Study which is a prospective study done in lung cancer patients with a new diagnosis of lung cancer provided intensive treatment for smoking addiction with significant improvement including overall survival (in press).
The new 10 year NHS plan will have specific investment for us to be able to treat tobacco addiction when patients attend the hospital and as specialists in the field of a devastating tobacco related disease; we can and should take the lead and treat tobacco addiction alongside tumour treatment to improve patient outcomes.