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Smoking in Cancer Care (PDQ®)

Effects of a Cancer Diagnosis on Quitting Smoking and Remaining Abstinent

Despite strong evidence about the deleterious effects of continued smoking in cancer patients, smoking cessation remains a challenging issue in this patient population, especially in patients with comorbid mental health issues and substance use disorders.[1-3] Most patients with a smoking-related cancer make serious efforts to quit at the time of diagnosis.[4-7] Studies suggest that approximately one-half of a group of patients with oral and pharyngeal cancers quit at or after diagnosis;[8,9] heavier smokers were substantially more likely to quit. Another study found a 12-month abstinence rate of 64.6% among head and neck cancer patients.[5] A quit rate of 52% was reported in 115 head and neck cancer patients just before diagnosis, suggesting that an increase in smoking and cancer-related symptoms drives a substantial part of the decision to quit smoking, in addition to knowledge of the diagnosis.[10]

Even patients who continue to smoke may remain motivated to quit. In a group of stage I small cell lung cancer patients, almost 90% had made one or more attempts to quit smoking, although 60% of survivors still smoked at 2 years.[4] In another study, 84% of the sample had made at least one attempt to quit since surgery, and 69% had made multiple attempts.[6] These studies found that while 80% of larynx and pharynx cancer patients remained abstinent after surgery, only 20% of those with oral cavity cancers did so. Patients who had undergone less intensive treatment (in particular, radiation therapy) were more likely to remain smokers; if they quit, they were 2.46 times more likely to resume tobacco use, even after controlling for severity. Higher relapse rates have also been associated with less radical treatment of head and neck cancers.[11]

Such a relationship between continued smoking and less severe disease has also been found in cardiac patients.[12] Another group in which secondary prevention may be particularly important is survivors of childhood cancer. In pediatric cancer survivors, initiation of smoking may be as high as in a group of healthy peers. An excellent review of the findings and recommendations in addressing smoking in this population has been published.[13]


  1. Nayan S, Gupta MK, Strychowsky JE, et al.: Smoking cessation interventions and cessation rates in the oncology population: an updated systematic review and meta-analysis. Otolaryngol Head Neck Surg 149 (2): 200-11, 2013. [PUBMED Abstract]
  2. Schnoll RA, Martinez E, Langer C, et al.: Predictors of smoking cessation among cancer patients enrolled in a smoking cessation program. Acta Oncol 50 (5): 678-84, 2011. [PUBMED Abstract]
  3. Blalock JA, Lam C, Minnix JA, et al.: The effect of mood, anxiety, and alcohol use disorders on smoking cessation in cancer patients. J Cogn Psychother 25 (1): 82-96, 2011.
  4. Gritz ER, Nisenbaum R, Elashoff RE, et al.: Smoking behavior following diagnosis in patients with stage I non-small cell lung cancer. Cancer Causes Control 2 (2): 105-12, 1991. [PUBMED Abstract]
  5. Gritz ER, Carr CR, Rapkin D, et al.: Predictors of long-term smoking cessation in head and neck cancer patients. Cancer Epidemiol Biomarkers Prev 2 (3): 261-70, 1993 May-Jun. [PUBMED Abstract]
  6. Ostroff JS, Jacobsen PB, Moadel AB, et al.: Prevalence and predictors of continued tobacco use after treatment of patients with head and neck cancer. Cancer 75 (2): 569-76, 1995. [PUBMED Abstract]
  7. Vander Ark W, DiNardo LJ, Oliver DS: Factors affecting smoking cessation in patients with head and neck cancer. Laryngoscope 107 (7): 888-92, 1997. [PUBMED Abstract]
  8. Day GL, Blot WJ, Shore RE, et al.: Second cancers following oral and pharyngeal cancers: role of tobacco and alcohol. J Natl Cancer Inst 86 (2): 131-7, 1994. [PUBMED Abstract]
  9. Duffy SA, Khan MJ, Ronis DL, et al.: Health behaviors of head and neck cancer patients the first year after diagnosis. Head Neck 30 (1): 93-102, 2008. [PUBMED Abstract]
  10. Browman GP, Wong G, Hodson I, et al.: Influence of cigarette smoking on the efficacy of radiation therapy in head and neck cancer. N Engl J Med 328 (3): 159-63, 1993. [PUBMED Abstract]
  11. Gritz ER, Schacherer C, Koehly L, et al.: Smoking withdrawal and relapse in head and neck cancer patients. Head Neck 21 (5): 420-7, 1999. [PUBMED Abstract]
  12. Ockene J, Kristeller JL, Goldberg R, et al.: Smoking cessation and severity of disease: the Coronary Artery Smoking Intervention Study. Health Psychol 11 (2): 119-26, 1992. [PUBMED Abstract]
  13. Tyc VL, Hudson MM, Hinds P, et al.: Tobacco use among pediatric cancer patients: recommendations for developing clinical smoking interventions. J Clin Oncol 15 (6): 2194-204, 1997. [PUBMED Abstract]
  • Updated: June 20, 2014