The American Association for Cancer Research issued a policy statement calling for the oncology community to regularly evaluate patients' tobacco use during office visits and as part of clinical trials, and to encourage efforts in smoking cessation.

Last summer, a study revealed that only 29% of clinical trials in the National Cancer Institute's (NCI) Clinical Trials Cooperative Group Program asked patients about tobacco use during study enrollment (JCO 2012;30:2869–75). In addition, less than 5% of clinical trials assessed tobacco use during follow-up appointments even though evidence shows that continued tobacco use during and after cancer treatment leads to more adverse side effects, less-effective treatment, and higher overall mortality rates.

“We were all disappointed with those results,” says Roy Herbst, MD, PhD, chair of the American Association for Cancer Research (AACR) Subcommittee on Tobacco and Cancer and chief of medical oncology at Yale Comprehensive Cancer Center in New Haven, CT.

Herbst's subcommittee released an AACR policy statement (Clin Cancer Res 2013;19:1941–8) calling upon oncologists to assess tobacco use by cancer patients in all settings and to help facilitate smoking cessation, at the AACR Annual Meeting 2013, held in Washington, DC, April 6–10.

“We have to get to a point in clinical trials where we factor a patient's tobacco use into how we evaluate patient outcomes, just like we do with other drugs or comorbidities,” says Herbst. “Right now, the field is not doing that with any regularity.”

“I think some clinicians feel that once a person is diagnosed with cancer that it's too late,” says Benjamin Toll, PhD, lead author of the policy statement and an associate professor of psychiatry and program director of the Smoking Cessation Service at Yale Comprehensive Cancer Center. “But that's just not true. There are plenty of reasons to help that person quit.”

Data suggest that, relative to continued use, tobacco cessation can

  • speed healing, with fewer complications, after cancer surgery;

  • increase the efficacy of radiotherapy and certain anticancer drugs;

  • decrease comorbidities; and

  • reduce the risk of recurrence of the primary cancer as well as the development of secondary cancers.

Because continued smoking can change clinical cancer outcomes, “it's not a huge stretch to say that it's a moderator of treatment in clinical trials,” adds Toll, potentially confounding trial results. Herbst and Toll say that patients' smoking status should be documented in their medical records at each visit. In addition, patients who currently use tobacco should be referred to a tobacco cessation program. Hospitals and private practices that lack such a program should direct patients to a state-run telephone quit line (1-800-QUIT-NOW).

But these measures are not enough. Herbst notes that every patient he sees plans to quit but that many continue to use tobacco to cope with the stress of treatment or because they simply aren't ready to try to break their addiction. “There has to be follow-up by the oncologist,” he says.

In 2010, the AACR subcommittee, previously called the AACR Task Force on Tobacco and Cancer, issued a much broader policy statement calling for increased investment in tobacco-related research, the creation of new strategies to convince people not to start using tobacco, and the continued development of evidence-based treatments for tobacco cessation. Rather than replacing this earlier policy statement, says Herbst, the new one complements it.

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