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Smoking after cancer diagnosis: Comment by Patrick Swayze’s doctor on CNN’s Larry King

Many people were saddened to hear of the recent death of the actor Patrick Swayze, after an almost two year battle with pancreatic cancer. Patrick Swayze was a very successful actor, most noted for his leading roles in the hit movies, Ghost and Dirty Dancing.

Within the past week, one of Patrick Swayze’s oncologists, Dr George Fisher, was interviewed on the CNN “Larry King Live” show and made the following comments:

LARRY KING: “He continued to smoke. Was that a bad idea?”

DR. GEORGE A. FISHER, ONCOLOGIST, STANFORD HOSPITAL & CLINICS: “I think at the point that one is already diagnosed with cancer, there's little additional harm in it. And if it -- it seems to provide him some comfort or partly identity of who he is, I certainly have no objections to that. But he would be the first to say that if you don't smoke, don't start. And if you do smoke, quit before you develop cancer.”

I suspect that Dr Fisher’s comments were referring to the specific context of someone suffering from a severe type of terminal cancer where the estimated life expectancy is in months rather than years, and not referring to all cancer diagnoses. So I think it is important that people, and particularly those people with a recent cancer diagnosis who are still smoking or recently quit, don’t take this comment out of context. Nowadays many types of cancer can be cured or effectively managed over a period of many years, and it is very clear that for many of these cancer diagnoses, the prognosis is much better if the patient quits smoking.

Below is a quote from a published review by an expert on this subject, Professor Ellen Gritz, of MD Anderson Cancer Center:
“The detrimental effect of smoking on cancer survival rates has been consistently demonstrated. Continued smoking after diagnosis has been found to negatively affect overall survival in patients with lung, head and neck, prostate, and cervical cancers. However, stopping smoking before diagnosis and treatment can have a positive influence on survival rates. Studies have generally indicated that the longer the interval between smoking cessation and initiation of cancer treatment, the better the prognosis.“

(Gritz ER, Fingeret MC, Vidrine DJ, Lazev AB, Mehta NV, Reece GP. Successes and failures of the teachable moment: smoking cessation in cancer patients. Cancer. 2006;106:17–27.)

Just last month the results of a very large study were published showing better outcomes for smokers who quit sooner after lung cancer diagnosis. I’ve copied the study summary below. Just to be clear, the research evidence shows that in the vast majority of cancer diagnoses, health outcomes will be improved by quitting smoking.

Impact of smoking cessation before resection of lung cancer: a Society of
Thoracic Surgeons General Thoracic Surgery Database study.
Mason DP, Subramanian S, Nowicki ER, Grab JD, Murthy SC, Rice TW, Blackstone EH. Ann Thorac Surg. 2009 Aug;88(2):362-70; discussion 370-1.

Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute,
Cleveland Clinic, Cleveland, Ohio 44195, USA.

BACKGROUND: Smoking cessation is presumed to be beneficial before resection of
lung cancer. The effect of smoking cessation on outcome was investigated.
METHODS: From January 1999 to July 2007, in-hospital outcomes for 7990 primary
resections for lung cancer in adults were reported to the Society of Thoracic
Surgeons General Thoracic Surgery Database. Risk of hospital death and
respiratory complications was assessed according to timing of smoking cessation,
adjusted for clinical confounders. RESULTS: Hospital mortality was 1.4% (n =
109), but 1.5% in patients who had smoked (105 of 6965) vs 0.39% in those who had
not (4 of 1025). Compared with the latter, risk-adjusted odds ratios were 3.5 (p
= 0.03), 4.6 (p = 0.03), 2.6 (p = 0.7), and 2.5 (p = 0.11) for those whose timing
of smoking cessation was categorized as current smoker, quit from 14 days to 1
month, 1 to 12 months, or more than 12 months preoperatively, respectively.
Prevalence of major pulmonary complications was 5.7% (456 of 7965) overall, but
6.2% in patients who had smoked (429 of 6941) vs 2.5%% in those who had not (27
of 1024). Compared with the latter, risk-adjusted odds ratios were 1.80 (p =
0.03), 1.62 (p = 0.14), 1.51 (p = 0.20), and 1.29 (p = 0.3) for those whose
timing of smoking cessation was categorized as above. CONCLUSIONS: Risks of
hospital death and pulmonary complications after lung cancer resection were
increased by smoking and mitigated slowly by preoperative cessation. No optimal
interval of smoking cessation was identifiable. Patients should be counseled to
stop smoking irrespective of surgical timing.

The CNN interview transcript is at:
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About the Author

MA, MAppSci, PhD

Dr. Jonathan Foulds is an expert in the field of tobacco addiction.