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Many keep smoking after cancer diagnosis

It took asthma, COPD, emphysema and finally, lung cancer to get Toni Manes, a retired cosmetologist, to try to quit smoking.

Unfortunately, the 58-year-old was so hooked, she couldn't kick the habit even after part of her left lung was removed.

"I remember my surgeon told me 'If you ever smoke again, your husband should break your fingers,'" says the Philadelphia resident, who was diagnosed and had surgery in 2010. "And I was like, 'Okay, I'm not going to smoke again.'  But then I came home from surgery, recuperated for a few weeks and started up again. I couldn't help myself."

According to a new study in the American Cancer Society journal CANCER, Manes is just one of many patients who've found themselves smoking after diagnosis.

Researchers looked at 2,456 lung cancer patients and 3,063 colorectal patients and discovered that at time of diagnosis, 38 percent of the lung cancer patients and 15 percent of the colorectal patients were smokers.

Courtesy of Toni Manes

Lung cancer patient Toni Manes continued to smoke after her diagnosis.

Five months later, despite a cancer diagnosis, 14 percent of the lung cancer patients were still lighting up (ditto for 9 percent of the colorectal patients).

'Why stop now?'
"People think it's a no-brainer and are surprised that cancer patients continue to smoke after they're diagnosed," says Elyse R. Park, a clinical health psychologist and associate professor of psychiatry at Massachusetts General Hospital/Harvard Medical School and lead researcher for the study. "But people still struggle to quit even after they're diagnosed. There are a lot of barriers to quitting, including a lot of stigma."

Park says many of the people who can't quit are "hard-core" smokers, i.e., they smoke a high number of cigarettes a day. Many, also, are surrounded by other smokers.

"These people are nicotine addicted, so it's tough for them," says Park. "They also have a lot of self-blame for causing the disease. There are feelings of fatalism. They think, 'Why stop now?' And a lot of people are very judgmental about lung cancer patients causing their own disease."

According to the Lung Cancer Foundation of America, 60 percent of new lung cancer diagnoses happen to non-smokers, 15 percent of whom have never smoked a day in their life (the rest are former smokers who quit 10, 20 or even 30 years prior to diagnosis). The American Lung Association estimates that active smoking is responsible for close to 90 percent of lung cancer cases; radon causes 10 percent, and occupational exposures to carcinogens account for approximately 9 to 15 percent.

Manes says following surgery, she went on to do three rounds of chemotherapy, followed by radiation. And even though she continued to smoke throughout, she worked with her oncologist at Thomas Jefferson University Hospital on ways to quit.

"We tried everything," she says. "Hypnosis, Chantix, patches, cessation groups, acupuncture, the gum, the lozenges -- and none of that stuff did anything for me. I was depressed and didn't want to face that I had cancer. I saw a death sentence for myself. What difference did it make if I smoked or not?"

Park says she hopes her study will pave the way for more smoking cessation programs and treatment options for patients who are smoking at the time of their diagnosis.

"One of the reasons it's hard to quit is that people think they have enough to worry about," she says. "But it's the best time to quit because it has the potential to improve their cancer treatment, from breathing easier and feeling less fatigue to reducing the chance of infection after surgery."

Parks says studies also show that quitting smoking can increase the efficacy of chemo and radiation and may even double the chances of survival for lung cancer patients.

"We're hoping to integrate evidence-based tobacco treatment into cancer care," she says. "So you don't just ask a patient, 'Do you smoke, yes or no?' But you try to get them to quit as part of their treatment. It's a tough time, but we're hoping to find ways to sit with patients and get them pharmacological and behavior counseling treatment."

The good news? There's some evidence Park's approach might just work.

"On October 31, 2011, I got a sinus cold again and with every puff, I was choking," says Manes. "So I put on a patch and humbled myself before God and begged him to help me. I needed some kind of inner strength. On the 31st of this month, it'll be three months that I've been smoke-free."