Tobacco Treatment Guide: For Patients and Their Families

This guide explains the benefits of quitting or cutting back the amount of tobacco products you use. It has strategies and medicines to help you quit or cut down your use of other tobacco products. It also offers reasons you may want to quit and how to cope with smoking urges as you quit smoking.

In this guide, “you” refers to you or your loved one. 

This guide will:

• Teach you how to cope with the urge to smoke.
• Help you plan to quit smoking.
• Explain what to expect when you quit.
• Help you get support from your friends and family.
• Teach you ways to manage cravings and nicotine withdrawal.
• Give you tips on how to stay smoke-free once you quit.

About MSK’s Tobacco Treatment Program

We understand the stress of a cancer diagnosis, treatment, and the fear of recurrence (cancer coming back). Wanting to quit smoking while you’re going through these things can be challenging.

MSK’s Tobacco Treatment Program (TTP) specializes in helping people with cancer, cancer survivors, and their family members. We offer coaching and ongoing behavioral support to anyone who wants to quit or is thinking about quitting smoking. Our counselors have special training in helping people quit smoking.

You may be able to quit just by using this guide. But most people benefit from support from a counselor and taking medicine. 

We can recommend safe and effective medicines to help you quit smoking. These include nicotine replacement therapy (NRT), bupropion (Zyban^®), and varenicline (Chantix^®). We can also recommend other support services here at MSK and in your community.

To learn more about our Tobacco Treatment Program, visit www.msk.org/tobacco or call 212-610-0507.

Find your reasons to quit smoking

Quitting smoking and your cancer care

No matter what kind of cancer you have or what stage it is, there are known risks if you keep smoking. Quitting smoking has many health benefits. The sooner you quit, the better, but it’s never too late to quit!

Being treated for cancer can change your priorities and outlook on life. These changes may help motivate you to quit. There are many good reasons to quit. We’re here to help you find yours.

Here are some ways quitting smoking can help with your cancer care. Check off the points that matter most to you and add any extra personal reasons to quit to your list. 

Quitting smoking:

• Lowers the amount of side effects you’ll have.
• Helps improve your breathing after surgery.
• Lowers the risk of cancer coming back.
• Lowers the risk of getting new cancers.
• Helps your heart and lungs work better.
• Improves your sleep and helps you feel less tired and have more energy.
• Helps you feel less stressed and have a better quality of life.
• Improves your self-esteem.
• Helps you feel more in control of your life.
• Can lower your risk of dying from cancer and other diseases.
• Improves your appetite and sense of smell and taste.
• Makes cancer treatments work better.

Quitting smoking may improve your cancer care and outcomes. Talk with your doctor to learn more.

Your reasons to quit smoking

Quitting smoking is a big choice. It’s important to do it for reasons that mean something to you. For some people, knowing the health benefits of quitting is enough to motivate them to quit. Many people also have other personal reasons for wanting to quit. 

Here are some reasons people in our program have quit smoking.

I want to quit smoking because:

• I want to be more involved in my cancer care.
• I want to have more energy.
• I want to set a good example for family and friends.
• Smoking is expensive.
• Smoking smells bad.
• Smoking causes yellow teeth and unhealthy gums.
• I want freedom from tobacco addiction.
• Most of my friends have already quit.
• I want to see my children and grandchildren grow up.
• I want my family to worry less about my health.

Health benefits of quitting smoking

Everyone can benefit from quitting smoking no matter how long you’ve been smoking. Here are some of the health benefits you’ll experience starting from 20 minutes after quitting.

How to manage your concerns about quitting

Knowing what concerns you have about quitting is important so that you can find ways to handle them. This table lists some common concerns about quitting and tips for dealing with them. Check off those that are true for you.

START approach to quitting

The National Cancer Institute recommends the START approach to stop smoking. When you’re ready, use these steps to quit smoking:

S = Set a quit date. This is the actual day you will stop smoking.

T = Tell family, friends, and coworkers you plan to quit and when.

A = Anticipate and plan for the challenges you may face while quitting.

R = Remove cigarettes and other tobacco products from your home, car, and work.

T = Talk with your doctor, counselor, or Tobacco Treatment Specialist about quitting. A tobacco treatment specialist is a healthcare provider with special training in helping people quit smoking.

Set a quit date

Choosing a quit date will help you reach your goal.

• If you’re ready to set a quit date right now, follow the steps below.
• If you’re not ready to set a quit date right now, that’s okay. Some people quit by slowly cutting down on how much they smoke each day. Review your reasons for quitting and use the steps in this guide. This can help you cut down and feel more confident in setting a quit date later.

Tell your friends, family, and coworkers about your plans to quit

Quitting smoking can be hard but having the support of your friends and family can make it easier. Before you try to quit, make a list of people you can call or text for support. This includes family and friends. You can also call the national toll-free Tobacco Quitline (800-QUIT NOW or 800-784-8669).

Here are some ways you can ask them for help:

• If they smoke, ask them to try to quit with you. You’ll be able to support each other as you try to quit together. If they aren’t ready to quit, ask them not to smoke around you or your home. Ask them to also keep cigarettes out of your sight. Tell them this is the best way to help you.
• When you feel like smoking, ask them to help you focus on your reasons for quitting.
• Ask them to focus on what you’ve achieved, not your setbacks. Celebrate your successes, no matter how small they may seem. Every step toward quitting is a step in the right direction.
• Practice relaxing together. Do deep breathing, walk, or listen to music you like.
• Ask them to help you plan how you will deal with your urges to smoke.
• Ask them to plan something special to celebrate your quit day, like a movie or dinner.
• Ask them to be there for you if you want to talk. Just having someone to talk to can help.

Expect and plan for challenges

Expecting challenges is an important part of getting ready to quit. If you’ve tried to quit smoking before, you’re one step closer to becoming tobacco-free.

Know your triggers

Knowing what makes you want to smoke is an important part of quitting. Most people have triggers and habits that set them off or “tell” them to smoke. What are your triggers? Check them off below.

• Drinking alcohol
• Being bored
• Coffee
• Meals
• Talking on the phone
• Using a computer
• Being around other smokers
• Stress
• Driving

Get ready to manage nicotine withdrawal

Nicotine is the addictive substance in cigarettes that makes you want them more. When you stop smoking, your body must get used to not having nicotine in your system.

As your body gets used to this, you might have short-term signs of withdrawal, such as:

• Being irritable
• Anxiety
• Low mood
• Being jittery
• Trouble concentrating
• Changes in sleep
• Increased appetite

These usually last a week or two. Some may last longer. Medicines, such as nicotine replacement therapy (NRT), can help reduce symptoms of nicotine withdrawal.

The first few days after quitting smoking are hard. You may feel annoyed, upset, or down. These can be a normal part of early nicotine withdrawal. These feelings will go away.

A few weeks after quitting, you’re likely to have other mental health benefits and much fewer feelings of stress. Remind yourself why you want to quit. Keep using your strategies for coping with smoking urges that you came up with.

Withdrawal is different for everyone. This table has common signs or conditions related to withdrawal and reducing tobacco. It also has helpful tips to manage them.

Quitting smoking while going through cancer treatment and other stressful situations can be overwhelming. If these feelings are keeping you from doing your usual activities, you may be having depression or anxiety.

Some healthcare providers have special training in helping people who are trying to quit smoking while coping with cancer and other stressors. Talking to them can help.

MSK’s Tobacco Treatment Program can provide emotional support and treatment for you and your family. Visit www.msk.org/tobacco or call 212-610-0507 to learn more.

Learn and use new self-talk to cope with smoking urges

You can change your level of stress, mood, and even your behavior by learning to control your thoughts. Having negative thoughts can make you feel more sad, worried, or depressed. Try to lower your stress level by thinking positive thoughts. Some people can talk themselves into or out of smoking a cigarette.

Use these tips to help change your thinking about smoking and quitting.

Remove cigarettes and tobacco from your home, car, and workplace

Making your home and car smoke-free is an important first step toward quitting. Go through all the places where you might have cigarettes or tobacco stored. Places like your pockets, drawers, and the glove compartment in your car are good places to start.

Getting rid of cigarettes is also important. This can make you less tempted to light up when you’re stressed or having nicotine withdrawal. Get rid of all the things that remind you of smoking, such as:

• Cigarettes
• Matches
• Lighters
• Ashtrays

Talk with your healthcare provider about getting help to quit

Talk with your healthcare provider about what challenges you expect. Tell them your concerns about quitting. They can give you advice and tell you about resources that can help you quit. This includes meeting with a tobacco treatment specialist to help you with your plan to quit.

About cessation medicines

Your doctor may also give you one or more cessation medicines to help with nicotine withdrawal. These medicines help by making you have less cravings for cigarettes. They can also help reduce nicotine withdrawal side effects, such as depression, anxiety, and increased appetite. Using both medicine and working with a tobacco treatment specialist will increase your chances of having success quitting and staying smoke-free.

Common questions about medicines to help quit smoking

Which types of medicines are there to help me stop smoking?

NRT is 1 type of quitting medicine that is approved by the Food and Drug Administration (FDA). These medicines replace some of the nicotine your body gets from smoking cigarettes without the harmful chemicals. They also help manage your side effects of nicotine withdrawal and help you slowly stop needing nicotine.

NRT comes in many forms, such as:

There are also medicines you can take as a pill, such as Bupropion SR (Wellbutrin SR^®, Zyban^®) or Varenicline (Chantix^®). They don’t have nicotine but can reduce your cravings to smoke and lessen side effects of nicotine withdrawal. Your doctor can give you a prescription for these medicines.

Are these medicines safe?

Yes, all of these medicines are safe to take and can help you quit smoking. These medicines don’t have the toxic chemicals that cigarettes have. Most are safe to use while getting cancer treatment.

Can I use more than one medicine at the same time?

Yes. It’s safe for you to use more than one medicine at the same time. Combination therapy often combines a long-acting nicotine patch with a fast-acting option like nicotine gum or lozenges. Combining two NRTs is the most common approach. Using two cessation medicines increases your chances of succeeding in quitting. 

• The long-acting medicine gives a steady level of nicotine to prevent withdrawal.
• The fast-acting option stops breakthrough cravings.

Using the nicotine patch with nicotine gum, lozenge, nasal spray, or inhalator (inhaler) is better than taking one NRT alone. You can also take non-nicotine medicines, such as bupropion, with NRT to increase your chances of quitting. MSK’s Tobacco Treatment Specialists can help make a medication plan that works for you.

Your doctor or prescriber might also recommend other combing other cessation medication options. This is often used for people with high dependence or those who have relapsed in the past. Some of these medicines may be covered by your health insurance.

This table shows examples of FDA-approved smoking cessation medicines. 

What are Electronic Nicotine Delivery Systems (ENDS)?

Electronic cigarettes are battery-powered devices. These devices come in many shapes and sizes. Some look like regular cigarettes, pipes, or cigars. Others look like everyday objects, such as pens or USB flash drives. Using any of these devices, including disposable e-cigarettes, is often called “vaping.”

Vaping during cancer treatment can:

• Affect your recovery.
• Lower your body’s resistance to infection.
• Increase your exposure to harmful, cancer-causing chemicals.

The vapor you breathe in from all vaping devices has dangerous chemicals and small bits of toxic metal. These products often give you a lot of nicotine. This puts extra stress on your heart and lungs. To get best possible outcomes during your therapy, avoid all tobacco products.

If you have questions or thoughts about using ENDS, talk with your tobacco treatment specialist. Read Frequently Asked Questions About Electronic Smoking Devices to learn more.

Can I use e-cigarettes (vapes) in the hospital?

No, you cannot use e-cigarettes inside the hospital. The hospital treats these products just like regular cigarettes. They are called tobacco products because they have nicotine in them.

What are nicotine pouches?

Nicotine pouches are small, tobacco-free pouches that you place between your gum and your lip. They deliver nicotine without making smoke or aerosol. Your body absorbs the nicotine through the lining of your mouth.

Nicotine pouches do not harm your lungs in the same way, but they are still not safe. They have a lot of nicotine. Nicotine is a powerful drug that makes you want to use the pouches over and over again. We still don’t know about the long-term health risks of using nicotine pouches yet.

The FDA considers nicotine pouches called tobacco products because they have nicotine in them. The hospital treats these pouches just like regular cigarettes, and they aren’t allowed in hospitals due to tobacco-free policies. Hospitals must be tobacco-free to keep all patients safe and clean while they heal.

The FDA has not approved nicotine pouches as a proven medicine to help you quit smoking. If you want to quit, it’s recommended to talk with a tobacco treatment specialist and use FDA-approved nicotine replacement therapies (NRT). NRTs include patches, gum, or lozenges. Read Frequently Asked Questions About Electronic Smoking Devices to learn more.

What to do on your quit date

Here are some things to try on your quit date.

• Get rid of any reminders of smoking if you haven’t done so already. This includes cigarettes, lighters, ashtrays.
• Review and use the tips in this guide.
• Remind your friends and family that today is your quit date.
• Treat yourself to something special during your first 1 to 6 weeks off cigarettes.
• Plan to celebrate the day you quit smoking each month.

Staying smoke-free

Sometimes you may not be able to turn down a craving for a cigarette after quitting. Here are some common terms healthcare providers may use if that happens:

• A slip is when you have a puff or a few cigarettes but don’t return to your regular smoking pattern. If you slip, you have a higher chance of relapsing.
• A relapse is when you restart smoking 1 or more cigarettes a day for a week or more.

Plan for situations that can lead to a slip or relapse

Here are some common situations that can lead to a slip or relapse. Be aware of these and plan ways to avoid smoking if you’re tempted.

• Stress or other negative feelings. You may feel like you want to smoke if you’re stressed, sad, or worried.
• Positive feelings. You may want to smoke when you feel happy or as a reward for when something goes right or well.
• Nicotine withdrawal. You may want to smoke when you’re going through nicotine withdrawal. It can be very hard, but NRT medicines can help you through it so you don’t slip or relapse.
• Alcohol. When you drink alcohol, you’re more likely to give in to cravings to smoke. Try to reduce alcohol use, or don’t drink alcohol or for the first month or so after your quit date.
• Relaxing after meals. Some people like to smoke after they eat. If you feel like smoking after a meal, make a list of other things you can do instead.
• Social situations. Try not to be around other tobacco users or ask them not to smoke around you. If you’re celebrating with friends and feel the urge to smoke, excuse yourself. Use one of the strategies from this guide to get you back on track.
• Recovery from cancer or treatment. You may want to quit smoking after a cancer diagnosis or before surgery. Some people are tempted to start smoking again once their cancer is gone or once they’ve recovered. Instead, use this time to break the habit. Make room for healthier activities like exercise or other hobbies.
• Feeling bored. If you don’t have energy or cannot work because of your treatment or cancer, you may feel very bored. Feeling bored can trigger smoking urges. Plan your day to include fun activities that make you happy and keep you busy. Staying busy with hobbies or other activities you enjoy helps distract you from urges to smoke.

What to do if you slip

If you have a slip, don’t worry! Learning to manage slips is often part of the process of quitting. Try to figure out what caused the slip. Ask yourself:

• “Was I in a situation that made it easier for me to slip? This could be being with friends who were smoking, feeling stressed, or keeping a supply of cigarettes after quitting.”
• “How can I plan for this situation next time? What strategies from this guide can I use to help me avoid my triggers?”
• “Was I having nicotine withdrawal? If I was using an NRT, was I using it the way I’m supposed to?”
• “Am I forgetting why I wanted to quit in the first place? If I am, I should review my reasons for quitting and talk myself out of it.”

You can get back on track by quitting smoking again. After thinking about what happened, make a plan to deal with the situation in a smoke-free way in the future. Think about whether it’s best to avoid these situations completely or face them head on using your best coping strategies.

What to do if you relapse

If you relapse, don’t beat yourself up. Avoid negative statements like “I’ll never quit,” or “I’m a failure.” Instead, think of ways you can recover if you relapse, such as:

• Throw away any cigarettes or tobacco products you still have.
• Tell yourself that you have tried to quit and think about what you learned about yourself and the nicotine habit.
• Think about times when you learned a new skill, such as riding a bicycle or using a computer. You didn’t just learn these new skills in one try. You figured out what worked and what didn’t as you went along. Learning to live life without cigarettes also means sticking with it and trying new ways to cope with the urge to smoke.
• If you slip or relapse, you may feel guilty or try to hide it. Instead, talk with your healthcare provider or others who are there to support you. Think about what led to the slip or relapse and figure out ways to deal with it next time.
• It may be time to come up with a stronger action plan. If you’re not sure why you relapsed or how to get back on track, contact MSK’s Tobacco Treatment Program. Visit www.msk.org/tobacco or call 212-610-0507. We’re here to help.
• Review the strategies in this guide.
• Set a new quit date and start again. You are one step closer to reaching your goal.

Reviewing the strategies and suggestions in this guide from time to time can help you stay a nonsmoker. It’s never too late to enjoy the benefits of being a nonsmoker.

What if I’m not ready to quit smoking?

Cutting down your daily smoking has benefits, even if you are not ready to quit yet. For example, you might set a short-term goal, such as smoking half the number of cigarettes each day. This can save money, boost your energy, and expose you to fewer toxins.

Cutting down can boost your confidence to quit by helping you become more aware of your triggers. This can also help you practice strategies for coping with urges to smoke and other symptoms of nicotine withdrawal.

In the beginning, focus on reaching small, low-pressure goals. You can slowly reduce the number of cigarettes you smoke, prepare your surroundings, and look for cessation support. These things can help get you ready to quit when the time feels right.

Steps you can take right now

• Cut down steadily. Lower your daily intake by adding more time between cigarettes or leave them at home during quick trips.
• Recognize your triggers. Notice exactly when and why you smoke.
• Change your routine. Swap your smoking routine for new ones. Start by making the easiest changes first.
• Create obstacles: Make it less convenient to smoke. If you smoke while driving, put your cigarettes in the trunk so you must pull over to get them. 
• Make your home smoke-free. Many people find this helpful. 
• Pause and ask. Before you light up, ask yourself, “Is this worth it”?
• Manage nicotine withdrawal. Talk to a healthcare provider about NRT, such as gum, lozenges, or patches. You can use medicine to manage cravings in places where smoking isn’t allowed.
• Look for support systems: Reach out to family and friends who will support you on this new journey. You can also ask your healthcare provider for resources.

To learn more about quitting smoking, watch

Resources

American Cancer Society
www.cancer.org
800-ACS-2345 (800-227-2345)
The American Cancer Society provides information and support to people with cancer and their caregivers.

American Heart Association
www.heart.org/HEARTORG/HealthyLiving/QuitSmoking/Quit-Smoking_UCM_001085_SubHomePage.jsp
The American Heart Association has resources to help people quit smoking.

American Lung Association
www.lung.org/stop-smoking
800-LUNG-USA (800-586-4872)
The American Lung Association has resources to help people quit smoking.

Centers for Disease Control and Prevention
www.cdc.gov/tobacco/campaign/tips
The Tips From Former Smokers^® campaign features stories of former smokers. They share stories of living with smoking-related diseases and disabilities and the toll that smoking-related illnesses have taken on them.

Memorial Sloan Kettering’s Tobacco Treatment Program
www.msk.org/tobacco
212-610-0507
MSK has specialists who can help you quit smoking or stop using tobacco. We use a wide range of approaches to help you quit, including medicines and behavioral techniques. To learn more about our Tobacco Treatment Program, visit www.msk.org/tobacco or call 212-610-0507.

National Cancer Institute
Clearing the Air. Quit Smoking Today
smokefree.gov/sites/default/files/pdf/clearing-the-air-accessible.pdf
This booklet is designed to help people quit smoking and prepare for the challenges that can come up after quitting.

National Smokers’ Quitline
www.smokefree.gov
800-QUIT NOW (800-784-8669)
The National Smokers’ Qutline has resources to help people quit smoking, including online counseling and text messaging.

NCI QuitGuide App
https://smokefree.gov/tools-tips/quitstart 

NCI QuitGuide is a free app. It tracks cravings, moods, slips, and smoke-free progress. It is designed to help you understand your smoking patterns and build skills to become and stay smoke-free.

US Department of Health and Human Services
www.surgeongeneral.gov/library/reports/50-years-of-progress/consumer-guide.pdf
A consumer guide to the Surgeon General’s report The Health Consequences of Smoking: 50 Years of Progress.

US Food and Drug Administration: Electronic Cigarettes (e-Cigarettes)
www.fda.gov/NewsEvents/PublicHealthFocus/ucm172906.htm
The FDA has Information about regulations for e-cigarette use and to learn about and report problems with these devices.