FAQs about Quitting Smoking and Cancer Care

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1. I have just been diagnosed with cancer. Will quitting smoking really make a difference?

YES, it does. In fact, persistent tobacco use is associated with a greater risk of recurrence (cancer comes back after treatment), as well as a greater risk of a new cancer developing (second primary cancer). Smoking during cancer treatment has also been linked to shorter survival, an increase in treatment complications, and poorer quality of life compared to those who do not smoke.

In addition, quitting reduces symptoms associated with chemotherapy toxicity, such as infection and problems involving the heart, breathing, or stomach. It can also improve your lung function, appetite, sleep, energy, and emotional well-being.

If you are a tobacco user who has received a cancer diagnosis and you are wondering, “Why bother quitting?” we encourage you to consider tobacco cessation as a way for you to become an active partner in your treatment and to assure a more successful recovery.

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2. What are cessation medications? How do they work?

The nicotine in tobacco products is very physically addictive. When smokers stop smoking abruptly, they often experience symptoms of nicotine withdrawal, such as cravings, restlessness, anxiety, and irritability. The US Food and Drug Administration has approved the use of several medicines to make it easier to stop using tobacco products by lessening the physical symptoms of nicotine withdrawal.

By temporarily supplying very small amounts of nicotine to the body through nicotine replacement therapies (NRT), such as gum, lozenges, inhaler, and skin patches, it can become easier to cope with the cravings and symptoms of physically withdrawing from nicotine. This will  free you to focus on changing your daily routines (such as avoiding coffee or alcohol if they trigger smoking)and  using behavioral strategies (such as staying busy, using mints) to help you resist smoking (.

There are currently 7 FDA approved medications shown to be safe and effective for cessation. Nicotine replacement products include over-the-counter nicotine lozenge, patch and gum, and by prescription nasal spray and inhaler. Other prescription medicines help with withdrawal symptoms and cravings without the use of nicotine. These include bupropion SR pills (Zyban®, Wellbutrin SR®) and varenicline pills (Chantix®).

Studies show that using these medications can double your chances of quitting for good. Most cessation medications can be used safely and effectively by patients undergoing cancer treatment. A tobacco treatment specialist at Memorial Sloan Kettering will work with you and your doctor to decide which cessation medicine might be right for you.

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3. Why should I take nicotine replacement therapies (NRT) if nicotine is addictive?

Nicotine is not a cause of cancer; rather, cancer-causing compounds in tobacco and tobacco smoke and carbon monoxide from the burning of tobacco cause diseases.  The nicotine found in all nicotine replacement therapy products is regulated by the Food and Drug Administration, and these products are both safe and effective when used properly.  The amount of nicotine you get from nicotine replacement therapy products is low, is delivered very slowly, does not contain chemicals causing cancer or other diseases, and has a much lower risk of addiction than cigarettes. Using nicotine replacement therapy for approximately 3 to 6 months is the most effective method in the long run because it is a proven way to help people quit smoking and stay quit. https://smokefree.gov/sites/default/files/pdf/mythsaboutNRTfactsheet.pdf

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4. Can I get addicted to nicotine replacement therapies (NRT)?

Most people find it easy to gradually stop taking nicotine replacement therapies (NRT) as they approach the end of their recommended treatment period. In fact, the likelihood of long-term addiction to NRT is very low; the FDA regulates the amount of nicotine in these products at levels below what would be found in cigarettes. Also, NRT products supply nicotine to the body at a much slower rate than cigarettes, and also have a much lower risk of addiction.

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5. What about vaping, electronic or e-cigarettes, vaporizers, vape pens, hookah pens, mods, and e-pipes?   Are any of these a healthy alternative to regular cigarettes? Will they help me to quit smoking?

These “electronic nicotine delivery systems” ore ENDS are not approved by the FDA to help people quit smoking. There is no scientific evidence that they are safe or effective.

Fortunately, for smokers who want to quit, there are approved medications for this use, as well as behavioral counseling — all of which are considered effective and safe. We advise people who are interested in and ENDS product to consider using the Nicotrol® inhaler, which allows you to puff on a plastic piece to get a reliable dose of nicotine vapor.

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6. What will give me the best chance of permanently quitting?

At Memorial Sloan Kettering, we have a great deal of evidence that certain treatments work. We just need to get these treatments to work for you. Your best chance to permanently quit is to use cessation medications along with a specialized, evidence-based behavioral counseling.

Our tobacco treatment specialists will customize a plan designed to work specifically for you. It may take more than one try, but our specialists will ensure that you always receive treatment that gives you the best chances of quitting.

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7. Does insurance typically pay for tobacco cessation counseling?

The Affordable Care Act requires that tobacco cessation treatment must be provided at no cost under most types of health insurance. However, there is no single definition of tobacco cessation treatment, so the scope of coverage is likely to vary by state, by type of insurance (e.g., Medicare, Medicaid, private insurance), and by the insurance provider (e.g., Aetna, Blue Cross, etc.).  Insurance coverage for tobacco cessation services depends on your particular insurance plan. Most companies provide at least some level of mental health coverage, which is where you are most likely to find support for tobacco cessation services.

You can contact our Tobacco Treatment Program at 212-610-0507 to determine if we accept your insurance coverage.

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8. I smoke cigars – isn’t that better than smoking cigarettes?

No.  Cigar use raises the risk of developing cancer of the mouth, lung, esophagus, and larynx and possibly leads to the development of chronic obstructive pulmonary disease (COPD).

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9. How can I be successful in quitting when I am around others who smoke?

When a smoker is trying to quit, the presence of other smokers can be challenging. We can help you identify social situations where you are likely to be tempted to smoke, and lay out a game plan.

We encourage you to make your home and car smoke-free so you can stay focused on your quitting goals. We find that it also helps to tell your friends and family that you’ve quit so they can be supportive of your efforts. You can also ask smokers you know to avoid smoking around you and refrain from giving you a cigarette, even if you ask. Avoid outdoor smoking areas outside of work or other places you often go.  Best of all, encourage others to join you in quitting smoking and make quitting a family affair so that all of your loved ones benefit from becoming smoke-free!

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10. What qualities make a tobacco cessation program successful?

Tobacco dependence is an addiction, and like most addictions, relapse is common. A person’s ability to quit depends upon a number of factors, including motivation to quit and adherence to and length of treatment.

Approximately 50 to 90 percent of smokers start smoking again within the first months of any treatment program — even in top programs offering the best evidence-based treatments available. In the Memorial Sloan Kettering Tobacco Treatment Program, we offer only treatments that have been found through scientific studies to be effective and safe in helping smokers quit, and we offer longer-term counseling and support to reduce the chances of relapse. We work with you to tailor a tobacco treatment plan that fits your individual needs.

In surveys, 90 percent of people treated through our program rate their satisfaction as “high,” and 96 percent say they would refer a friend or family member to the program. Significantly, approximately 45 percent of participants report being smoke-free at six months and 33 percent are smoke-free at 12 months. These quit rates compare very favorably with published research conducted with cancer patients and other medically ill smokers.

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