CHEST Guidelines-Treatment-of-Tobacco-Use-in-Lung-Cancer

Treatment-of-Tobacco-Use-in-Lung-Cancer_chest

Pdf Summary

The 2013 "Diagnosis and Management of Lung Cancer, 3rd Edition: ACCP Guidelines" supplement in CHEST journal details guidelines for integrating tobacco dependence treatment into lung cancer care. Smoking cessation is critical, as continued smoking undermines cancer treatment and survival. Despite the challenge, effective treatment involves a combined approach of pharmacotherapy and counseling. The guidelines recommend:

1. <strong>Screening and Counseling</strong>: Current smokers undergoing lung cancer screening should receive comprehensive cessation interventions that include both counseling and pharmacotherapy. Screening alone is inadequate to encourage smoking cessation.

2. <strong>Lung Cancer Surgery</strong>: Smokers should cease smoking before surgery to reduce postoperative complications. While cessation timing does not increase surgical risk and immediate surgery should not be delayed for long cessation periods, cessation interventions should be initiated preoperatively.

3. <strong>Chemotherapy</strong>: For those undergoing chemotherapy, cessation interventions including counseling and pharmacotherapy are recommended to improve abstinence rates and manage depressive symptoms, using bupropion specifically to address both nicotine dependence and depressive symptoms.

4. <strong>Radiotherapy</strong>: Cessation interventions with both counseling and pharmacotherapy are recommended for patients undergoing radiotherapy, as continued smoking increases complications.

The guidelines emphasize the biological complexity of nicotine addiction, likening it to a chronic disease requiring ongoing management. Nicotine affects brain survival mechanisms, making quitting a difficult yet vital part of cancer care. The paradox of willingness to undergo surgery but not to quit smoking may reflect disordered motivation functions of the brain rather than a lack of desire to quit.

The article acknowledges the gaps in evidence specific to oncology and calls for research into optimal cessation strategies tailored to the realities of cancer treatments. Clinicians are urged to actively address tobacco use as a standard part of lung cancer treatment to improve patient outcomes and quality of life.

Keywords

lung cancer

tobacco dependence

smoking cessation

pharmacotherapy

counseling

chemotherapy

radiotherapy

nicotine addiction

oncology

patient outcomes