ABSTRACT
Highly nicotine dependent oncology patients are at high risk for psychiatric morbidity when they enter the medical care setting where smoking restrictions apply. Nicotine withdrawal symptoms exacerbate cancer-related distress as well as common physical side effects of cancer treatment. This case report illustrates the management of a patient whose ongoing treatment for bladder cancer was jeopardized as a result of nicotine dependence and withdrawal. Several associated complications are described, the most serious of which were his acute anxiety and non-adherence to medical recommendations. A short-term management approach that included anxiolytics and nicotine replacement was effectively used to reduce this patient's excessive anxiety and thus facilitate compliance with stressful treatments. The severity of complications that can result from untreated nicotine dependence and withdrawal underscores the importance of assessing and monitoring smoking status in every patient. Greater staff awareness of the clinical practice guidelines regarding the diagnosis and treatment of nicotine dependence will likely result in improved patient care and compliance.
Subject(s)
Anxiety/prevention & control , Carcinoma, Transitional Cell/complications , Substance Withdrawal Syndrome/complications , Tobacco Use Disorder/complications , Tobacco Use Disorder/therapy , Urinary Bladder Neoplasms/complications , Anti-Anxiety Agents/therapeutic use , Anxiety/etiology , Carcinoma, Transitional Cell/psychology , Carcinoma, Transitional Cell/therapy , Humans , Male , Middle Aged , Nicotine/therapeutic use , Patient Compliance , Secondary Prevention , Smoking Cessation/methods , Treatment Outcome , Urinary Bladder Neoplasms/psychology , Urinary Bladder Neoplasms/therapyABSTRACT
BACKGROUND: Patients with head and neck cancer who continue to smoke after diagnosis and treatment are more likely than patients who quit to experience tumor recurrence and second primary malignancies. Therefore, information about patients' smoking status and the factors associated with continued tobacco use are important considerations in the comprehensive care patients with head and neck cancer. METHODS: Study participants were 144 patients with newly diagnosed squamous cell carcinomas of the upper aerodigestive tract who underwent surgical treatment, with or without postoperative radiotherapy or chemotherapy, 3-15 months before assessment of their postoperative tobacco use. RESULTS: Among the 74 patients who had smoked in the year before diagnosis, 35% reported continued tobacco use after surgery. Compared with patients who abstained from smoking, patients who continued to use tobacco were less likely to have received postoperative radiotherapy, to have had less extensive disease, to have had oral cavity disease, and to have had higher levels of education. Hierarchical regression analysis indicated that most of the explained variance in smoking status could be accounted for on the first step of analysis by disease site. Interest in smoking cessation was high, and most patients made multiple attempts to quit. CONCLUSIONS: Although the diagnosis of a tobacco-related malignancy clearly represents a strong catalyst for smoking cessation, a sizable subgroup of patients continue to smoke. Patients with less severe disease who undergo less extensive treatment are particularly at risk for continued tobacco use. These data highlight the importance of developing smoking cessation interventions designed to meet the demographic, disease, treatment, and tobacco-use characteristics of this patient population.
