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Seeing Past the Smoke Screen

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Katrina Burton, MD Anderson Staff Writer

Breannacheer.jpgWith nearly one in five teens smoking cigarettes, there is no better advocate for smoking-cessation than Breanna Jordan, a senior at Stone Mountain High, a school nestled in DeKalb County in Georgia.

As a member of the National Honor Society, varsity cheerleader squad and active participant of SADD (Students Against Destructive Decisions) - a student-run program that discourages students from drinking, smoking and engaging in destructive behaviors - Jordan is no stranger to peer pressure and what's popular among teens.

"Smoking is the in thing to do for those going through the cool phase," says Jordan. "There is a lot of stress that comes with being a teenager, and some think that smoking among other things helps relieve that stress."

Jordan says it is not only the hygiene problems - bad breath, bad teeth and body odor - that have made her say no to smoking, but diseases like cancer that concern her. Jordan, like most people, has either had a personal experience with cancer or knows someone whose life has been touched by the disease. Just last year her aunt died of a non-smoking related cancer - ovarian cancer.

Lung Cancer Screening Clinical Trial Yields Promising Results

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By Will Fitzgerald, MD Anderson Staff Writer

A first-of-its-kind study has found that CT scans detect lung cancer at an earlier, curable stage in the population at highest risk compared to traditional X-rays -- resulting in 20% fewer deaths from the disease. Until now, there's been no recommended screening tool to detect early lung cancer. However, these results may be a major breakthrough.

 

MD Anderson was one of 33 sites that participated in the NCI-led trial. Reggie Munden, M.D., professor in the Department of Thoracic Imaging, is the study's principal investigator at MD Anderson. In this video, he explains the findings, significance and hope that could transform the way lung cancer is detected and treated.

Resources
Lung cancer trial results show mortality benefit with low-dose CT (NCI news release)

Video from ABC News

Traveling the Road to Wellness

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Matthew Ballo, M.D., is a radiation oncologist at the MD Anderson Regional Care Center in the Bay Area. His passion for survivorship and post-treatment care led to the creation of the Road to Wellness program in 2007. Today the program is open to breast cancer and prostate cancer patients treated at the MD Anderson Regional Care Center in the Bay Area. MD Anderson's main campus offers a number of programs and clinics for survivors, but the Bay Area location is the first of the institution's regional care centers to offer this service.By

By: Matthew Ballo, M.D.


When I began training at MD Anderson I observed that fatigue was a common problem in patients receiving radiation. Since there were few active interventions to address the issue at the time, I pledged that when I moved my practice to the Bay Area, I would work to find diet and exercise solutions to relieve fatigue.

As the idea of the program began to grow, it became apparent that fatigue was only one of several quality of life issues that patients faced. I started thinking more globally about issues such as stress management and smoking cessation and soon realized this program fit under the emerging discipline of survivorship.

In 2007 we began the Road to Wellness program, which offers lifestyle rehabilitation programs to transition patients from active cancer care to survivors who are preparing for life post-treatment.

Cancer survivors have unrecognized and untreated aftereffects of cancer treatment, so we put two and two together and created a program that addresses fatigue and the global issues of quality of life in cancer patients undergoing treatment. This program prepares patients for survivorship by equipping them with the tools necessary to be healthy cancer survivors.

The Road to Wellness is a five-step program:

  1. Initial consultation. Studies show that the majority of patients prefer to undergo lifestyle counseling at the time of diagnosis rather than after treatment.
  2. Consultation with an exercise physiologist. A tailored exercise regimen is created for each patient based on cardiovascular and resistance testing.
  3. Nutritional consultation. Patients meet with an MD Anderson registered dietician and undergo counseling regarding specific diet modifications endorsed by the World Cancer Research Fund for reducing cancer risks.
  4. Meeting with a social worker. A social worker performs a needs assessment and teaches stress management skills. Patients may be directed to support groups or other resources in the community that they can attend.
  5. Smoking cessation, if needed. MD Anderson's Tobacco Treatment Program is a comprehensive tobacco-cessation program that may consist of face-to-face and telephone behavioral counseling, nicotine replacement therapies and tobacco-treatment prescription medications.

With cigarette prices on the rise and statewide smoking bans in 26 states, it seems as though quitting smoking would be more convenient than ever. However, quitting - and its health benefits - remains out of reach for many smokers.

It's a well-known fact that the nicotine in cigarettes makes them dangerously addictive, but when coupled with the deadly carcinogens contained in cigarette smoke, the habit can kill. Quitting smoking is one of the best decisions you can make for your health, as it helps lower the risk for cancer, stroke, and heart and lung disease. So what's the best way to quit?

Whether you've been smoking for 30 years or 30 days, your body has developed a dependence on nicotine - not the DNA-damaging, cancer-causing smoke - so quitting will inevitably result in some degree of nicotine withdrawal. This is often what causes many smokers to give up trying to quit, but there are many options to manage nicotine withdrawal and successfully work toward quitting.

From gums and lozenges to electronic devices and patches, nicotine-replacement therapies abound. The primary therapeutic use of these products is to deliver controlled doses of nicotine to an individual without the harmful chemicals that are in tobacco products.

"You really can't go wrong with any of the nicotine replacement therapies," says Damon J. Vidrine, Dr.P.H., assistant professor in the Department of Behavioral Science at M. D. Anderson. "It just depends on what works for you."

NicotineGum.jpgOral Options
Gum and lozenges are especially useful for quitters that feel the need to keep their mouths busy without a cigarette. For smokers that light up during certain times of the day or while at certain places, these therapies assist their quitting effort by allowing them to pop a piece of gum to replace their post-meal cigarette or the one right after leaving work.

E-Cigarettes
While quitting, some people have a hard time finding ways to occupy their hands at times they would normally be smoking. For these people, e-cigarettes might be the best option. These electronic nicotine delivery devices resemble cigarettes but do not use tobacco. Instead, they release a small dose of nicotine with each puff.

NicotinePatch.jpgThe Patch
For heavy smokers, the patch is often the best option, since it delivers a steady, 24-hour stream of low-dose nicotine to your system, helping to keep cravings at bay.

"Although any of these products can be helpful, I would typically recommend trying the patch first," Vidrine says. "The other products give you nicotine in isolated doses when you need it - more like cigarettes do. But, if not used correctly, they may leave you with more nicotine cravings than the patch. You can put the patch on and forget about it - even in the shower."

Make Quitting Count
Mark Twain once mused, "Quitting smoking is easy. I've done it a thousand times," but Vidrine says that the goal should be complete cessation, not just to cut back. "This can be difficult, but nicotine-replacement products really do help people who are committed to quitting."

If you would like more information on smoking cessation and nicotine-replacement therapies, Vidrine will be available on www.twitter.com/cancerwise Thursday, April 29, at 12:30 p.m. CT to answer your questions.

Follow the conversation on tweetchat or log into twitter and follow the Hashtag #QuitSmoking.

Tobacco Use and HPV Exposure

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By: Maurie Markman M.D.

The two most prevalent causes of head and neck cancers are tobacco use and human papillomavirus exposure. Maurie Markman, M.D., vice president for clinical research at M. D. Anderson, reviews a study reported in Clinical Cancer Research last month on what happens when a patient has HPV exposure and uses tobacco.

The study looked at 124 patients with advanced oropharyngeal cancer, or cancer of the tonsils or the base of the tongue. Of the HPV-positive patients who had never used tobacco, 6% had a recurrence of their cancer. Meanwhile, 19% of former tobacco users and 35% of current tobacco users had a recurrence.



Resources

Tobacco Use Linked to Worse Outcomes in HPV-Positive Head and Neck Cancer (Science Daily)

Head and Neck Cancers (MD Anderson)

Supporters of the e-cigarette see it as a safer alternative to traditional cigarettes. After all, it produces no smoke and uses rechargeable batteries. It's even promoted as a new way to get around public smoking bans. But this nicotine delivery device is not safe. Groups like the American Lung Association, American Cancer Society, American Heart Association and the Campaign for Tobacco-Free Kids have called for its removal from the market.

Joel Dunnington, M.D., professor in M. D. Anderson's Department of Diagnostic Radiology, and Rob Watkins, a puppet from Too Cool to Smoke: with The Kids on the Block, chime in on the growing debate.


Puppet appears courtesy of The Kids on the Block, Inc., Columbia, Maryland, www.kotb.com.

If you are in the Houston area, request a visit from Rob. Too Cool to Smoke: with The Kids on the Block puppet show is a free tobacco awareness program for children in kindergarten through fourth grade.

So what do YOU think? Let us know your take on the e-cigarette controversy.


Resources
Become a fan of Too Cool to Smoke on Facebook
Visit our website to learn more about smoking and tobacco, including how to quit.


Former Smoker Leads the Pack of Nurses Promoting Cessation

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By Robin Davidson, Staff Writer


marylouheater.jpg

Mary Lou Heater, MSN, RN, PMHCNS-BC, is an advanced practice nurse who works for M. D. Anderson's Tobacco Treatment Program (TTP) and each day, she may provide counseling to 10 or more cancer patients struggling to break the hold of the tobacco addiction that may have caused their disease.

The TTP is an intensive tobacco cessation program, that is open to all patients, as well as M. D. Anderson employees and their dependents, free of charge. In some cases, family members of patients living in the same household may also be considered eligible for the program. With an outstanding 41-percent success rate, Mary Lou Heater wants more people to take advantage.

Patients like Mary Lou's no-nonsense approach. As a former smoker who's married to a former smoker, she knows just how hard it is to quit.

 "The Tobacco Treatment Program is a holistic approach to addiction therapy. I see patients every day who really want to quit. They need help," she says. "When they are first diagnosed, they are scared. Maybe they're going through chemotherapy treatments or maybe they are dealing with a secondary cancer. I have a real appreciation for our patients, their struggles and their resiliency."

A brief intervention may be all it takes to get people to come around to an idea. "I want nurses to learn the five A's: Ask, Advise, Assess, Assist and Arrange. Nurses see the most patients and have the most interaction with patients. They are far and away the best health care practitioners to intervene, and studies prove nursing interventions are effective. If one of our doctors or nurses has a patient interested in quitting, I will go directly to that patient."

The TTP involves three months of active treatment, but follow-up extends to 15 months to monitor status. As an advanced practice nurse in collaboration with the program's addiction psychiatrist, she both dispenses pharmacological therapy and provides the behavioral counseling that may make it possible for a patient to quit. Outpatient visits to the Behavioral Research Treatment Center may be ideal, but Heater's job often sends her directly to a patient's bedside. Those who need support know she's just a phone call away.

"Being with patients, you forget everything else. Since I've been in nursing, I've worked strictly with psychiatry and addictions. My work is very rewarding, but most importantly I love the patients. They are as amazing as the work we do here."

Visit the Tobacco Treatment Program to learn more about the no-cost cessation services provided, call 713-792-QUIT, or send an e-mail to quitnow@mdanderson.org.

 

Smoking Cessation Resources

Guide to Quit Smoking (ACS)

How to Quit (CDC)

Last week The New York Times reported that the U.S. House of Representatives moved quickly to pass the Senate's tobacco bill and get it to the White House, where President Obama promised to sign it.

The Family Smoking Prevention and Tobacco Control Act would for the first time give the U.S. Food and Drug Administration the authority to regulate tobacco products. What effect will this legislation really have on the use of tobacco products in the United States? Paul Cinciripini, Ph.D., professor and director of the Tobacco Treatment Program in the Department of Behavioral Science at M. D. Anderson, weighs in on the topic.





More articles about Tobacco and Smoking

Smoking Facts from M. D. Anderson

Center for Disease Control - Tobacco Use

Questions About Smoking, Tobacco, and Health (American Cancer Society )

Tobacco Legislation Expected to Pass Senate (New York Times)

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