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From OncoLog, November-December 2011, Vol. 56, Nos. 11-12

House Call: Smoking Cessation
Medications may help smokers quit

You probably already know that smoking is the leading cause of lung cancer. And you may also know that smoking contributes to heart disease, stroke, and lung diseases such as emphysema. But did you know that even patients who have been diagnosed with these diseases greatly benefit from kicking the smoking habit? And if you’re trying to quit smoking, did you know that over-the-counter aids and prescription medicines are available to help you?

Benefits of quitting

Quitting smoking has both short-term and long-term benefits. Within a few months of quitting, most former smokers have improved blood circulation and lung function as well as less coughing.

As a group, former smokers who have not smoked for 1 year have just half the risk of heart disease as that of smokers. Those who have not smoked for 5 years have half the risk of cancers of the mouth, throat, esophagus, and bladder as that of smokers and the same risk of cervical cancer as that of lifelong nonsmokers. Those who quit smoking 15 years ago have the same risk of heart disease as that of lifelong nonsmokers.

Even after a cancer diagnosis, it’s not too late to stop smoking. Studies have shown that lung cancer patients who continue smoking while undergoing treatment have more severe side effects, lower rates of response to therapy, lower 5-year survival rates, and a higher risk of lung cancer recurrence than patients who quit.

Aids to help you quit

Quitting smoking is important but isn’t easy. Nicotine, the substance in cigarettes that keeps you physically addicted, is extremely powerful. And the habit of smoking is deeply ingrained in daily life. Overcoming a smoking addiction takes determination, but you don’t have to rely on willpower alone. Here are some of the aids available to help you quit.

Nicotine replacement therapies

Nicotine replacement therapies slowly wean you from your nicotine addiction by providing controlled doses of nicotine, which you can lower over time. As your body adjusts to lower and lower doses of nicotine, your cravings for cigarettes and your symptoms of withdrawal will decrease. Studies have shown that nicotine replacement therapy can double your chances of successfully quitting smoking. These therapies are considered relatively safe because they don’t contain the cancer-causing chemicals and harmful compounds found in tobacco.

Common nicotine replacement therapies such as patches, gum, and lozenges are available without a prescription and can be purchased at pharmacies and grocery stores. The nicotine patch is frequently the best option for heavy smokers because it delivers a steady stream of low-dose nicotine. The gum and lozenges keep your mouth busy without a cigarette and are especially helpful for people who habitually smoke at certain times, such as after dinner or with their morning coffee.

Electronic cigarettes (e-cigarettes) resemble cigarettes but do not contain tobacco. The doses of nicotine and other additives vary among e-cigarette brands. The safety of e-cigarettes has not been established, and e-cigarettes are not approved as a nicotine replacement therapy by the U.S. Food and Drug Administration.

Some nicotine replacement therapies are available by prescription. The nicotine nasal spray is like a nasal spray you might use for a stuffy nose or allergies. It delivers a fast-acting single dose of nicotine and can be used the moment a craving hits. The nicotine inhaler works like an asthma inhaler—you put it in your mouth and breathe deeply. Like the nasal spray, it delivers a fast-acting, measured dose of nicotine at the moment you need it most.

When considering your options for nicotine replacement therapy, keep in mind that—like cigarettes—these agents contain nicotine, which can cause side effects in some people. Talk to your doctor before using any nicotine replacement therapy.

Non-nicotine medications

Your doctor may prescribe a non-nicotine medication to be used instead of or along with nicotine replacement therapy. These medications reduce nicotine cravings and withdrawal symptoms, and studies have shown that smokers who use non-nicotine drugs are more likely to quit than those who don’t take the medications.

Bupropion (Zyban) and varenicline (Chantix) are the most commonly prescribed non-nicotine drugs. Some people taking these drugs have side effects, such as nausea, sleeplessness, or mood swings. Your doctor or pharmacist will provide details on possible side effects, and your doctor will monitor you closely if you are taking one of these drugs.

Nicotine replacement therapies and non-nicotine medications work best when used in conjunction with a behavioral counseling program. These medications can help reduce your urge to smoke, but quitting is still up to you. You must commit to changing the habits that trigger your smoking. While making a lifestyle change isn’t easy, this is one change that could save your life.

— S. Moreau

For information about smoking cessation programs, ask your physician, call 713-792-QUIT, or visit www.mdanderson.org/quitnow.

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