Treating and Preventing Lung Cancer

This issue's Guidelines focus on small cell and non-small cell lung cancer and bring up an important issue, both for physicians and patients: compliance and barriers to it. Among the major barriers to physician compliance with the recommendations made in a clinical practice guideline are 1) how much the recommendations upset normal practice routines and 2) whether they require new clinical skills.1 Both the non-small cell and small cell lung cancer guidelines in this issue call for counseling patients with these tumors about the need to stop smoking. Counterintuitively, some lung cancer patients will continue to smoke even after treatment for tobacco-related tumors.2 The pernicious effects of persistent use of this noxious substance, both in decreasing the efficacy of therapy3 and promoting second primary tumors,4 is well documented. The guidelines impel oncologists to include smoking cessation as part of routine management of these diseases. Physicians are often well aware of their power to promote healthy change, especially in the “moment of opportunity” afforded by a dread diagnosis. But do we make the most of the opportunity? Unfortunately, in the crush of explaining complex therapies, not to mention administering them, this effort may be somewhat perfunctory and therefore not optimized. Importantly, a recent study has shown that a brief intervention by an oncologist is effective in increasing smoking abstinence rates at 12 months for patients with lung and head and neck cancers.5 The task is not trivial. Extra time must be allotted (routine is upset) and new, structured interventions must be...

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Rodger J. Winn is the Editor-in-Chief of JNCCN, as well as chair of the NCCN's Guidelines Steering and Principal Investigators Committees. His past positions include Associate Professor of Clinical Medicine at the University of Texas M. D. Anderson Cancer Center. Dr. Winn received his medical degree from Jefferson Medical College of Philadelphia. His postgraduate training includes an internship and residency at Jefferson Medical College, and he also completed a medical oncology fellowship at Memorial Sloan-Kettering Cancer Center in New York. He is board certified in internal medicine and holds subspecialty certification in oncology.
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    Sanderson CoxLSloanJAPattenCA. Smoking behavior of 226 patients with diagnosis of stage IIIA/StageB non-small lung cancer. Psychooncology2002;11:472-478.

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    VideticGMMStittSWDarR. Continued cigarette smoking by patients receiving concurrent chemoradiotherapy for limited-stage small cell lung cancer is associated with decreased survival. J Clin Oncol2003;21:1544-1549.

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    TuckerMAMurrayNShawEG. Second primary cancers related to smoking and treatment of small-cell lung cancer. J Natl Cancer Inst1997;89:1782-1788.

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    SchnollRAZhangBRueM. Brief physician-initiated quit-smoking strategies for clinical settings: A trial coordinated by the Eastern Cooperative Oncology group. J Clin Oncol2003:21:355-365.

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    CarterCLKeyJMarshL. Contemporary perspectives in tobacco cessation: What oncologists need to know. The Oncologist2001;6:496-505.

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    www.ahcpr.gov/clinic/tobacco/5steps.pdf last accessed December 23 2003.

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