The benefits of smoking cessation are well-known to those in the healthcare field and perhaps especially to those who work with patients with cancer. In my role as a social worker focusing on patients with lung cancer, my patients constantly remind me of the smoking/lung cancer link. Patients’ (mostly spontaneous) reports of their smoking history range from an ashamed “I’m still smoking” to “I quit as soon as I was diagnosed” to an astonished “I quit 15 years ago” to an angry “How could this happen to me, I never smoked?” (as if anyone deserves to get lung cancer, or that only people who have smoked will get lung cancer.)

Lung cancer is the most common cause of cancer-related deaths in the United States and the world. The Centers for Disease Control (CDC) report that in 2011, 207,339 people in the United States were diagnosed with lung cancer and 156,953 died from lung cancer (http://www.cdc.gov/cancer/lung/statistics/index.htm). 

The American Lung Association states that cancer kills more women than breast cancer and is responsible for more deaths than breast, colon, and pancreatic cancer combined (http://www.lung.org/lung-disease/lung-cancer/resources/facts-figures/lung-cancer-fact-sheet.html#1).

According to the CDC’s Prevention Smoking and Cancer Fact Sheet, nearly 9 out of 10 lung cancers are caused by smoking cigarettes and smoking can cause cancer almost anywhere…including the mouth, nose and throat, larynx, trachea, esophagus, stomach, pancreas, liver, kidneys and ureters, bladder, colon and rectum, cervix, bone marrow and blood (leukemia). Alarmingly, it also states that "women smokers with breast cancer and men with prostate cancer who smoke may be more likely to die from these diseases than nonsmokers."

Hospitals traditionally focus on disease management. However, with these distressing statistics in mind, I sought to enhance prevention and awareness of smoking-related cancers and other lung disorders by providing smoking-cessation services. There are no other evidence-based smoking cessation services for the general community in our county. In my role as a social worker dedicated to patients with lung cancer, I provide one-to-one counseling for smoking cessation. In collaboration with my colleague, a pulmonary nurse navigator from our Pulmonary Center of Excellence, we offer a 6-week smoking-cessation group called “It’s Not Quitting, It’s Living.” The group is open to the community and targets disease prevention and the needs of those with smoking-related medical issues.
    
“It’s Not Quitting, It’s Living!” utilizes the University of Medicine and Dentistry of New Jersey model for smoking cessation, which incorporates the Public Health Service Guidelines. The program is a collaboration across disciplines, departments and community philanthropy.

The first step my colleague and I took was to become Certified Tobacco Treatment Specialists (CTTS). We then wrote a grant to The Health Foundation that initially funded free nicotine replacement therapy (NRT) to all participants who desired this method and were appropriate for it. We enlisted a pulmonologist to review the tobacco assessments of all participants and attend one session in order to provide information and answer questions regarding lunch health for our participants. We also built a relationship with our pharmacy for easy purchase and delivery of NRT.
    
“It’s Not Quitting, It’s Living!” is broadly advertised and results in referrals from oncology, pulmonary, clinics, mental health, cardiology, dental and local health departments. As social worker, I complete a smoking assessment, either in person or by phone, with every participant prior to the first group to gather a smoking history and to gauge commitment to the quitting process. The group meets once a week for 6 weeks with a maximum of 15 participants.

In every session we measure the amount of carbon monoxide in the exhaled breath of each participant, utilizing the Smokerlyzer®. This provides a fun way to give the participants instant feedback on their abstinence from smoking and helps them maintain enthusiasm. In addition to the support group members receive from one another and the NRT we provide, there is a strong educational component emphasizing tools and techniques that can help participants work through the behavioral and emotional components of smoking. These are discussed and given in writing. After completion of the six week program, we help to maintain the group’s tobacco-free status by having monthly relapse-prevention sessions open to all past participants. Of course, not every participant is able to quit. But those who wish to can participate in the group again.

Patients with lung cancer often have a statistically poor prognostic outcome. It is exciting and rejuvenating to be able to provide a service that could potentially prevent lung cancer and also to share in the participants’ success and happiness in conquering their tobacco addiction.

Helpful websites:

• American Cancer Society Cigarette Smoking Fact Sheet
• Centers for Disease Control and Prevention. Lung Cancer Risk Factors