Nicotine Dependence
Current Treatments and Future Directions
Summary of Key Points
Prevalence of Tobacco Use and Nicotine Dependence in Patients with Cancer
• Approximately one in five American adults is a current smoker.
• Smoking accounts for one third of all cancer deaths.
• Patients with cancer in general have a higher dependence on nicotine and are more likely to be smokers or ex-smokers.
• Approximately 15.1% of adult cancer survivors are current smokers.
Current Treatment Recommendations
• Nonpharmacologic treatments include behavioral counseling (e.g., identifying triggers and managing withdrawal), quitlines, and self-help material (e.g., booklets and videos).
• Nonpharmacologic approaches are popular but yield relatively low quit rates.
• Pharmacologic treatments approved by the U.S. Food and Drug Administration, including nicotine replacement therapies (e.g., transdermal patch, gum, nasal spray, inhaler, and lozenge) and bupropion, have been shown to double smoking cessation rates compared with placebo. Varenicline is the newest agent, with efficacy superior to that of nicotine replacement therapies and bupropion.
Smoking among Cancer Patients
• About half of patients with cancer continue to smoke after diagnosis, even though tobacco use complicates cancer treatment, reduces survivorship rates, increases the risk for a second primary tumor, and diminishes quality of life.
