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I'll die whether I smoke or not - (9/4/2018)

By Dr. Ron Gasbarro 

The two pharmacists were on overlapping shifts that day. Joe said to Tom, “Did you read that new study which showed that even if you stop smoking today, your risk of getting lung cancer is still high for decades after you’ve quit?” Tom, a long-time heavy smoker, said that he read the study. “Makes me wonder if I should bother to quit. Sounds like I’m going to get cancer anyway,” Tom said with a cough. 

The 2018 study, published in the Journal of the National Cancer Institute, revealed that smokers who quit have a substantially lower risk for lung cancer than current smokers do, even within 5 years of stopping smoking. However, the same research shows that the risk for lung cancer among long-term former smokers remained "persistently elevated," even 25 years after quitting. For example, among those who had stopped smoking for less than 5 years, the risk for lung cancer was more than 12 times higher than it was for never smokers. For the same long-term former smokers who quit smoking 5 to 9 years ago, the risk for lung cancer was still almost 12 times as high as it was for never smokers, whereas for those who had not smoked for 10 to 14 years, the risk for lung cancer was still almost 8 times higher than for never smokers. For former heavy smokers who had stopped smoking 15 to 24 years ago, lung cancer risk was approximately 6 times higher than it was for those who never smoked, whereas for those who quit 25 years ago or more, the risk was more than 3-fold higher. Importantly, 4 of every 10 lung cancers diagnosed in former smokers in the current study occurred in individuals who had stopped smoking more than 15 years ago. Hence the reason for Tom’s remark. “I would have to go through withdrawal which I have done a dozen times – never pleasant.”

What was unpleasant was when Joe worked in a hospital and had patients who were dying of late-stage lung cancer. Many of the patients that he treated struggled to breathe as they neared their death. They were given oxygen, morphine, and sedatives. There is not much else to do except give more medications. The patient generally had two options: Either be more alert but struggle to breathe and endure the pain, or be sedated and asleep with easier breathing and less pain. And some patients chose the latter. Near the end, the breathing would get very wet with secretions, making it difficult to understand them when they speak. They would get scopolamine patches behind the ear (the ones used for motion sickness) and/or atropine eye drops given in the mouth to dry them up. It was really to help the family deal with the sound, not the patient. It was terrible to watch a loved one struggle to breathe.

Even before lung cancer is diagnosed, emphysema can occur making one less mobile, less independent. Smoking causes heart problems that can begin before a tumor is detected, meaning more drugs. Once the patient starts chemotherapy, there may be interactions between the chemo and the heart medications. Essentially, Tom would have to choose whether to protect his heart or kill the tumor.  

As a healthcare professional, Tom should know better than to have the attitude that it is his life to lose. His wife and children would be heartbroken if lung cancer was his fate. And so would Joe. As a pharmacist, he knows there are smoking cessation medications that can make kicking the habit more bearable. Joe finally had it out with Tom. “I am tired of you coming in and smelling like an ashtray,” Joe said. Tom agreed that he was being selfish and he would seek help from his doctor that very week. Quitting would be tough but Tom was ready to toss his dirty, disgusting habit. 

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.com. Read more at www.rx-press.com

 


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