An NCI-designated Comprehensive Cancer Center
By Wayne Lewis | November 21, 2019
Brian Tiep Bio Brian Tiep, M.D.
November 21 is the Great American Smokeout.
It’s a cruel irony, but smokers can find it particularly difficult to give up cigarettes when they’re in cancer treatment.
“A lot of people say, ‘Look, I don’t want to quit smoking right now. I’ve got all this stress from having cancer,’” said Brian Tiep, M.D., director of pulmonary rehabilitation and smoking cessation at City of Hope. “However, smoking cessation should be considered an integral part of cancer care.”
That’s more than one physician’s opinion. It’s a guideline set forth by the National Comprehensive Cancer Network, and for good reason — studies show that using cigarettes can sabotage cancer treatment . Fortunately, City of Hope’s Smoking Cessation Program is here to help attain the hard-won achievement of kicking the habit.

The Findings Are Sobering

The research on smoking and cancer care has produced consistent results: It’s always better to quit. Tiep summarized the case against tobacco use:
  • Smoking affects circulation, slowing down healing after surgery, and increases the risk of postoperative lung complications.
  • Smoking renders the effects of chemotherapy less potent.
  • Former smokers have a lower rate of recurrence after radiation treatment than current smokers.
  • With immunotherapy, former smokers have better results than current smokers.
  • Continued smoking makes it more likely that cancer will recur, as well as promotes the development of new cancers.
  • Numerous studies show that smoking with cancer negatively affects survivorship.
Summing up, Tiep encourages patients to think of quitting cigarettes as a way of augmenting their cancer care.
“What if I told you that we have a therapeutic option that would improve the effectiveness of your treatment, prevent recurrence of the same cancer, prevent new cancers from emerging and improve your chances of long-term survival?” he said. “It’s worthwhile to dedicate a part of your life to quitting smoking.”

Quitting Isn’t Easy

Kicking the habit takes a lot of motivation — and, typically, multiple attempts. The addiction to nicotine is particularly strong, and fortified further by additives that tobacco companies include in their products.
Some people report that smoking is harder to quit than heroin. One culprit: the pleasure principle.
“When you’re addicted, nicotine binds to the nicotine receptors in the midbrain and releases dopamine, which is the feel-good chemical,” Tiep said. “In fact, dopamine is released as soon as you think about and start grabbing for a cigarette.”
What’s more, lighting up and inhaling pushes nicotine into the body extremely quickly.
“Smokers get immediate gratification,” Tiep said. “Smoke goes to the lungs, the heart, the blood vessels and the brain within seven to 10 seconds. That’s the fastest drug-delivery system we know of.”

E-Cigarettes Aren’t the Answer

With the cards stacked against the reluctant smoker, some reach for e-cigarettes as a way of making progress toward abstinence. However, right now the results of research evaluating vaping as a route to quitting cigarettes are mixed at best.
Tiep warns that using e-cigarettes introduces new risks.
  • Although there is new evidence suggesting that the recent outbreak of vaping-associated lung illness is related to vitamin E acetate — a component in some vaping cartridges, particularly black market ones — the risk factors still are not well understood.
  • There is no consistent quality control across the e-cigarette industry.
  • When heated, some typical cartridge ingredients change into toxic compounds, including formaldehyde.
  • Cartridges can contain high levels of nicotine — up to the same amount as a whole pack of cigarettes.
  • A recent study shows that many who take up vaping to quit smoking instead become users of both cigarettes and e-cigarettes.

Help Is Out There

City of Hope’s Smoking Cessation Program assists those who want to give up smoking but feel as though they can’t do it on their own. The program has a comprehensive approach, embracing multiple strategies for quitting to maximize patients’ chances for success.
Tiep and his colleagues often prescribe nicotine-replacement therapies such as “the patch” or Chantix; for some patients, that treatment is augmented by Zyban, which can cut down on cravings and symptoms of withdrawal.
The program also provides a personal brand of assistance, with one-on-one counseling and support groups. And the support doesn’t end when a session lets out.
“We’re passionate about helping people quit,” Tiep said. “When a person is off of cigarettes and has a lapse, they give us a call and we talk them through it. They know we’re there for them. It’s hard to quantify, but that makes a difference.”
Additionally, the Smoking Cessation Program’s staff teaches straightforward behavioral tips for fighting the urge. For instance, some people find it helpful to substitute cinnamon sticks, celery or carrots for cigarettes.
Tiep emphasizes that, as hard as it can be to quit, it’s worth the effort. And he adds one more very simple reason: Quitting makes you feel better, physically and emotionally.
“If you’re not smoking, there’s a feeling of conquest,” he said. “It’s not very scientific, but it’s very real.”
If you’re a patient looking for help to give up cigarettes, please contact the Smoking Cessation Program at 626-535-3983 or [email protected]

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