Why do cancer patients continue smoking, even after they are treated?
People often hear stories of the little old lady on oxygen tanks discovered smoking after the house fire has subsided. Walk into Dr. Ralph Madeb’s clinic at Newark-Wayne Hospital on any day and the smell of cigarette smoke permeates the waiting room. It’s not that the clinic allows smoking on their campus, it is the smell permeating the patient’s clothes.
Dr. Madeb, Chief of Surgery at Newark-Wayne Hospital specializes in cancer patients at his Finger Lakes Urology Institute. Patients suffering with bladder, and kidney cancers are well aware of Dr. Madeb’s reputation in the field. He treats scores of cancer patients, most of whom are over the age of 60. One of the remarkable statistics Dr. Madeb has run into, is that almost 75% of urinary cancer patients who smoke, continue to do so after their cancer is in submission.
Urinary cancers don’t get the publicity, or spokesperson acknowledgement of lung, or prostate cancers. One of the first questions Dr. Madeb asks of new patients? “Do you smoke?” Cigarette smoking increases the risk of developing bladder cancer nearly fivefold. As many as 50% of all bladder cancers in men and 30% in women may be caused by cigarette smoke.
About one in four cases of bladder cancer is caused by exposure to cancer-causing chemicals (carcinogens) on the job. Dye workers, rubber workers, aluminum workers, leather workers, truck drivers, and pesticide applicators are at the highest risk. Another risk factor is heredity. Over 14,000 people in the US will die of bladder cancer this year.
So, why would anyone with a history of smoking continue to do so after diagnosis and treatment? “Smoking is by far the worst addiction to overcome,” said Dr. Madeb. A smoking addiction means a person has formed an uncontrollable dependence on cigarettes to the point where stopping smoking would cause severe emotional, mental, or physical reactions.
Smoking damages the circulatory system. Smokers have twice the rate of erectile dysfunction of non-smokers. The more you smoke, the higher the risk of becoming impotent. Chances are that about one in three smokers who do not stop will eventually die because of their smoking. Some will die in their 40s, others will die later. On average, they will die 10 to 15 years earlier than they would have died from other causes.
The treatment for bladder cancer is extensive and at best very uncomfortable. (the hospital lingo for painful). At its worst, the cancer patient can die, have the bladder removed and be put on a colostomy bag for the rest of his/her life. On the upper end, patients must undergo a series of tests. In men, that includes the insertion of a camera and surgical removal tubes up through the penis. This is followed up by a series of vaccine bladder insertions after the surgical healing. The procedure is repeated every two weeks, up to six times, before another search of the bladder is conducted to see if any other tumors have developed. If more tumors have developed, the whole process is completed again, unit the tumor growths are put in check.
A non-smoker still has a 40% chance of developing bladder cancer again during their life. That number jumps to 65% for those who continue smoking.
Dr. Madeb was frustrated that many of the same smoking patients were returning. Since they are the older sector of the population, most use Medicare for costs involved in procedures. This has put a burden on local, state and state Medicare costs.
HMOs (medical insurance plans) traditionally have not taken a hard stand on prevention of such things as bladder cancers. Most do not reimburse a family doctor or specialist to spend any significant time with patients beyond the ‘smoking is bad for you speech’.
Dr. Madeb decided to put significant resources behind a unique Smoking Cessation” clinic. His staff have all been trained to become smoking counselors to patients. Instead of the brief “don’t smoke” talk, the counselors will spend up to 45 minutes or more per session helping both out-patients and hospital-bound patients on the smoking cessation benefits. This will include the usual medications, patches, hypnosis, or other techniques employed in the field. A phone line is being established, along with a website and specialized classes.
In the long run, Dr. Madeb hopes not only to bring down the cancer wheel of repetition, but Medicare costs as well. The clinic will be available to pediatricians to encourage young mothers using Newark-Wayne, along with the myriad cancer patients treated at the hospital.
“This will be the first such clinic around. This will put Wayne County on the map,” said Dr. Madeb. “We have to make cessation support as accessible as buying cigarettes for those patients who want to quit.” Recent surveys showed 62% of tobacco users want to quit in the next 6 months. Cessation support must have a range of intensity. One “size” of tobacco cessation will not cover all patients who wish to quit
Part of the program will involve regular urine tests to determine the gravity of smoking in the individuals. A pharmaceutical company has agreed to supply the clinic the required tests at cost, but Dr. Madeb said he needs more help from the outside.
Wayne County receives about $1.1 million per year in a 20 year settlement with tobacco companies. About $1 million is put back into the County’s general fund. It was explained that this helps offset the County’s staggering and growing Medicare costs. About $75,600 is given to the Wayne County Health Department. They hired an individual who places non-smoking ads and billboards in the County. Part of the funds given to the Health Department are used for rent and utilities within their own building.
Dr. Madeb will be making a presentation to the Board of Supervisors on Tuesday night beginning at 7 p.m. He hopes that the County will see the benefit of such a program and how the tobacco money could be used to make a positive push against not only rising Medicare costs, but the heavy smoking population in Wayne County.
The following sentence was inadvertently left out of the story above.
In the paragraph that reads:
Wayne County receives about $1.1 million per year in a 20 year
settlement with tobacco companies. About $1 million is put back into the
County’s general fund. It was explained that this helps offset the
County’s staggering and growing Medicare costs. About $75,600 is given
to the Wayne County Health Department. They hired an individual who
places non-smoking ads and billboards in the County. Part of the funds
given to the Health Department are used for rent and utilities within
their own building.
The next sentence should have read: The person hired by the Health
Department is also responsible for conducting/providing smoking
cessation presentations and education.