Continued tobacco use has been documented in patients with cancer. In some studies, between 40% and 60% of lung cancer patients continued smoking after their diagnosis and, as seen in other studies with lung cancer patients who quit smoking, relapses are frequent. The continued consumption of tobacco in patients with cancer can lower their possibilities for survival, increase the risk for the appearance of a second primary tumor, and compromise the effectiveness of the medical treatment as well as causing a loss in quality of life.1–3 Consequently, the importance of integrated smoking cessation therapy in the oncologic context is growing in strength.

Unfortunately, there are very few studies in the literature that research anti-smoking therapy in lung cancer patients, while, in the majority that do, there is an insufficient number of participants and a lack of physiological validation of the verbal manifestation of abstinence (CO [carbon monoxide] measurement in exhaled air). Although there is more and more evidence that smoking cessation after the diagnosis of lung cancer is linked with greater treatment efficacy and a better prognosis of the disease, there is an erroneous prevailing belief that nicotine-dependence treatment is not useful in this group of patients.4

Lung cancer survival rates are improving each year, and the current expectations for 5-year survival of non-small-cell lung cancer is 60%–75% for stage I and 36%–60% for stage II. The new anti-carcinogenic agents have the capability to increase survival in patients with lung cancer.5

In the past, the treatment of tobacco habit was not considered an important factor in cancer patients, despite the new anti-cancer treatments that achieved greater survival. Today, there is a notable need for clarifying the role that smoking cessation plays in the follow-up of lung cancer patients.

It has been verified that smoking cessation in this type of patients has very significant positive effects, such as the reduced risk for disease, increased survival times, reduced surgical and post-operative complications, less complications from radiotherapy, a greater tolerance and resistance to exercise, and a significantly improved quality of life, increasing the levels of activity and mobility.4 Having quit smoking also lowers the risk for the appearance of a second primary tumor or a recurrence of the disease (metastasis).

Nicotine itself is not cancerous, but it has been confirmed in vivo that nicotine can propel the proliferation of carcinogenic cell lines, promote angiogenesis, and strengthen the resistance to apoptosis (cell death) induced by chemotherapy. Another subject that is worthy of mention is that the persistence in smoking during chemotherapy and radiotherapy causes more complications in smokers than in non-smokers. Tobacco can diminish the response to chemotherapy and affect pharmacokinetics and the toxicity profile of some drugs.6

Given the prevalence of lung cancer patients who keep on smoking and the notorious benefits of quitting, it would be necessary to develop and offer complete support and integral smoking treatment aimed at the specific needs of this group of patients. The intensive and long-term programs that entail advice, behavioral therapy, pharmacological therapy, and an extensive follow-up are highly effective, cost-efficient, and a decisive component of quality of lung cancer patient treatment and care.