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Re: Nicotine May Spur Breast Cancer's Spread
Ongoing smoking may significantly affect the outcome of subsequent surgery or therapy and negatively impact long-term survival, according to Dr. Carolyn Dresler, in an article "Smoking, The Missing Drug Interaction in Clinical Trials: Ignoring the Obvious."
No pharmaceutical trial ever followed whether patients smoked during their clinical trials, despite dosing themselves daily with cigarettes with hundreds chemicals in them. Dr. Dresler stated that "the addition of nicotine inhibits the ability of a chemo drug (like etoposide) to induce apoptosis by 61%."
If a drug like nicotine, which occurs in the highest concentration of any drug in a cigarette, inhibits the ability of a major chemotherapy drug by 61%, a medical oncologist should care if it was being ingested during treatment.
Dr. Dresler and her colleagues concluded that we can no longer ignore the obvious: smoking is a critical variable that affects cancer treatment and outcome and has been shown to vitiate or interact with the effects of some therapeutic agents and chemopreventive agents.
Measurement of smoking history and status in clinical trials of cancer therapy will increase our knowledge of the adverse effects of the constituents of tobacco smoke, including nicotine, and of drug interactions.
Oncology health professionals have called for increased advocacy for tobacco control. Furthermore, the routine inclusion of smoking status and cessation need to become a standard of care for all patients. The inclusion of smoking data in oncology clinical trials will also provide clinicians with improved means of delivering individualized advice to patients with cancer that may be critical in motivating their cessation efforts and sustained abstinence.
With the new Medicare Modernization Act (MMA), medical oncologists are reimbursed for providing evaluation and management services, making referrels, and offer any other support needed to reduce patient morbidity and extend patient survival. I certainly hope this would include smoking cessation guidance and support.
Literature Citation: Cancer Epidemiol Biomarkers Prev 2005;14(10):2287-93
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