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ESMO E-Learning: Smoking Cessation in the Oncology Population

E-learning video block

This content is for ESMO members only.



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Learning objectives

  • To provide an update on the impact of tobacco smoking on various cancer related issues, including cancer development, disease severity, treatment complications and treatment failure rate
  • To provide an update on smoking related changes in the clinical pharmacology of antineoplastic drugs and subsequent clinical implications
  • To understand basics in different smoking cessation interventions and associated challenges in cancer patients


Tobacco smoking is a well-established risk factor for the development of many malignancies and increases the risk of oncology treatment failure rates and second primary tumours. In theory, tobacco cessation strategies should be an integral part of oncology treatment plans. Collaboration within the health care team is paramount in implementing a smoking cessation intervention. However, tobacco cessation remains a challenging issue in the oncology population.

This E-learning module provides an excellent teaching on smoking and development of malignancies in different organ sites. It advocates that smoking cessation and cancer prevention methods are essential measures. Tobacco has procarcinogens and carcinogens which can further accelerate and facilitate the proinflammatory state, promoting tumour growth.

The module represents an overview of the effect of tobacco on the pharmacokinetics of anti-cancer drugs. It provides examples of acceleration of CYP450 enzymes and glucoronysltransferases, induced by tobacco smoking. Smoking related changes in the clinical pharmacology of antineoplastic drugs may have meaningful clinical implications in oncology and the examples are provided for different diseases and different treatments.

The authors further discuss cessation challenges. Despite adverse health effects, the data show that patients with head and neck cancer and lung cancer, who smoked prior to diagnosis, continue to do so after diagnosis. In addition comorbid conditions such as depression, disease-related anxiety, and alcohol abuse often make cessation challenging. The authors further describe relations of smoking cessation in the health care setting, which is an ideal place for health care professionals to initiate cessation interventions and review lifestyle habits with smokers who are newly diagnosed with a malignancy. However, they emphasise that the ideal health care setting for smoking cessation may be hospital-, community- and individual-based.

According to the systematic review of data published in 2013, the ideal smoking cessation is one initiated in the preoperative period prior to major oncological surgery and continued in the postoperative period (with regular follow-up).

Furthermore, the authors describe in their module advantages and disadvantages of different pharmacological and non-pharmacological smoking cessation interventions, as well as methods to verify smoking cessation. They conclude that future research is needed to continue to explore and investigate novel and known methods of smoking cessation to better translate the perceived benefits of tobacco cessation in the oncology population. Regular follow-up is a critical component of cessation intervention.

Declaration of interest

The authors have reported no conflicts of interest.

Last update: 17 Sep 2014

This E-Learning module was published in 2014. The CME test expired in 2017.

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