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Practice, patterns and perceptions

Conquest - Summer 2013

Continuing to tackle lung cancer prevention

By Sandi Stromberg and Katrina Burton

Ellen Gritz

Ellen Gritz, Ph.D., professor and chair,
Department of Behavioral Science
Photo: F. Carter Smith

Ellen R. Gritz, Ph.D., has spent her professional life crusading for smoking cessation. Her dedication, and that of the many researchers with whom she’s worked over the years, is paying off.

A recent study, on which she was co-author, presented results of an online survey of physicians, members of the International Association for the Study of Lung Cancer. The intent was to describe physicians’ practices, perceptions and barriers to providing tobacco assessment and cessation help to their patients.

More than 90% of the 1,500 members who responded believe that continuing to smoke during treatment affects outcomes. They also agree that cessation should be a standard part of clinical care. However, only 39% said they routinely provide it.

Barriers to having this conversation include a belief that patients would resist quitting and that physicians feel ill prepared to deliver the support patients need.

“The fact that several institutions - Roswell Park Cancer Institute, the Medical University of South Carolina, Yale University and    MD Anderson - worked together to assess physician practice is a positive step,” says Gritz, professor and chair of MD Anderson’s Department of Behavioral Science and a member of the Institute of Medicine.

“Hopefully, we can continue to make progress by bringing experts in diverse fields together to increase our ability to address adverse health behaviors, such as tobacco use in cancer patients.”

AACR issues policy guidelines on tobacco use

April 9, 2013, was a red-letter day for crusaders like Gritz. Policy guidelines presented at the annual meeting of the American Association for Cancer Research urged greater focus on assessing tobacco use and offering tobacco cessation services to cancer patients during clinical visits.

In the United States alone, nearly 30% of all cancer-related deaths and 87% of all lung cancer-related deaths are attributed to tobacco use.

“The policy statement is of great importance to all physicians and oncology providers. In particular, it highlights the importance of tobacco cessation, from the point of view of both the treating physicians and other health care providers, as well as the patient,” Gritz says.

Calls to action include:

  • documented assessment of tobacco use by cancer patients during clinic visits and in oncology clinical trials,
  • development of universal standards for the measurement of tobacco use,
  • offering tobacco-cessation assistance and support for tobacco users, and
  • collaborative support and funding for tobacco-cessation programs and tools.

“The general public must be aware of the increased risk and poorer survival outcomes to emphasize that it is never too late to stop smoking,” Gritz says. “The diagnosis and treatment of cancer provides a ‘teachable moment’ to stop smoking for family members and to reduce secondhand smoke exposure in the household.”

New finding shows higher risk for male smokers

Yet another study has found that male smokers with low levels of bilirubin — a yellow-tinged chemical in the blood — are at higher risk for developing lung cancer and dying from the disease.

After an analysis of global metabolite levels and further analysis of the top three metabolites among healthy controls compared to early-stage and late-stage non-small cell lung cancer patients, bilirubin emerged as the most significant. This led to another validation study with a Taiwanese cohort of more than 435,985 people, including 208,233 men.

“Our study indicates male smokers with low levels of bilirubin are a high-risk group that can be targeted with smoking cessation help, low-dose spiral CT lung screening and other preventive measures,” says Xifeng Wu, M.D., Ph.D., professor and chair of MD Anderson’s Department of Epidemiology and senior author on the paper presented at the American Association of Cancer Research annual meeting in April.

Efforts toward tobacco cessation and understanding lung cancer continue to be a strong focus at MD Anderson with outreach to the larger community and most recently to Mexico and Columbia. 

See MD Anderson’s online Newsroom and Cancer Frontline for more information on these and other basic, translational and clinical research findings at
MD Anderson.

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