In an international collaboration with a Hollings researcher known for his expertise in smoking cessation, the Canadian Partnership Against Cancer (CPAC) reports that it has increased the number of smoking cessation services offered in cancer care facilities in Canada since 2015. has increased from 26% to 87% .
“The progress made across Canada over the past five years is astounding and represents world-class leadership in reducing tobacco use after a cancer diagnosis,” said Graham Warren, MD, Ph.D., MUSC Hollings Cancer researcher. Center and Vice Chair for Research in Radiation Oncology at the MUSC College of Medicine.
In addition to his positions at Hollings, Warren serves as an expert advisor to CPAC, where he plays an influential role in the ongoing project aimed at providing smoking cessation programs to patients in every cancer care setting across Canada.
CPAC wanted to implement a nationwide smoking cessation program aimed at providing critical smoking cessation assistance to some of the patients most at risk: cancer patients.
“If my story can stop a teen or adult from ever picking up a cigarette, I’ve enriched their lives. I think that’s my goal and why I’m still alive all these years later. Cigarettes have destroyed me, but they don’t have to destroy others.”
— Archie Stewart
“We know there is a 50% to 60% increased risk of cancer recurrence if you smoke,” Warren said. “It increases a patient’s risk of developing another cancer later on and continues to increase the risk of heart disease, stroke and other smoking-related diseases even after a cancer diagnosis. It reduces the effectiveness of chemotherapy, radiation and surgery and increases the toxicity of cancer treatments.”
Warren said the effects of smoking on cancer patients cannot be ignored. Smoking affects 320,000 to 400,000 cancer patients in the US every year. That number is around 40,000 in Canada. “If we get people to quit smoking, we’re not only making our cancer treatment better, but also the treatment of most other health problems.”
Warren said smoking affects 320,000 to 400,000 cancer patients in the US each year. Photo by Sarah Pack
The program has been hailed as a game changer by former smokers such as Archie Stewart, 71, who serves as a patient advisor at CPAC. Stewart was diagnosed with terminal cancer and chronic obstructive pulmonary disease (COPD) after more than 40 years of smoking. He is now on a mission to prevent others from going the same way as he did.
“Now when I talk to smokers, I try to tell them what effects smoking can have on the effectiveness of their treatment. You quickly learn that most patients have a lot to live for,” he said. “A lot of doctors don’t smoke, so they can’t fully understand the problems with smoking. A lot of doctors can’t connect with that smoker to tell them to stop smoking. However, I get it, so I can help medical professionals deal with that patient.” to go and make a bigger impact. That’s what I’ve done as a CPAC patient counselor.”
Stewart educates current smokers about the dangers of the addiction. Stewart is no stranger to dangerous experiences. Serving on the front lines in Vietnam, he was shot twice and stabbed multiple times while doing security work for the US government. But in the end he thinks it won’t be a bullet or a knife that will end his life.
“I don’t know why I’m still alive,” he said. “When the cancer returned in 2009, I was told I had two to five years to live. Twelve years later, and I’m still here.”
Living on borrowed time and giving back
Stewart lives with his wife on Cape Breton Island, a small community near Nova Scotia, Canada, and spends as much time as possible with his four children and a grandson.
He said he is grateful for the work of medical experts such as Warren in educating smokers before a medical condition becomes terminal. When he started smoking at age 12, Stewart said there were no conversations about the harmful effects of nicotine. Smoking was part of Stewart’s daily life from 1962 to 2009, when he finally quit. At the height of smoking, he estimated that he was using between two or two and a half packs of cigarettes each day.
“Nicotine had such a hold on me. I likened it to a dragon sitting on my shoulder,” Stewart said. “It was a happy dragon as long as I smoked, but as soon as I stopped smoking, it started sticking its claws into my shoulders. The longer I didn’t smoke, the deeper the claws would go.”
“The progress made across Canada over the past five years is astounding and represents world-class leadership in reducing tobacco use after a cancer diagnosis.”
— Dr. Graham Warren
Despite having part of his lung removed after a lung cancer diagnosis in 1995, Stewart remained committed to his relationship with nicotine. He thinks back to the time and realizes that he refused to see the correlation of his smoking behavior with his medical diagnosis. “I had a wall up. I didn’t believe cigarettes caused cancer. If I had been offered help at the time, I would have listened, but probably not acted on it.”
It wasn’t until Christmas 2005 that Stewart came to realize that his smoking was affecting those he loved most. “My wife asked my stepson what he wanted for Christmas,” Stewart said. “He said to her, ‘I want Archie to stop smoking.’ That really stuck with me. It took me a few years to stop, but I think that was one of the factors that contributed to this.”
In 2008, Stewart saw a television ad promoting a drug that aided smoking cessation. He tried – it worked. In January 2009, the urge to smoke faded into darkness – he never picked up a cigarette again.
After first being diagnosed with cancer in 1995, Stewart went to his chest surgeon regularly for checkups — first weekly, then monthly, and finally yearly. His cancer remained under control until late 2009 when the lung cancer returned. In 2010, doctors told Stewart the cancer was terminal.
“It was tough. I wanted to make sure before I died that my wife wouldn’t have to work for the rest of her life and never have to worry about money to pay bills. I wanted the same for my sons and grandson,” he said.
Still work to do
Stewart hopes that experts like Warren can continue to expand smoking cessation efforts in Canada. As a certified radiation oncologist, Warren works with local, regional, national and international groups to increase smoking cessation support for cancer patients. Warren’s past achievements include:
Contributing to the 2014 and 2020 Surgeon General’s Report, which was the first to document the comprehensive effects of smoking on cancer treatment and the survival benefits of smoking cessation after a cancer diagnosis. Collaborate with Michael Cummings, Ph.D., Matt Carpenter, Ph.D., and several others to establish a smoking cessation program at Hollings and MUSC. Working with state and community cancer centers across Michigan to help cancer patients quit smoking. Collaborate with various cancer organizations to develop policies and guidelines for tackling tobacco use in cancer care. Serve as expert advisor to the National Cancer Institute’s Cancer Center Cessation Initiative, which provided funding to 52 NCI-designated cancer centers to provide smoking cessation services for cancer patients.
Warren said that while significant progress has been made in recent years, the initiative is not reaching enough patients. “Most patients receive cancer treatment outside of the cancer centers designated by the NCI. The Cancer Center Cessation Initiative is a great program here in the US, and our next steps should support these efforts and reach patients in the community.”
Warren said the goal is to have 100% of cancer care facilities in Canada offering smoking cessation programs to cancer patients within the next year.
“What has happened across Canada over the past five years has truly been transformed. They brought together a network of collaborators across provinces and territories to develop a vision to help every patient quit smoking to improve cancer treatment and the best quality of life. Expanding access to 87% of clinical settings really spreads this message and gives patients an excellent opportunity to get help with smoking cessation and ultimately improve their cancer treatment,” said Warren.
He said the focus will then shift from building programs to maintaining them over a long period of time. He hopes Canada’s smoking cessation program can serve as a model for other countries around the world.
For former smokers like Stewart, the smoking cessation program in his home country is a life-saving tool. He said he wants to impact as many lives as possible with the time he has left.
“If my story can stop a teen or adult from ever picking up a cigarette, I’ve enriched their lives,” Stewart said. “I think that’s my goal and why I’m still alive all these years later. Cigarettes have destroyed me, but they don’t have to destroy others.”