DundeeChest 3.0

When patients come to clinic and tell me that they gave up smoking 4 weeks ago, my doom-ometer starts swinging wildly. When patients stop smoking “Out of the blue”, we know there’s a high chance that they have lung cancer. Whether patients consciously decide to stop, because they know they have something seriously wrong, or there’s an unconscious push to stop, it’s a recurring theme. But is stopping smoking at the point of lung cancer diagnosis worth it?

One of my more cynical colleagues says “Why stop now? The outlook is terrible, it’s their only pleasure in life, the damage is done”. Our oncological colleagues are adamant that chemotherapy is more effective if the patient stops smoking, and “reduces the risk of second primary”.

So what should we be telling our patients? What this needs is a bit of evidence base, I suspect.

This week’s BMJ has an editorial, and a meta-analysis on smoking cessation in early lung cancer. They conclude that it’s never too late to stop, even in early lung cancer.

The difficulty putting this data into clinical practice in Dundee, though, is that we don’t see very much limited stage lung cancer. Well over 80 % of our presenting lung cancer is Stage IIIb or above (In the old system – it’ll be a higher with the new system, I’m sure). What do we tell someone with stage IV NSCLC, with a life expectancy of 2 months?

I think the message here, kids, is: don’t smoke in the first place.