Dead keen for a smoke: puffing on with lung and colorectal cancer

Addiction and cognitive dissonance: many smokers keep puffing even after a diagnosis of lung cancer. Flickr/drinksmachine.

About one in seven people diagnosed with lung cancer report that they keep smoking, as do one in 11 colorectal cancer patients, despite smoking reducing the effectiveness of their treatment and significantly increasing the chances that the cancer will kill them.

These are among the findings reported in ‘A Snapshot of Smokers After Lung and Colorectal Cancer Diagnosis’, published today in the journal Cancer.

The researchers led by Dr Else Park of the Harvard Medical School studied smoking rates at diagnosis and five months later in 5338 US lung and colorectal cancer patients, and tried to determine which smokers were most likely to quit. They found that at diagnosis, 39 percent of lung cancer patients and 14 per cent of colorectal cancer patients were smoking; five months later, 14 per cent of lung cancer patients and 9 per cent of colorectal cancer patients were still smoking.

Professor Michael Farrell, the Director of National Drug and Alcohol Research Centre at the University of New South Wales, said that “cognitive dissonance” and the unforgiving power of cigarette addiction were at play, given that it was no secret that half of all smokers will die of a smoking-related disease and, compared to the average, smokers lose 16 years of life.

Asked if smokers had a death wish, Professor Farrell said that they were “more likely to think that they’re not going to incur the negative consequences of their behaviour. That’s where cognitive dissonance comes in; you say, ‘It’ll happen to other people but it won’t happen to me.’”

“They don’t wish to see the connection between the two and they feel they’re too far down the road. But the gains from smoking are there at any time. Within a short time of stopping you benefit, and you get some life extension, although obviously the earlier you stop the better,” he said.

“There’s a slightly more complicated thing when there’s been a diagnosis and they may feel that they’re at the stage where it’s too late to stop, and they don’t then accept the logic”, but the plain fact was that cigarettes are “quite an addictive drug” that make addicts of many people who give them a go, Professor Farrell said.

Regardless of what reasoning different people may indulge in about their habit, almost all smokers find it hard to stop: “We know that if you have a group of people and they stop smoking, even with assistance over 90 per cent of them will return to smoking within 12 months,” Professor Farrell said.

The tobacco industry was finding lucrative numbers of new addicts in developing economies, while in Australia the smoking rate has been driven down to about 16 per cent of the population, Professor Farrell said. This has not happened because of personal epiphanies, but rather “through a complex range of social policy and environmental [factors].”

How low the rate will go depends on when we hit the core of “hardened smokers”, who smoke significantly more than average and are also more likely to be living in poverty and fractured circumstances such as on the streets or in prison,“ Professor Farrell said. This group found it even more difficult to part with their smokes than the the rest of the puffers.

The Harvard-led team found that factors and characteristics that predicted continued smoking after cancer diagnoses differed by cancer type. Lung cancer patients who continued smoking tended to have Medicare or other public health insurance, have a lower body mass index, have low emotional support, not have received chemotherapy, not have had surgery, have had prior heart disease, and have smoked a high number of cigarettes per day at some point during their lives. Colorectal cancer patients who continued to smoke tended to be male, have completed less education, be uninsured, not have had surgery, and have once smoked a high number of cigarettes per day.

However, the authors admit that due to the patients self-reporting their smoking habits, the figures cited "are probably an underestimate”.