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| ORIGINAL ARTICLE |
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| Year : 2018 | Volume
: 15
| Issue : 1 | Page : 53-57 |
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Tobacco use and Smoking among patients undergoing treatment of Cancer”
Laxmi Kumari1, Sandhya Gupta2
1
2 College of Nursing, AIIMS, New Delhi, India
| Date of Web Publication | 10-Jul-2019 |
Correspondence Address:
 Source of Support: None, Conflict of Interest: None  | 1 |
DOI: 10.4103/2231-1505.262508
Introduction: It is estimated that 46-75% individuals has tobacco-smoking history at the time of diagnosis of cancer and 14% - 58% continue to smoke even after the initiation of their treatment. The current study is done in a tertiary care hospital to find out the continuation of tobacco use among patients post diagnosis of cancer. The objectives were to assess current tobacco use among cancer patients after diagnosis and after initiation of treatment, to assess awareness about the available tobacco cessation treatments and types of facilities for treatment and exposure to passive tobacco-smoking. Methods: The study was conducted in adult patients suffering from cancer, admitted in a tertiary care hospital for treatment. It was a quantitative approach cross-sectional survey design. Total enumeration sampling method was used for enrolling the patients. Tools: a questionnaire containing five items was used to assess the history of tobacco use, continuation of tobacco use after diagnosis, continuation of tobacco use after initiation of cancer treatment, awareness about the treatment services available for tobacco de-addiction and exposure to passive smoking. Written informed consent was taken from patients and their family care giver. Results: The mean age of 102 study patients was 46.18 years. Sixty percent of study patients were male and 40% were female. Fifty three percent of study patients were using tobacco in past it includes both smoke and smokeless tobacco, among the tobacco users (n=52), 81% of study patients stopped tobacco use after diagnosis of cancer. A total of fifty three percentage of study patients were currently using tobacco. Forty percent of Study patients did not have any knowledge about available medical treatment for tobacco cessation. Forty two percent of study patients reported that they were exposed daily to passive smoking. Conclusion: Despite enormous gains from tobacco cessation, very few persons give up tobacco use spontaneously, and that is also due to illness factor. Therefore it is the responsibility of the health professionals to guide the patients for enrolling into the tobacco cessation program at the earliest after the diagnosis of cancer.
Keywords: Tobacco Use, Cancer patients, Tobacco cessation, Relapse of tobacco use
How to cite this article:
Kumari L, Gupta S. Tobacco use and Smoking among patients undergoing treatment of Cancer”. Indian J Psy Nsg 2018;15:53-7 |
How to cite this URL:
Kumari L, Gupta S. Tobacco use and Smoking among patients undergoing treatment of Cancer”. Indian J Psy Nsg [serial online] 2018 [cited 2023 Jun 3];15:53-7. Available from: https://www.ijpn.in/text.asp?2018/15/1/53/262508 |
| Introduction: | |  |
Globally India has one of the highest tobacco users. In India, 47% of males and 14% of females use tobacco and there are about 194 million users of both smokeless and smoking forms (1). Smoking of cigarettes and beedis (tobacco wrapped in dried leaves of special trees) is one form of tobacco use i.e., smoking form whereas Smokeless tobacco use consists of chewing pan (mixture of lime, pieces of areca nut, tobacco and spices wrapped in betel leaf), chewing gutkha or pan masala (scented tobacco mixed with lime and areca nut, in powder form), and mishri (a kind of toothpaste used for rubbing on gums) (2). Tobacco use is associated with the growing risk of cancer. Smokeless tobacco is very addictive in nature and causes cancer of various body organs including the head and neck, oesophagus and pancreas, besides many other oral diseases (3). It is estimated that 46-75% individuals has smoking history at the time of diagnosis of cancer and 14% - 58% continue to smoke even after the initiation of their treatment (4). Continued smoking decreases the overall survival time of cancer patients and cancer survivors (5), smoking also increases the risk for a second primary cancer (6), it reduces the effect of chemotherapeutic agents as well as decreases the effect of radio therapy (7), (8) and diminish overall quality of life of patients by elevating the complications following treatment, increases hospitalization rates and pain. Patients with cancer who continued to smoke after diagnosis reported higher levels of pain and other lung cancer complications, such as shortness of breath and fatigue, than non-smokers and former smokers (9), (10). In order to reduce tobacco-related deaths and diseases, current users must quit tobacco use. It is well documented and evidence based that both smokers and smokeless tobacco users have substantial benefits from cessation. Despite enormous gains from tobacco cessation, very few persons, particularly in developing countries (2-5%), give up tobacco use spontaneously, and that is also due to illness factor (11), (12).
The current study is conducted in a tertiary care hospital to find out the percentage of tobacco use among patients suffering from cancer. Aim: 1)To assess current tobacco use among cancer patients after diagnosis and after initiation of treatment and 2) To assess awareness about the available tobacco cessation programs and treatment facilities among cancer patients and exposure to passive smoking.
| Methodology | | |
The study was conducted in adult patients suffering from cancer, admitted in a tertiary care hospital for treatment. It was a quantitative approach cross-sectional survey design. Total enumeration sampling method was used for enrolling the patients. Inclusion criteria were age at least 18 years, patients admitted in cancer hospital, able to communicate, willing to participate in study no other medical or psychiatric co-morbidities. A subject data sheet was developed for assessing socio-demographic variables of study patients. An another self developed questionnaire containing five yes-no type questionnaire was used to assess the history of tobacco use, tobacco use history after diagnosis, tobacco use after initiation of treatment, awareness about the medical services available for tobacco de-addiction and exposure to passive smoking. Written informed consent was taken from patients and their family care giver. All recorded data was coded and scored into a Microsoft Excel-2007 spreadsheet, all entries were checked for any errors. A descriptive statistical analysis was done to find out frequency and percentage and mean of the study variables.
| Results | | |
Description of socio-demographic characteristics of study patients
As given in [Table No. 1], showing that the mean age of 102 study patients was 46.18 years. Sixty percent of study patients were male and 40% were female. Eighty nine percent of study patients were married. All the study patients were formally educated, with 9% educated up to 5th standard, 46% till 10th, 39% up to 12th class, 2% were graduated and 4% were have post graduate degree. Thirteen percent of study patients were student, 25% did not had any current occupation, 4% had government job, 9% were doing self-business and private jobs, 2% retired, 3% were farmer and 35% were housewives. Fifty two percent of study patients were belong to Hindu religion while 30% and 19% were Muslims and christens respectively. Fifty six percent of study patients were from urban residence. | Table No 1: Frequency distribution of Socio-demographic characteristics of the study-patients n=102
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1. As given in [Figure No. 1]. Fifty three percent of study patients were using tobacco in past it includes both smoke and smokeless tobacco. This finding is similar to the study done by Abu Shomar et.al in 2014, they found about 55% of participants were in ever smoker category and 31% were current cigarette users (13). [Figure No. 2]. Showing that among the tobacco users ( n=52), 81% of study patients stopped tobacco use after diagnosis of cancer. 19% of study patients did not stopped tobacco use even after their diagnosis of cancer and continued its use. [Figure No. 3]. Describes that 34% of study patients started tobacco use again after initiation of cancer treatment. A total of (19% + 34% =53%) fifty three percentage of study patients were currently using tobacco. These findings were similar to the study done by Vilensky D et al on bladder cancer patients; they reported 76% of respondents who had been active smokers at the time of diagnosis out of them 58% continued to smoke. The two most common barriers to quitting tobacco reported in there study were trouble managing stress and mood and fear of gaining weight (14). Another study done by Ostroff JS on prevalence and predictors of continued tobacco use after treatment of patients with head and neck cancer reported that among 74 patients who had smoked in the year before diagnosis, 35% reported continued tobacco use after surgery (15). Study done by Vaidya V et.al revealed the same findings that large number of patients continued to smoke even after the diagnosis of COPD and lung cancer. They concluded that Ethnicity disparities and insurance status were associated with the use of smoking cessation. This study suggests the need based smoking cessation programs for tobacco users (16). | Figure 1: Bar diagram of frequency percentage of study patients used tobacco (smoking/chewing) in past n=102
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 | Figure 2: Bar diagram of frequency percentage of study patients stopped tobacco disagnosis after (n=53)
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 | Figure 3: Bar diagram of frequency percentage of study patients restarted tobacco use after initiation of treatment (n=53)
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Knowledge about availability of medical treatment for tobacco cessation among study patients
As given in [Figure No. 4]. Forty percent of Study patients did not have any knowledge about available medical treatment for tobacco cessation. This finding is similar to findings of the study done by Bottorff et.al in 2015 where only 39.6% of patients were aware of the community program available for tobacco cessation (17). The study done by Abu Shomar et.al in 2014, found that students had less knowledge(94.3%) about the existing tobacco cessation centres and services (13). Study done on adult patients by Kaplan et.al in 2013, found 46% percent of smokers and 56.3% non-smokers are aware smoking cessation outpatient clinics. The percentage of awareness of smoking cessation line was 67.8% (18). This contradiction might be due to large sample size of the study and also all the patients were taken from whole hospital not only from one setting | Figure 4: Bar diagram of frequency percentage of study patients stoppedtobacco disagnosis after (n=53)
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As gieven in [Figure No. 5] that the exposure of study patients to passive smoking. Forty two percent of study patients reported that they were exposed daily to passive smoking. A study done by K Asomaning et.al in 2007 reported that individuals exposed to second hand smoking have a higher risk of risk of lung cancer, furthermore study suggests that subjects first exposed before age 25 have a higher lung cancer risk compared to those for whom first exposure occurred after age 25 years (19).{Figure:5}
Centre of disease control and prevention in one of their publication “Cancer among adults from exposure to second hand smoke” revealed that there is higher risk of lung cancer among women whose husbands smoked than among women whose husbands did not smoke (20).
A large prospective cohort study of more than 76,000 women confirmed a strong association between cigarette smoking and lung cancer but found no link between the disease and second hand smoke.
“The fact that passive smoking may not be strongly associated with lung cancer points to a need to find other risk factors for the disease [in nonsmokers],” said Ange Wang, the Stanford University medical student who presented the study at the June 2013 meeting of the American Society of Clinical Oncology in Chicago.
The only category of exposure that showed a trend toward increased risk was living in the same house with a smoker for 30 years or more. “Passive smoking has many downstream health effects asthma, upper respiratory infections, other pulmonary diseases, cardiovascular disease but only borderline increased risk of lung cancer,” said Patel. “The strongest reason to avoid passive cigarette smoke is to change societal behaviour, to not live in a society where smoking is a norm.
“It’s very reassuring that passive smoke in the childhood home doesn’t increase the risk of lung cancer [in this study],” said Patel. “But it doesn’t decrease the need for us to have strong antismoking measures. There are very few never-smokers in smoking families”.
A large body of research has linked passive smoking to lung cancer, as well as to coronary heart disease, asthma, emphysema, respiratory infections, sudden infant death syndrome, low birth weight, and childhood ear infections. According to the Centers for Disease Control and Prevention, second hand smoke is responsible for 46,000 heart disease deaths and 3,400 lung cancer deaths among US non smoking adults each year (21).
| Conclusion | | |
The smoking behaviour of patients after a diagnosis of cancer is important to assess because continued smoking in cancer patients lead to a number of adverse health effects. Continued smoking not only increases the number and severity of complications for cancer patients but other serious illnesses like chronic obstructive pulmonary disease, coronary artery disease, peripheral artery disease and stroke. The ill effects of tobacco makes overall quality of life of patients miserable that leads to poor survival rates (4). In order to reduce tobacco-related deaths and diseases, current users must quit tobacco use. It is well documented that both smokers and smokeless tobacco users have substantial benefits from cessation. Despite enormous gains from tobacco cessation, very few persons give up tobacco use spontaneously, and that is also due to illness factor. The main barriers in tobacco cessation are lack of awareness about the ill effects of tobacco on health and lack of tobacco cessation advice by the health professionals (22),(23),(24). The role of health professionals like treating physicians, nurses, social workers is vital in tobacco cessation efforts. It is well documented by several studies that tobacco cessation advice provided by health professionals enhances the quit rate among tobacco users (12).
| Recommendations | | |
Similar studies with larger sample size and with different disease conditions can be done. Qualitative studies can be done to find out the exact factors acting as barrier in tobacco cessation. Interventional studies can be done to find the effect of tobacco cessation counseling on tobacco cessation of patients.
| Acknowledgement | | |
I would like to express my heartfelt gratitude and thanks to all nursing fraternity and staff on the Department of Oncology for their support during data collection. I am indebted to all my patients along with their family caregivers for willingly participating in the study, as without their co-operation, this work would never have been possible.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1]
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