Hollings researcher instrumental in Canadian smoking cessation success

In an international partnership with a Hollings researcher known for expertise in smoking cessation, the Canadian Partnership Against Cancer (CPAC) reports that it has increased the number of smoking cessation services being offered at cancer care settings in Canada from 26% to 87% since 2015.

“The progress that has been made across Canada over the past five years has been amazing and represents world-class leadership in curbing tobacco use after a cancer diagnosis,” said Graham Warren, M.D., Ph.D., MUSC Hollings Cancer Center researcher and vice chairman for research in radiation oncology with the MUSC College of Medicine.

In addition to his roles at Hollings, Warren serves as an expert advisor for CPAC, where he plays an influential role in the ongoing project aimed at providing smoking cessation programs to patients at every cancer care setting across Canada.

CPAC wanted to implement a countrywide smoking cessation program aimed at providing critical help in quitting to some of the patients most at risk – cancer patients. 

“If my story can stop one teenager or adult from ever picking up a cigarette, then I have enriched their lives. I think that is my purpose and why I’m still alive all these years later. Cigarettes destroyed me, but they don’t have to destroy others.”
— Archie Stewart

“We know there’s a 50% to 60% increased risk of cancer recurrence if you smoke,” Warren said. “It increases a patient’s risk of developing another cancer down the road and continues to increase the risk for heart disease, stroke and other smoking-related diseases even after a cancer diagnosis. It decreases the effectiveness of chemotherapy, radiation and surgery and increases toxicity from cancer treatment.”

Warren said the impacts of smoking on cancer patients can’t be ignored. Smoking affects between 320,000 and 400,000 cancer patients in the U.S. every year. That number is around 40,000 in Canada. “If we get people to quit smoking, we’re not just making our cancer treatment better but also treatment for most other health conditions better as well.”

 

The program is being hailed as a game changer by former smokers like Archie Stewart, 71, who serves as a patient advisor with CPAC. Stewart was diagnosed with terminal cancer and chronic obstructive pulmonary disease (COPD) after smoking for more than 40 years. He is now on a mission to prevent others from going down the same path he did.

“When I talk to smokers now, I try and tell them the impacts smoking can have on the effectiveness of their treatment. You quickly learn most patients have a lot to live for,” he said. “A lot of doctors don’t smoke, so they can’t fully understand the issues with smoking. A lot of doctors can’t connect with that smoker to tell them to quit smoking. I get it, though, so I can help medical professionals relate to that patient and make a bigger impact. That’s what I’ve been doing as a CPAC patient advisor.”

Stewart educates current smokers about the dangers of the addiction. Stewart is no stranger to dangerous experiences. He served on the front lines in Vietnam and was shot twice and stabbed several times while doing security work for the U.S. government. But in the end, he thinks it won’t be a bullet or knife that ends his life.

“I don’t know why I’m still alive,” he said. “I was told in 2009 when the cancer returned that 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 on Cape Breton Island, a small community off Nova Scotia, Canada, with his wife and spends as much time as possible with his four children and one grandson.

He said he is grateful for the work of medical experts like Warren for educating smokers before a medical condition becomes terminal. When he began smoking at just 12 years old, Stewart said there were no conversations about the harmful impacts of nicotine. From 1962 until 2009, when he finally quit, smoking was a part of Stewart’s daily life. At the height of smoking, he estimated that he was going through between two or two and half packs of cigarettes each day.

“Nicotine had such a hold over me. I compared it to a dragon sitting on my shoulder,” Stewart said. “It was a happy dragon as long as I was smoking, but the second I stopped smoking, it started digging its claws into my shoulders. The longer I went without smoking, the deeper the claws would go.” 

“The progress that has been made across Canada over the past five years has been amazing and represents world-class leadership in curbing tobacco use after a cancer diagnosis.”
— Dr. Graham Warren

Despite having a portion of his lung removed following a lung cancer diagnosis in 1995, Stewart remained committed to his relationship with nicotine. He reflects on the time and realizes 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. Had help been offered to me back then, I would have listened but probably wouldn’t have acted on it.”

It wasn’t until Christmas of 2005 that Stewart came to the realization that his smoking was affecting those he loved most. “My wife asked my stepson what he wanted for Christmas,” Stewart said. “He told her, ‘I’d like Archie to stop smoking.’ That really stayed with me. It was several years before I quit, but I think that was one of the contributing factors.”

In 2008, Stewart saw an advertisement on the television promoting a medication that offered help for quitting smoking. He tried it – it worked. In January of 2009, the urge to smoke faded into darkness – he’s never picked up a cigarette again.

Following the initial cancer diagnosis in 1995, Stewart went in routinely for checkups with his thoracic surgeon – first weekly, then monthly and eventually yearly. His cancer remained in check until late in 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 passed away that my wife wouldn’t have to work for the rest of her life and never would have to worry about having money to pay bills. I wanted the same for my sons and grandson,” he said.

Still work to be done

Stewart hopes that experts like Warren can continue to grow the smoking cessation efforts in Canada. As a board-certified radiation oncologist, Warren partners with local, regional, national and international groups to increase tobacco cessation support for cancer patients. Warren’s previous accomplishments include:

• Serving as a contributor to the 2014 and 2020 Surgeon General’s Report, which were the first to document the extensive effects smoking have on cancer treatment and the survival benefits of quitting smoking after a cancer diagnosis.
• Working with Michael Cummings, Ph.D., Matt Carpenter, Ph.D., and several others to establish the smoking cessation program at Hollings and MUSC. 
• Working with state quitlines and community cancer centers across Michigan to help cancer patients to quit smoking.
• Working with several cancer organizations to develop policies and guidelines for addressing tobacco use in cancer care.  
• Serving as an expert advisor for 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 strides have been made over the past few years, the initiative isn’t reaching enough patients. “Most patients receive cancer treatment outside of NCI-designated cancer centers. The Cancer Center Cessation Initiative has been a tremendous program here in the U.S., and our next steps need to sustain these efforts and reach out to patients in the community.” 

Warren said the goal is to have 100% of cancer care settings in Canada offering smoking cessation programs to cancer patients within the next year.

“What has happened across Canada over the past five years has been truly transformative.  They pulled together a network of collaborators across all provinces and territories to develop a vision of helping every patient quit smoking to improve cancer treatment and for the best quality of life. Expanding access to 87% of clinical settings really disseminates this message and provides an outstanding opportunity for patients to receive help quitting smoking and ultimately improve their cancer treatment,” Warren said.

He said the focus will then switch from building programs to sustaining them over a long period of time. He hopes that Canada’s smoking cessation program can serve as a model to other countries around the world.

For former smokers like Stewart, the smoking cessation program in his home country represents a resource to save lives. He said he wants to affect as many lives as possible with the time he has left.

“If my story can stop one teenager or adult from ever picking up a cigarette, then I have enriched their lives,” Stewart said. “I think that is my purpose and why I’m still alive all these years later. Cigarettes destroyed me, but they don’t have to destroy others.”

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