Quitting smoking during cancer treatment may seem overwhelming, but this is an especially important time to try. Active cancer patients and survivors who cut down on their cigarettes, vaping, or other nicotine use can experience a reduction in heart, stomach, and infection problems related to chemotherapy toxicity, improve their healing and breathing post-surgery, and decrease their chance of cancer coming back (recurring) or of developing new cancers.
Mindful of these benefits, as well as the many additional long-term advantages of kicking the habit, the Adult Survivorship Program at Dana-Farber has worked in partnership with colleagues at Massachusetts General Hospital (MGH) to bring its individualized smoking cessation program to our patients. The evidence-based program aims to help patients set realistic goals for quitting or cutting down. Karen Morales, MSW, LCSW, a social worker and tobacco cessation counselor in the Adult Survivorship Program, meets one-on-one with patients of all cancers and blood diseases to help them learn to identify when and why they smoke — and then develop strategies for ending their nicotine dependency.
“All smokers have things in their lives that are directly linked to their nicotine use,” says Morales, who directs the program. “By understanding them, they can take the steps to change them.”
During their 11 sessions together, Morales explains, patients work through a process to:
Recognize what smoking is — and what it is not.
“People say to me all the time that even though they know smoking is bad for them, they look at it as a ‘friend’ that helps them cope,” Morales says. Smoking is not your friend. It doesn’t calm you down — nicotine is a stimulant, not a relaxant. It is designed to hype you up, and like many illicit and prescription drugs is very, very addictive. Cigarettes are also filled with chemicals and carcinogens that can damage your body in ways you might not even realize, and research is showing the impact that long-term smoking can have on cancer patients and all people. Even if you think you know the risks, smoking just isn’t worth it.
Understand your smoking triggers.
Everybody has big stressors in their life. Maybe they just got a new cancer diagnosis, or went through a big transition in their life. Regular, day-to-day life can be stressful too, from dealing with work challenges to getting kids to school to paying the bills. The key is to recognize when these stressors occur, and where — at home, at work, in your car — and then look for other ways to deal with them besides smoking.
Use the Five D’s to tame your triggers.
When faced with the option to smoke, it’s important to be mindful and ask yourself, “What can I do instead?” Here are “Five D’s” you can actively do in the moment rather than smoke:
- Delay. Wait a few moments.
- Drink. Have a glass of water.
- Distract yourself. If I know I’m going to want to smoke right now, what can I do instead to take my mind off it? Maybe I can go look in on my children, or go see what’s in the fridge.
- Deep breathing. When we breathe, we release positive endorphins in our bodies. By taking a deep breath, and being mindful of what’s going on around you, you can gain a little “me time” that doesn’t involve smoking. This can be done throughout the day, whether listening to music, reading, socializing, going outside for a walk, or even driving.
- Document your cravings. If you are trying to cut back, be mindful of when you’re craving a cigarette. When do you need it? Is it because it’s lunchtime? Do you have to go pick up your child, and know there is going to be traffic? By recognizing those times you crave nicotine, you can use the moment to try some of the other “Ds” instead.
Try ACE (Avoid, Change, or Escape).
Once you understand your triggers, and how to handle them, you can look at the bigger picture. If you are able to AVOID a situation where you think you might smoke, and remove yourself from it, that’s always ideal. When faced with a situation that comes up unexpectedly, think of what you can do to CHANGE the circumstances and stay away from smoking. And if you can ESCAPE the situation — maybe step away or step outside — do it.
Identify your allies.
Patients have great support when at Dana-Farber, but it’s important to have somebody looking out for you at home as well. A person cutting back on nicotine can have everything from uncertainty and anxiety to real withdrawal symptoms. If you have allies who know what’s going on, they can help make things more comfortable for you. There are also allies available at the Mass Quit Line: 1-800-QUIT-NOW (1-800-784-8669) or through other remote and in-person services.
“The patient is really the one making these determinations,” says Morales of the program. “They are the one saying, ‘I can try this — I can do this.’ And while we focus on smoking cessation, we also talk a lot about positive change. How patients feel emotionally, physically, and mentally is as important as how few cigarettes they are smoking.”