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Quitting Smoking Helps in Treating Lung Cancer


Nov. 20, 2008 – Far and away the leading cause of lung cancer, the hazards of smoking are well-known. Quitting is beneficial even for those already facing a lung cancer diagnosis. In this episode of Cancer Connection, oncologist Ramaswamy Govindan, MD, discusses the effects of continued smoking on lung cancer  and shares his thoughts on future developments in the treatment of the disease.

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On this edition of Cancer Connection, we’ll talk about smoking and lung cancer, why people should quit and what treatments are on the horizon for lung cancer patients.

Host: Thanks for downloading this podcast from the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St Louis. I’m Jason Merrill. Millions of smokers try to quit every November for the annual Great American Smokeout. While smoking cigarettes increases the risk of several cancers and heart disease, lung cancer is the most notable, and over 90 percent of all lung cancers are directly related to smoking. To talk about it is Ramaswamy Govindan. He is an oncologist at the cancer center specializing in lung cancer. Dr. Govindan, thank you for joining us.

Govindan: Thank you, Jason. Good to be here.

Host: You’re an oncologist who specializes in lung cancer. Obviously a lot of the patients you see are smokers. What is the connection between lung cancer and smoking?

Govindan: Jason, as you know, 90 percent of patients with lung cancer get lung cancer because of smoking. Either they are actively smoking now, or they have smoked in the past and quit smoking 10, 20 years ago. Only about 10 percent of patients who have lung cancer report no history of ever smoking. Smoking is the No. 1 cause of lung cancer.

Host: So with numbers that high, what do you tell the patients who are smoking about ways to quit?

Govindan: So it’s very important for patients quit smoking the moment they're diagnosed with cancer. This is particularly important for patients who have early-stage lung cancer, that is those patients who are going to go for surgery. There is clear evidence to suggest that patients who continue the smoke tend to get a lot of postoperative complications like pneumonia. And in fact, our surgeons would not operate on patients who are actively smoking. So they are asked to quit smoking for at least a couple of weeks before they can have an operation. And for patients who have a fairly advanced cancer that is still confined to the lung, what we call stage 3 lung cancer, we tend to treat them with chemotherapy and radiation and not with surgery. For those patients, we still would recommend stopping smoking because if you smoke, you have a high risk for getting bronchitis, pneumonia and other problems. There is some evidence to suggest that people who smoke actively tend to metabolize chemotherapy drugs faster, and therefore they don't get as much benefit from chemotherapy as those who quit smoking. So clearly, there's no reason to argue, “Gee, after all, I have cancer. Forget it. I can continue to smoke.” We would strongly encourage quitting smoking even for patients with advanced lung cancer.

Host: Even though there are so many complications that can happen after you’ve been diagnosed with lung cancer, it's really hard for those smokers to quit after years of smoking, isn’t it?

Govindan: Without question. You know smoking is a very difficult habit to quit. There’s a famous quote: “Quitting smoking is easy. I’ve done that many times.” So it's not an easy thing. We encourage our patients to quit smoking. I think the most fundamental thing is you have to have the mindset to quit, and everything starts from there. A good number of patients actually get very motivated when they're faced with severe illnesses like cancer or heart attack. You'd be amazed to see how many patients quit cold turkey the moment they are told of the diagnosis. Of course for those for whom quitting is a problem, we have several ways of helping. We have drugs that can replace the active compound, the nicotine, in various ways – patches, gums and, even now, inhalers. There are different ways people can use nicotine supplements to help get over nicotine withdrawal. Also, there are other drugs that pharmacologically influence the brain’s addictive pattern and slow down the desire for smoking. Definitely, physicians can use pharmacological methods to help patients quit smoking.

Host: For those who are diagnosed with lung cancer, what treatments are out there that you work with in oncology?

Govindan: Things have changed, Jason, over the past 10 to 15 years. Ten to 15 years ago, we asked this fundamental question: Is it worth giving chemotherapy to patients with lung cancer at any stage? We first showed that chemotherapy improves the outcomes in patients with stage 4 lung cancer when compared to a group of patients who never got chemotherapy. We also learned very quickly that in patients with advanced lung cancer that is confined to the lung – stage 3 lung cancer – adding chemotherapy to radiation improves outcomes. Now it’s the standard therapy. Contrary to what was the case 15 years ago, when chemotherapy was seldom used in lung cancer, now we use chemotherapy for almost all stages of lung cancer, even sometimes after an operation. To give you an example, in patients with stage 2 or 3 lung cancer who go for an operation, chemotherapy given after the operation improves the survival by a good 15 to 20 percent. That's quite significant. In stage 3 patients who do not go for an operation, without question chemotherapy and radiation improve the cure rate almost by fourfold compared to radiation alone. And in stage 4 lung cancer, in the past you would just get one or two rounds of chemotherapy and stop. But now several different options exist, and it's not uncommon at all for patients with advanced lung cancer that has metastasized to the bone or other organs to live now for quite some years and lead a fairly normal life. That's happening more and more often. You know we would like that to happen to every patient of ours, and we would like that to go on for a long time. I think we are definitely taking baby steps in that direction. We have never had this many options for lung cancer before, and today we are looking at lots of new drugs. I think in the next two to three years, we’re going to see new classes of drugs that can actually slow down the cancer growth, turn off the bad genes, turn on the good genes and hopefully make a significant impact. I see good reason to be optimistic about the treatment of lung cancer in the coming years.

Host: Do you have anything you'd like to add?

Govindan: I would say that while we are making significant progress in the treatment of lung cancer, it is very important to keep in mind one basic fact: Lung cancer wouldn’t be the No. 1 killer today if it weren’t for the smoking problem. It is very clear that kids should be encouraged to not start smoking. And it’s never too late to quit smoking. It's very important for people to appreciate and understand what a bad thing smoking is, as plain as that is.

Host: Dr. Govindan, thank you joining us.

Govindan: Thank you, Jason.

Host: For more information about lung cancer, you can visit, or to find out your own risk for developing the disease, visit Thanks for downloading. Until next time, I’m Jason Merrill.