Nicotine Dependence: Current Treatments and Future Directions

Approximately one in six American adults is a current smoker, and smoking accounts for one-third of all cancer deaths. In general, patients with cancer have a higher dependence on nicotine and are more likely to be smokers or ex-smokers. Several instruments measure nicotine dependence among cigarette smokers. However, the evaluation and final recommendation are clinical, and the treatment plan must be individualized. Nonpharmacologic treatments include behavioral counseling, quitlines, and self-help material, but yield relatively low quit rates if used alone. Pharmacologic treatments approved by the US Food and Drug Administration include nicotine replacement therapies, bupropion, and varenicline. Patients with cancer who use tobacco should be treated according to evidence-based treatment guidelines, with particular attention to tailoring education about their disease-tobacco link, pharmacotherapy, comorbid medical and psychiatric disorders, and family and household tobacco use. Health care providers have limited time and expertise to address smoking among patients with cancer, and patients may have comorbid substance use or dependence or other emotional and mental disorders that undermine their ability to quit smoking. Systems-level challenges and tailored treatment approaches are needed to identify all tobacco users, lower the rate of persistent tobacco use, and reduce recidivism among patients with cancer.