David Zaridze: ‘Treatment of smoking patients is money thrown away!’
Oncologist — how smoking shortens the life of HIV-infected people by 6 years due to lung cancer
In the treatment of HIV-infected people, science has achieved results in which the life expectancy of patients has almost equalled the life expectancy of healthy people. A lot of effort and money is spent on antiviral therapy in healthcare. At the same time, there are at least twice as many smokers among HIV-positive people as among the general population of the planet, scientists note, and lung cancer is the most common cause of death of such patients. David Zaridze, MD, Professor, Corresponding Member of the Russian Academy of Sciences, tells about the decrease in the effectiveness of therapy for HIV-infected people and patients with lung cancer in the author's column for Realnoe Vremya on the occasion of International Cancer Day.
Smoking is the main cause of the development of 15 forms of cancer
“When will you learn how to treat cancer?" the sacramental question that friends, acquaintances and journalists have been asking me and continue to ask me throughout the 50 years of my scientific career. Ironically, the tremendous progress in cancer treatment, especially over the past decade, has gone unnoticed in society. Even more strange is the question: “Is smoking really the cause of cancer?" A journalist of a popular and seemingly serious newspaper asked me about this a couple of days ago.
Certainly, first of all, as always, I want to blame journalists and the media for this lack of information of society. However, I am afraid that the blame will have to be borne by the medical community and, of course, oncologists who do not inform their patients about the most important threats to their health, and first of all, smoking.
The fact that smoking is the main cause of development of fifteen forms of cancer and a number of other diseases most common in modern society, such as heart and vascular diseases, chronic lung diseases, diabetes, etc., has long been a proven scientific fact. Quitting smoking at any age leads to a significant reduction in the likelihood of developing cancer and other diseases listed above. Many hundreds of thousands of pages have been written about this in both scientific and popular publications. I personally made a significant contribution to the research of this most important problem for the health of the nation and its popularisation, for which I and academicians I.S. Stilidi and A.G. Rumyantsev were awarded the State Prize of the Russian Federation for Science and Technology in 2021.
Result is comparable to the effectiveness of antitumor agents
In the same article dedicated to Oncologist's Day, celebrated by the World Health Organisation on February 4, I would like to draw attention to our relatively recent discovery, in which we showed that smoking of cancer patients negatively affects the effectiveness of antitumor therapy and the prognosis of the disease. Patients with an oncological diagnosis who quit smoking live 2-3 years longer than patients who continue to smoke. Quitting smoking reduces mortality and the risk of disease progression by 35%. This result is at least comparable to the effectiveness of modern innovative anticancer drugs.
Cancer patients, alas, do not know that smoking significantly worsens the chances of healing and survival. They are not told about it. Not that they conceal it, but they just don't know or don't have time. According to the USA, 20-40% of doctors report the negative impact of smoking on the outcome of the disease to patients. I think that the situation in our country is no better in this regard. As a result, significant progress in drug therapy of cancer, in particular lung cancer, is practically nullified by smoking.
Smoking worsens the prognosis of patients with other severe, until recently incurable diseases. The most impressive example is HIV-infected patients. The use of modern antiviral therapy significantly prolongs their life. Their life expectancy is not lower than that of practically healthy people, but, alas, many of them die from lung cancer and other malignant tumors associated with smoking. The prevalence of smoking among HIV-positive people in the United States is at least twice as high as in the general population and, accordingly, the incidence of lung cancer among them is also significantly higher than in the general population. Lung cancer is the most common cause of death in HIV-positive patients. Besides, smoking worsens the effectiveness of antiviral therapy, reduces the life expectancy of HIV-infected patients by an average of 6 years. The euphoria caused by the success of antiviral therapy of HIV patients, in which huge intellectual and material resources were invested, is overshadowed by the high mortality rate from lung cancer among them. As they say, money thrown to the wind. In this regard, quitting smoking should be one of the most important components of the treatment of HIV-infected patients.
Tobacco smoking treatment is economically beneficial
Smoking is a disease that appears in the International Classification of Diseases. Smokers must be treated! Moreover, it is necessary to treat both “healthy” smokers and smokers with oncological and other serious diseases, on the prognosis and outcome of which smoking has a disastrous effect.
The treatment programme should include scientifically based methods of quitting smoking, taking into account: the use of nicotine replacement therapy (NRT) plus counseling by a psychotherapist; the possible transition to the use of electronic nicotine delivery systems (ENDS) when abandoning traditional tobacco products for the category of patients for whom it is psychologically difficult to take this step on their own and who are not satisfied with the effect of NRT. The consumption of ENDS is not associated with an increased risk of cancer and their use as an alternative to cigarettes is acceptable. Tobacco smoking treatment is economically beneficial for the health care system, especially compared to other treatment methods. Conversely, continued smoking significantly increases the cost of treatment. In this regard, I consider the proposal to treat nicotine addiction under the CHI to be economically justified.
David G. Zaridze — President of the Cancer Society of Russia, head of the Department of Clinical Epidemiology of the Research Institute of Clinical Oncology of the N.N. Blokhin National Research Centre of Oncology of the Ministry of Healthcare of Russia.
The author's opinion may not coincide with the position of the editorial board of Realnoe Vremya.