Smoking whilst living with a serious illness: when cutting down is already part of the treatment

Every step must strike a balance between the risks and benefits. The benefit of reduction or discontinuation must be balanced against the risk of clinical destabilisation, poor adherence or uncontrolled changes to medication. Clinical monitoring and dose adjustments allow psychological stability to be maintained whilst progressing towards abstinence.

In cancer and respiratory disease patients, a diagnosis can lead to fear, depression and fatalism. Smoking, which has long been associated with immediate relief, may become more frequent precisely when it would be most necessary to give it up. Cancer patients often feel that “it doesn’t matter anymore”; in patients with lung disease, denial of the role of smoking may prevail. Blaming the patient is ineffective: the focus must be on mood, motivation, confidence and tangible benefits. In oncology, giving up smoking even after a cancer diagnosis improves the prognosis, reduces surgical complications and can increase the effectiveness of treatments: this is why smoking cessation is referred to as the ‘fourth pillar’ of care.

Why is it so difficult to quit in these cases? Resistance operates on three levels: biological, psychological and contextual, involving the severity of the addiction, mood, habitual behaviours, relationships and access to services. A relapse does not equate to a lack of willpower, but signals a need for more intensive care, which requires the involvement of various specialists.

Today, the treatment of tobacco use is often excluded from care pathways for chronic conditions. However, every consultation in which the issue is not addressed represents a missed therapeutic opportunity. FeDerSerD believes that the diagnosis and treatment of tobacco use disorder must be permanently incorporated into the Essential Levels of Care and the Diagnostic-Therapeutic Care Pathways, thereby strengthening the link between hospitals, local communities, general practice and addiction services.

Against this backdrop, a paradoxical and contradictory reality emerges: the ways in which tobacco and nicotine are consumed, and the products themselves, are evolving more rapidly than therapeutic responses. The industry is innovating devices and strategies, whilst services are struggling to develop integrated, accessible and continuous care pathways at the same pace. The reorganisation of local healthcare services can bridge this gap by strengthening Substance Abuse Services (SerD) and Smoking Cessation Centres, and by creating integrated, interdisciplinary networks and facilities with direct access, such as community centres. Reduction and cessation are not conflicting therapeutic goals: in the most complex cases, the former may be the most realistic pathway towards the latter.

*FeDerSerD President

Contributors:

Vincenzo Verardi: Medical Pharmacologist – Head of Healthcare, Inpatient Substance Use Disorders Service, Department of Pathological Addictions – Taranto Local Health Authority;

Giulia Audino: Physician, Pharmacologist and Clinical Toxicologist – Director of SerD – President of FeDerSerD Calabria;

Concettina Varango: Physician, Pharmacologist and Clinical Toxicologist – Director of the Addiction Unit at ASST Pavia;