Impact of Smoking and Alcohol on Cancer Survivors
It is a well-known fact that both, smoking and excessive alcohol consumption increase the risk for many cancers. This dual combination significantly increases the risk of cancers in the aero-digestive tract—the lips, mouth, larynx, pharynx, throat, esophagus, stomach, liver, pancreas, and colon. Alcohol is known to enhance the effect of tobacco: increase in the production of certain enzymes converts tobacco tar into carcinogens.
There is mounting evidence that smoking and alcohol use persists among cancer survivors increasing their risk in either developing a second new cancer or reducing mortality rates expected from their original cancer.
Novel and effective treatments are now available for many cancers today increasing the life span of cancer survivors quite dramatically. Hence, during and after cancer treatments, all cancer survivors are provided with information to lead a healthy lifestyle, which primarily includes cessation of smoking and limiting alcohol consumption.
The negative impact of continued smoking has been observed even during cancer treatment. Smoking promotes tumor progression, increases inflammation thereby delaying the healing process, and increases resistance to chemotherapy due to a nicotine-induced resistance effect.
Continued smoking is also related to inferior outcomes of treatment with novel targeted therapies such as erlotinib. Further, there is also evidence that tobacco smoking aggravates and prolongs radiotherapy-induced complications. Cancer survivors who continue to smoke will report more severe pain than those who have never smoked. It is now evident that continued smoking is related to reduced treatment efficacy and reduced survival, increased risk for second primary malignancies, and a deterioration of quality of life.
A similar negative impact on cancer survivors has been observed with heavy alcohol use. Researchers have observed that a dose-dependent relationship exists with alcohol consumption: survivors who drank between 124 and 289 g of alcohol per day showing the highest death rate. (The National Institute on Alcohol Abuse and Alcoholism defines a standard drink as 11-14 g of alcohol, that is, one drink of 40% spirit, one glass of wine or one 0.33 l (12-oz) beer. Hence, a “safe” daily intake of alcohol should not be more than two “drinks”.)
A comprehensive population-based study conducted in the US noted alcohol consumption among adult cancer survivors: 34.9% exceeded moderate drinking limits and 21.0% engaged in binge drinking. Additionally, binge drinking was more prevalent among those who were also smokers.
Those patients with a history of melanoma and/or cervical, head and neck, and/or testicular cancer were more likely to engage in binge drinking, likely a reflection of younger age associated with these cancer diagnoses.
Alcohol intake by cancer survivors has also been shown to increase risk of recurrence. Breast cancer survivors who drank more than three to four drinks per week were at a higher risk for recurrence.
Excess drinking is also associated with weight gain, which is one of the acknowledged risk factors for cancer.
The recommendation for alcohol intake post cancer treatment varies with the organ affected due to cancer. Usually alcohol intake is not recommended for head and neck, esophagus, stomach, liver, pancreas, colon, urinary bladder and brain tumour patients. Others may take a glass of wine once in a while. Smoking is advised to be completely eliminated from the life style, after cancer treatment.
Cancer specialists can identify groups of patients who continue to smoke or drink after cancer treatment by using management strategies to promote the overall health and well-being of their patients.