Tobacco Treatment Guide: For Patients and Their Families

The information in this guide will help you understand the benefits of quitting or cutting back on the amount of tobacco products you use. It offers reasons you may want to quit. It also helps you learn how to cope with smoking urges as you quit smoking.

This guide will:

• Teach you how to cope with the urge to smoke.
• Help you come up with a plan to quit smoking.
• Let you know what to expect when you quit.
• Help you get support from your friends and family.
• Teach you ways to manage cravings and nicotine withdrawal.
• Give you tips on how to stay a nonsmoker once you quit.

About MSK’s Tobacco Treatment Program

You may be able to quit just by using this guide, but most people benefit from getting support from a counselor who specializes in helping people quit smoking and by taking medication. The Tobacco Treatment Program at MSK specializes in helping people with cancer, cancer survivors, and their family members. We understand the challenge of wanting to quit smoking while at the same time dealing with the stress of a cancer diagnosis, treatment, and the fear of recurrence (cancer coming back).

MSK’s Tobacco Treatment Program offers recommendations for safe and effective use of medications to help you quit smoking, (such as nicotine replacement therapy (NRT), bupropion (Zyban^®), and varenicline (Chantix^®)), coaching, and ongoing support to anyone who wants to quit or who is thinking about quitting smoking. We can also recommend other support services here at MSK and in your community. For more information, call 212-610-0507 or visit www.msk.org/tobacco.

Find your reasons to quit

Quitting smoking and your cancer care

There are known risks if you continue to smoke and benefits if you quit no matter what kind of cancer you have or what stage it is. The sooner you quit, the better but it is but it’s never too late to quit!

If you or someone you love is being treated for cancer, the changes in your priorities and outlook on life may help motivate you to quit. If you’re a cancer survivor, knowing you beat cancer may encourage you to live a healthier life. There are lots of good reasons to quit—we’re here to help you find yours.

Here are some ways quitting smoking can help with your cancer care. Check off the points that matter most to you and add any extra personal reasons to quit to your list. Remember to talk with your doctor and find out more about how quitting smoking may improve your cancer care and outcomes.

Quitting smoking:

• Lowers the amount of side effects you’ll have.
• Helps improve your breathing after surgery.
• Lowers your risk of your cancer coming back.
• Lowers your risk of getting new cancers.
• Helps your heart and lungs work better.
• Improves your sleep and helps you feel less tired and have more energy.
• Helps you feel less stressed and have a better quality of life.
• Improves your self-esteem.
• Helps you feel more in control of your life.
• Can lower your risk of dying from cancer and other diseases.
• Improves your sense of smell and taste.
• Improves your appetite.
• Improves the effectiveness of your cancer treatments.

Your reasons to quit smoking

Knowing the health benefits of quitting is enough to motivate many people to quit, but many people have other personal reasons for wanting to quit. Quitting smoking is a big decision, so it’s important to do it for reasons that mean something to you.

Here are some reasons people in our program have quit smoking. Do you have any of the same reasons to quit? If so, check them off, and use the blank spaces to write in your own reasons.

I want to quit smoking because:

• I want to be more actively involved in my cancer care.
• I want to have more energy.
• I want to set a good example for family and friends.
• Smoking is expensive.
• Smoking smells bad.
• Smoking causes yellow teeth and unhealthy gums.
• I want freedom from tobacco addiction.
• Most of my friends have already quit.
• I want to see my children and grandchildren grow up.
• I want to reduce my family’s worry about my health.

Health benefits of quitting

Everyone can benefit from quitting smoking regardless of how long you’ve been smoking for. Here are some of the health benefits you’ll experience starting from 20 minutes after quitting.

Managing your concerns about quitting

Now that you’ve listed your reasons for quitting, it’s time to think about what concerns you have about quitting. This is important so that you can find ways to handle them.

The table below lists some common concerns about quitting, and tips for dealing with them. Check off those that are true for you and add your own.

START quitting

The National Cancer Institute recommends the START approach to stop smoking. When you’re ready, use the steps below to quit smoking.

S = Set a quit date (the actual day you will stop smoking).

T = Tell family, friends, and coworkers you plan to quit and when.

A = Anticipate and plan for the challenges you may face while quitting.

R = Remove cigarettes and other tobacco products from your home, car, and work.

T = Talk with your doctor, counselor, or Tobacco Treatment Specialist about quitting.

Set a quit date

Choosing a quit date will help you reach your goal. If you’re ready to set a quit date right now, follow the steps below.

If you’re not ready to set a quit date right now, that’s okay. Some people quit by slowly cutting down on how much they smoke daily. Review your reasons for quitting and use the steps in this guide to help you cut down and feel more confident in setting a quit date later.

Tell your friends, family, and coworkers about your plans to quit

Quitting smoking can be hard but having the support of your friends and family can make it easier. Here are some ways you can ask them for help.

• If they smoke, ask them to try to quit with you. You’ll be able to support each other as you try to quit together. If they aren’t ready to quit, ask them not to smoke around you or your home, and keep cigarettes out of your sight. Tell them this is the best way to help you.
• When you feel like smoking, ask them to help you focus on your reasons for quitting.
• Ask them to focus on what you’ve accomplished, not your setbacks. They should celebrate your successes, no matter how small they may seem. Every step toward quitting is a step in the right direction.
• Practice relaxing together using deep breathing, walking, or listening to music you like.
• Ask them to help you plan how you will deal with your urges to smoke.
• Ask them to plan something special to celebrate your quit day, like a movie or dinner.
• Ask them to be there for you if you want to talk. Just having someone to talk to can help.

Before you try to quit, make a list of telephone numbers of people you can call or text for support, such as your family, friends, and the national toll-free Tobacco Quitline 800-QUIT NOW or 800-784-8669. Keep your telephone list handy for when you may need it.

Anticipate and plan for challenges

Expecting challenges is an important part of getting ready to quit. If you’ve tried to quit smoking before, you’re one step closer to becoming tobacco free.

Know your triggers

Knowing what makes you want to smoke is an important part of quitting. If you’re like most people, you have triggers and habits that set you off or “tell” you to smoke. What are your triggers? Check them off below and add your own to the list.

• Drinking alcohol
• Being bored
• Coffee
• Meals
• Talking on the phone
• Using a computer
• Being around other smokers
• Stress
• Driving

Get ready to manage nicotine withdrawal

When you stop smoking, your body has to get used to not having nicotine in your system. Nicotine is the substance in cigarettes that makes them addictive, making you want them more. As your body gets used to this, you’ll have signs of withdrawal. These usually last a week or 2, but some may last longer. Using medications, such as nicotine replacement therapy (NRT) can help reduce symptoms of nicotine withdrawal.

The first few days after quitting smoking are hard. Keep in mind that feeling annoyed, upset, or down can be a normal part of early nicotine withdrawal. These feelings will go away. In fact, after a few weeks of quitting, you’re likely to have significantly fewer feelings of stress. Remind yourself why you want to quit. Keep using your strategies for coping with smoking urges that you came up with. Withdrawal is different for everyone, but below are the most common signs of withdrawal and helpful tips on managing them.

Quitting smoking while going through other stressful situations, such as cancer treatment, can be overwhelming. If these feelings are keeping you from doing your usual activities, you may be experiencing depression or anxiety. Talking with a healthcare provider who specializes in treating people who are quitting smoking can help. At MSK, our Tobacco Treatment Program can provide emotional support and treatment for you and your family. Call 212-610-0507 for more information.

Learn how to cope with smoking urges by using self-coaching

You can change your level of stress, mood, and even your behavior by learning to control your thoughts. Having negative thoughts can make you feel more sad, worried, or depressed. Try to lower your stress level by thinking positive thoughts. You can talk yourself into or out of smoking a cigarette.

Use the tips below to help change your thinking about smoking and quitting.

Remove cigarettes and tobacco from your home, car, and workplace

Get rid of all the things that remind you of smoking such as:

• Cigarettes
• Matches
• Lighters
• Ashtrays

Remember to go through all the places where you might have cigarettes or tobacco stored. Places like your pockets, kitchen drawers, and the glove compartment in your car are good places to start. Making your home and car smoke-free is an important first step toward quitting. Getting rid of cigarettes at work is also important so you don’t think about having one when you’re stressed.

Talk with your healthcare provider about getting help to quit and your cessation medication options

Talk with your healthcare provider about what challenges you expect and your concerns about quitting. They can give you advice and tell you about resources that can help you quit, including meeting with a tobacco treatment specialist (a special healthcare provider trained in helping people quit smoking) to help you with your quitting efforts.

About cessation medications

Your doctor may also give you one or more cessation medication to help with nicotine withdrawal. These medications help by making you have less cravings for cigarettes and less nicotine withdrawal side effects (such as depression, anxiety, and increased appetite). Using both medication and working with a tobacco treatment specialist will increase your chances of successfully quitting and staying smoke-free.

Frequently asked questions about medications

Here are some frequently asked questions about taking medication to help quit smoking.

Which types of medications are available to help me stop smoking?

• NRT is 1 type of quitting medication that is approved by the Food and Drug Administration (FDA). These medications replace some of the nicotine your body gets from smoking cigarettes, help manage your side effects of nicotine withdrawal, and help you slowly stop needing nicotine. NRT comes in many forms, such as:
  • Nicotine gum (Nicorette®, Nicotrol®)
  • Nicotine inhaler (Nicotrol®)
  • Nicotine lozenge (Commit®)
  • Nicotine nasal spray (Nicotrol®)
  • Nicotine patch (NicodermCQ®, Nicotrol®, Habitrol®)
• There are also medications you can take as a pill. They don’t contain nicotine but can reduce your cravings to smoke and lessen side effects of nicotine withdrawal. Your doctor can give you a prescription for these medications if you need them. These medications include:
  • Bupropion SR (Wellbutrin SR®, Zyban®)
  • Varenicline (Chantix®)

Are these medications safe?

Yes. All of the available medications are safe to take and can help you quit smoking. These medications don’t have the toxic chemicals that cigarettes have and, with few exceptions, are safe to use while undergoing cancer treatment.

Can I use more than one medication at the same time?

Yes. It’s safe for you to use more than 1 medication at the same time. Using the nicotine patch with nicotine gum, lozenge, nasal spray, or inhaler is better than taking 1 form of NRT alone. You can also take non-nicotine medications, such as bupropion, with NRT to increase your chances of quitting. MSK’s Tobacco Treatment Specialists can help you come up with a plan that works for you.

Can I use these medications if I’m not ready to quit smoking?

Yes, even if you’re not yet ready to quit, you can use NRT to help you cut back on how much you smoke every day. You can also set weekly goals for yourself to smoke less. You may also find it helpful to delay smoking and increase the time between cigarettes. Talk with one of MSK’s Tobacco Treatment Specialists about using these medications safely to cut down your use of cigarettes before you set a quit date.

The table below shows smoking cessation medications that are FDA approved. The medications with the star before their name is cover NRT with a prescription. Call your insurance company for more information.

What are Electronic Nicotine Delivery Systems (ENDS) such as electronic cigarettes, e-cigs, e-cigarettes, or other vaping devices?

ENDS are battery-powered smoking devices that may look and feel like regular cigarettes. Instead of burning tobacco like regular cigarettes, they use cartridges filled with a liquid containing nicotine, flavorings, and some other chemicals. The battery heats up the liquid, turning it into a vapor or mist that you then breathe in. Using these products is sometimes referred to as “vaping”, “vaporing”, or “e-smoking.” ENDS don’t have the same harmful chemicals found in tobacco smoke, but we don’t yet know the long-term health risks of using e-cigarettes. Although some people use ENDS to help them quit smoking, there isn’t enough evidence to recommend them as a safe and effective way to quit smoking.

If you have questions or thoughts about using ENDS, talk with your tobacco treatment specialist. For more information, read Frequently Asked Questions About Electronic Smoking Devices.

On your quit date

Here are some suggestions for your quit date.

• Get rid of any reminders of smoking (cigarettes, lighters, ashtrays), if you haven’t done so already.
• Review and use the tips in this guide.
• Remind your friends and family that today is your quit date.
• Treat yourself to something special during your first 1 to 6 weeks off cigarettes.
• Plan to celebrate the day you quit smoking each month.

Staying smoke-free

Sometimes you may not be able to turn down a craving for a cigarette after quitting. Here are some common terms healthcare providers may use if that happens:

• A slip is when you have a puff or a few cigarettes but don’t return to your regular smoking pattern.
• A relapse is when you restart smoking 1 or more cigarettes a day for a week or more.
• If you slip, you have a higher chance of relapsing.

Plan for situations that can lead to a slip or relapse

Here are some common situations that can lead to a slip or relapse. Be aware of these and plan ways to avoid smoking if you’re tempted.

• Stress or other negative feelings. You may feel like you want to smoke if you’re stressed, sad, or worried.
• Positive feelings. You may want to smoke when you feel happy or as a reward for when something goes right or well.
• Nicotine withdrawal. You may want to smoke when you’re going through nicotine withdrawal. It can be very hard, but NRT medications can help you through it so you don’t slip or relapse.
• Alcohol. When you drink alcohol, you’re more likely to give in to cravings to smoke. Try not to drink alcohol or reduce alcohol use for the first month or so after your quit date.
• Relaxing after meals. Some people like to smoke after they eat. If you feel like smoking after a meal, make a list of other things you can do instead to avoid this trigger.
• Social situations. Try not to be around other tobacco users or ask them not to smoke around you. If you’re celebrating with friends and feel the urge to smoke, excuse yourself and use one of the strategies from this guide to get you back on track.
• Recovery from cancer or treatment. You may want to quit smoking after a cancer diagnosis or before surgery. Some people are tempted to start smoking again once their cancer is gone or once they have recovered. Instead, use this time to break the habit and make room for healthier activities like exercise or other hobbies.
• Feeling bored. If you don’t have energy or aren’t able to work because of your treatment or cancer, you may feel very bored. Feeling bored can trigger smoking urges. Plan your day to include activities that are fun, make you happy, and keep you busy. Staying busy with hobbies or other enjoyable activities helps distract you from urges to smoke.

If you slip

If you have a slip, don’t worry! Try to figure out what caused the slip. Ask yourself:

• Was I in a situation that made it easier for me to slip, such as being with friends who were smoking or feeling overly stressed?
• How can I prepare for this situation next time? What strategies from this guide can I use to help me avoid my triggers?
• Was I having nicotine withdrawal? If using NRT, was I using it the way I’m supposed to?
• Am I forgetting why I wanted to quit in the first place? If I am, I should review my reasons for quitting and talk myself out of it.

You can get back on track by quitting smoking again. After thinking about what happened, make a plan to deal with the situation in a smoke-free way in the future. Think about whether it’s best to avoid these situations completely or face them head on using your best coping strategies.

If you relapse

If you relapse, don’t beat yourself up. Avoid being negative and saying statements like “I’ll never quit,” or “I’m a failure.” Instead, think of ways you can recover if you relapse, such as:

• Throw away any cigarettes you still have.
• Tell yourself that you have tried to quit and think about what you learned about yourself and the nicotine habit.
• Think about times when you learned a new skill, such as riding a bicycle or using a computer. You didn’t just learn these new skills in one try. You figured out what worked and what didn’t as you went along. Learning to live life without cigarettes also means sticking with it and trying new ways to cope with the urge to smoke.
• If you slip or relapse, you may feel guilty or try to hide it. Instead, talk with your healthcare provider or others who are there to support you. Think about what led to the slip or relapse and figure out ways to deal with it next time.
• It may be time to come up with a stronger action plan. If you’re not sure why you relapsed or how to get back on track, call MSK’s Tobacco Treatment Program at 212-610-0507. We’re here to help.
• Review the strategies in this guide.
• Set a new quit date and start again. You are one step closer to reaching your goal.

Reviewing the strategies and suggestions in this guide from time to time can help you stay a nonsmoker. It’s never too late to enjoy the benefits of being a nonsmoker.

For more information about quitting smoking, watch this video.

Resources

Memorial Sloan Kettering’s Tobacco Treatment Program
www.msk.org/tobacco
212-610-0507
MSK has specialists who can help you quit smoking or stop using tobacco, whether or not you’re a patient at MSK. We use a wide range of approaches to help you quit, including medications and behavioral techniques. For more information about our Tobacco Treatment Program, call 212-610-0507.

Centers for Disease Control and Prevention
www.cdc.gov/tobacco/campaign/tips
The Tips From Former Smokers^® campaign features stories of former smokers living with smoking-related diseases and disabilities and the toll that smoking-related illnesses have taken on them.

US Department of Health and Human Services
www.surgeongeneral.gov/library/reports/50-years-of-progress/consumer-guide.pdf
A consumer guide to the Surgeon General’s report The Health Consequences of Smoking: 50 Years of Progress.

National Cancer Institute
Clearing the Air. Quit Smoking Today
smokefree.gov/sites/default/files/pdf/clearing-the-air-accessible.pdf
This booklet is designed to help people quit smoking and prepare for the challenges that can come up after quitting.

National Smokers’ Quitline
www.smokefree.gov
800-QUIT NOW (800-784-8669)
Provides resources to help people quit smoking, including online counseling and text messaging.

American Cancer Society
www.cancer.org
800-ACS-2345 (800-227-2345)
Provides information and support to people with cancer and their caregivers.

American Heart Association
www.heart.org/HEARTORG/HealthyLiving/QuitSmoking/Quit-Smoking_UCM_001085_SubHomePage.jsp
Provides resources to help people quit smoking and stay quit.

American Lung Association
www.lung.org/stop-smoking
800-LUNG-USA (800-586-4872)
Provides resources to help people quit smoking.

US Food and Drug Administration: Electronic Cigarettes (e-Cigarettes)
www.fda.gov/NewsEvents/PublicHealthFocus/ucm172906.htm
Information about regulations for e-cigarette use and to learn about and report problems with these devices.