Expert Point of View: Richard Hurt, MD

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Richard Hurt, MD, Director of the Nicotine Dependence Center at the Mayo Clinic in Rochester, Minnesota, applauds the new American Association for Cancer Research (AACR) policy recommendations.

“It is disappointing that more oncologists are not paying enough attention to tobacco use in their practices,” he commented. “Left untreated, tobacco dependence will kill 60% of smokers in the general population of smokers. There are three good reasons for cancer patients to stop smoking: Stopping smoking will improve outcomes from chemotherapy and radiation therapy and reduce side effects from these treatments as well as reduce the risk of second cancers.”

More attention is paid to nutrition at cancer centers than to tobacco cessation, he continued. “People on the nutritional side have done a better job than we have at educating oncologists and cancer patients about the need to maintain a good nutritional status while undergoing therapy,” Dr. Hurt continued.

Documentation of tobacco use is essential in clinical trials, since tobacco use is a major confounding factor, compromising outcomes of a new therapy. “Tobacco use should be assessed at baseline and at every follow-up and be included in the analysis,” he noted.

Tobacco Treatment Specialists

The Mayo Clinic Nicotine Dependence Center has trained at least 1,500 people to be Tobacco Treatment Specialists, and these specialists now work at centers around the United States. He pointed out that physician extenders such as nurse practitioners and physician assistants could easily complete the training and are eligible for reimbursement for tobacco dependence interventions.

“Every medical center [including oncology practices] should have a trained Tobacco Treatment Specialist. The payback for stopping smoking is immediate in terms of reduced risk of heart disease,” he commented.

“Oncology practices and professional societies need to embrace this policy statement and also develop their own policy statements and infrastructure for delivering intervention. Tobacco dependence treatment should be at the top of the agenda for oncologists and other medical specialties,” he emphasized. “Hopefully these guidelines will enlighten oncologists.” ■

Disclosure: Dr. Hurt reported no potential conflicts of interest.

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