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Supporting a Patient’s Choice to Smoke When Dying of Stage IV Lung Cancer

August 13, 2021 | AONN+ Blog | Lung Cancer
Featuring:
Lillie D. Shockney, RN, BS, MAS, HON-ONN-CG
Lillie D. Shockney, RN, BS, MAS, HON-ONN-CG
Editor-in-Chief, JONS; Co-Founder, AONN+; University Distinguished Service Professor of Breast Cancer, Professor of Surgery, Johns Hopkins University School of Medicine; Co-Developer, Work Stride-Managing Cancer at Work, Johns Hopkins Healthcare Solutions

Patients who have smoked for decades are usually not surprised when they are diagnosed with advanced lung cancer. However, they may be unwilling to stop smoking when asked to do so by their treatment team. Will it save their life if they stop now? No. Will it help extend their life by a few months potentially? Maybe. We know that smoking is an addiction, and we also know that people smoke more when under stress, making it difficult to ask a patient to stop smoking at this point in their life.

Family members may get angry with their loved one if they continue to smoke, seeing it as this person does not want to give up smoking in order to have more time with their family. Patients with advanced lung cancer are usually in poor physical and emotional shape and may be making this choice solely due to the addiction, or due to wanting to see their life end sooner because of how awful they feel. They may even want to punish themselves by having their life end as soon as possible.

We as oncology navigators may need to spend more time with the patient’s spouse or other loved ones who are demanding that the smoking halt. These individuals may not be able to see the big picture and may not have a grasp on addictive behaviors. We must educate them about this type of addiction, the stigma that is associated with lung cancer (such patients are rarely felt sorry for as are breast cancer or colon cancer patients for example), and how they can constructively help their loved one.

If a patient becomes oxygen-dependent, there needs to be a more serious discussion about smoking and we need to evaluate the patient’s safety, as well as the safety of those who live with them. We don’t want a fire to start, so it might mean turning off the oxygen tank while they smoke 1 cigarette, then resuming the oxygen afterward. As they get sicker, it will become harder for them to be able to smoke because they won’t be able to draw in air.

This is not the time to blame the patient for their serious situation or tell them, “If only you had quit years ago.” There is no marginal benefit in looking in the past. We, along with the patient and their family members, should not go in that direction. Simply focus on what care and support is needed now, and take it forward.

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