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Some People Just Can't Stop Smoking, Even After They've Had Lung Cancer

The link between smoking and lung cancer is well established in the scientific literature. But medical researchers at Washington University in St. Louis, Missouri, have confirmed that many patients continue to smoke, even after surgery.

Psychologist Mark Walker and colleagues studied more than 150 lung cancer patients, diagnosed in the early stage when the disease is highly curable. All had surgery for the cancer; most had parts of their lungs removed. Walker found that after one year, more than one third of the patients had resumed smoking. "Our estimates that 37 percent were smokers at one year is really our most conservative estimate of what that number really is. We believe it's 40 percent or perhaps a little bit higher. And we believe that at least 50 percent of the patients end up smoking some, at least to some extent during the year."

Walker says part of the reason patients resumed smoking has to do with the highly addictive quality of nicotine. But he also says lighting up a cigarette is a behavioral habit that can be triggered at any time. "Unlike other forms of addiction, people are satisfying this addiction throughout the day," he points out. Activities like drinking coffee, driving and talking on the phone all become cues for smokers to desire a cigarette. "So it's really an insidious addiction because of the way it really weaves itself throughout our lives."

Walker says many of the patients in the study really wanted to quit smoking, but were unable to overcome their physical dependence on nicotine. He stresses that it isn't ignorance or denial that keeps them smoking. "It's the intensity of their cravings and the strength of the addiction. And I've had patients make the decision that even though they know their smoking will cause them to die if they don't stop, they just can't do it. And they accept death instead of doing what they have to do to quit. It's that powerful an addiction."

Mark Walker says health care providers can not assume that their patients will quit smoking just because they are diagnosed with lung cancer. He says doctors need to use all the tools at their disposal to help smokers stop. And, he says, making sure people don't start smoking should be a public health priority.