Caring for Cancer Survivors Who Use Tobacco

Photo of a doctor having a serious conversation with her patient

Talking with survivors about the risks of tobacco use after a cancer diagnosis may help them quit.

Tobacco use can cause many cancers throughout the body.

Tobacco use is the leading preventable cause of cancer and cancer deaths.1 Cancers linked to tobacco use make up 40% of all cancers diagnosed.2 Cigarette smoking causes 3 in 10 of all cancer deaths.2,3 Cigarette smoking causes 10 to 80% of deaths from at least 12 tobacco-related cancers, including oral cavity and pharynx; larynx; esophagus; lung, bronchus, and trachea; stomach; kidney and renal pelvis; pancreas; liver; urinary bladder; uterine cervix; colon and rectum; and acute myeloid leukemia.1,4,5

What are the health risks for survivors who use tobacco?

Cigarette smoking not only causes cancer but also can negatively impact cancer treatment and survival. In the US, 9% to 18% of survivors smoke cigarettes.6 A higher percentage of survivors younger than 40 years smoke cigarettes compared with older survivors. Psychosocial factors, including distress, are associated with cigarette smoking among survivors.

Tobacco use among survivors can increase their risk for—

  • Having poorer response or outcomes to treatment (treatment toxicity).
  • Having their cancer recur.
  • Developing a new primary cancer.
  • Dying from their primary cancer or from a secondary cancer.
  • Dying from other causes such as pneumonia and infection.

Quitting tobacco can improve a survivor’s prognosis. Patients who receive advice about cessation from their health care provider are more likely to quit tobacco use.

Health care providers can help survivors quit tobacco use.

  • Talk with survivors about the risks of tobacco use after a cancer diagnosis.
  • Ask survivors whether they use tobacco products, encourage those who do to quit, and assess their willingness to quit.
  • Help survivors quit by prescribing FDA-approved cessation medications and referring them to tobacco cessation counseling services, when indicated.
  • Ensure that tobacco cessation medications and counseling services are outlined as part of a survivorship care plan, when indicated.
  • Follow up with survivors regularly about their tobacco use.
  • Identify and address psychosocial issues as part of recommended distress screening, when indicated.


1U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014. [PDF-35.9MB]

2Henley SJ, Thomas CC, Sharapova SR, Momin B, Massetti GM, Winn DM, Armour BS, Richardson LC. Vital Signs: Disparities in tobacco-related cancer incidence and mortality—United States, 2004–2013. MMWR 2016;65(44):1212–1218.

3U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2013 incidence and mortality web-based report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2016.

4International Agency for Research on Cancer. IARC monographs on the evaluation of carcinogenic risks to humans: Volume 100E: Personal habits and indoor combustions. Lyon, France: International Agency for Research on Cancer; 2012.

5Siegel RL, Jacobs EJ, Newton CC, Feskanich D, Freedman ND, Prentice RL, Jemal A. Deaths due to cigarette smoking for 12 smoking-related cancers in the United States. JAMA Internal Medicine 2015;175(9):1574–1576.

6Shoemaker ML, White MC, Hawkins NA, Hayes NS. Prevalence of smoking and obesity among U.S. cancer survivors: estimates from the National Health Interview Survey, 2008–2012. Oncology Nursing Forum 2016;43(4):436–441.