Fifty-three-year-old Kanpur resident Madan Gupta was operated for oral cancer in 2014. A part of his jawbone had to be removed to get rid of the cancer he developed after being a heavy smoker since the age of 20. His treatment at Mumbai’s Tata Memorial Hospital (TMH) included a jaw reconstruction procedure with a flap taken out of his chest, dental rehabilitation and therapy to talk, swallow and chew normally. The doctors were happy with his progress until last week when Mr. Gupta came down for a follow-up. He had started smoking again.
Not saying never again
It is said that an unpleasant experience induces caution. But that definitely seems untrue when it comes to nicotine addiction. Cancer surgeons say that an increasing number of patients who have suffered from oral and lung cancers go back to smoking and chewing tobacco. “Nicotine works on the dopamine pathway in the brain and generates a reward phenomenon making a person feel good. The addiction is such that you want to keep going back,” says head and neck surgeon Dr. Pankaj Chaturvedi who is attached to TMH, one of the biggest cancer hospitals in Asia. He says out of the 9,000-odd new head and neck cancer patients that he sees annually, 15% go back to their tobacco habits, mostly smoking. Chewing tobacco at times becomes difficult after an oral cancer surgery. “Going back to smoking is much easier,” he says. The relapse happens as early as six months post-surgery in some cases. Dr. Chaturvedi adds that 30% of tobacco-related cancer patients have a chance of getting a cancer for the second time, and it doubles with a smoking or chewing relapse.
Behavioural therapy does help in quitting but only in 5% cases. Behavioural therapy clubbed with nicotine replacement therapy increases the chances to 10%. But 90% of addicts who are trying to quit fail. The relapse of addiction has made the doctors label tobacco addiction as a disease in itself. In 2006, a study published by the American Association for Cancer Research observing relapse patterns during the first year after treatment of early stage non-small-cell lung cancer revealed that nearly half of the patients returned to smoking if they had a history of recent smoking.
Cancer society study
Another 2012 study by the American Cancer Society had revealed that at 12 months after surgery, 60% head and neck cancer patients who smoked during the week prior to surgery had resumed smoking while only 13% of patients who were abstinent prior to surgery had gone back to the habit. The study pointed towards the need of early cessation and extensive efforts for relapse prevention during the acute period following surgery.
However, the problem with nicotine addiction is such that patients turn to it after a wider gap as well. Take the example of Dr. Rajendra Kerkar, head of the gynaecological oncology department at TMH and an oral cancer survivor. Dr. Kerkar went back to smoking after a gap of five and half years. More than 70% of his tongue had to be cut off as a part of the treatment in 1988. “The clasp of nicotine is a tough one,” says Dr. Kerkar.
Mr. Gupta, who runs a shop in Kanpur, agrees. He feels that the craving is so maddening that the fear of cancer takes a back seat. “I sell cigarettes and tobacco in my shop — I just have to stretch my arm to get it,” he says, adding that the doctors at TMH are helping him enrol in a cessation programme to keep away from lighting up.
jyoti.s@thehindu.co.in
