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1 A practical guide to living with and after cancer giving up SmOking

2 After a diagnosis of cancer, many people want to make positive changes to their lives. Taking steps to live a healthier lifestyle is often a major part of these changes. This leaflet is for you if you re living with or after cancer and would like to stop smoking. This leaflet is divided into the following sections: Reasons to give up Making changes Preparing to stop Stopping Staying stopped Using medicines to help reduce cravings NHS Stop Smoking Services Further information. Giving up smoking 2

3 This leaflet is for you wherever you are on the cancer journey whether you ve recently been diagnosed, are undergoing treatment or have finished treatment. This leaflet is part of our series Living with and after cancer. It has information about the benefits of quitting, and practical advice about how you can stop smoking and stay stopped. We ve also included a list of organisations that will be able to give you the information, advice and support that you need to help you succeed. Reasons to give up If you re a smoker, choosing to stop is a decision that will benefit your health. Giving up smoking may be stressful and difficult to do, but in the long term it will help you feel better and be healthier. People smoke for a number of reasons. Most smokers do it because they find it relieves stress and helps them relax. Smoking can also be a source of support when things go wrong and can give a feeling of pleasure. These are all reasons why many people continue smoking once they ve been diagnosed with cancer. Living with cancer and its treatment can be very difficult, and you may feel you need all the support you can get, including smoking. Nobody can force you to give up the best reason to stop smoking is because you want to and because you feel ready to. Giving up smoking 3

4 Sometimes your doctor may advise you on the benefits of stopping smoking in your specific situation or for your type of cancer. Having an understanding of how smoking affects your health may also motivate you to stop. Smoking increases the risk of several types of cancer, including cancers of the lung, mouth, gullet, stomach, pancreas, kidney, bladder and cervix, and some types of leukaemia. It also increases your risk of developing many other health problems, including heart and lung diseases, strokes, circulatory problems, dementia, impotence and infertility. There s also some research that shows that smoking can make some types of cancer grow more quickly. This may be because smoking weakens the body s immunity and some of the chemicals in cigarette smoke may help the tumour to grow. Non-smokers have fewer side effects from cancer treatment than smokers. If you re having treatment for cancer, stopping smoking will help you with this too. It can help the body s ability to respond to treatment and heal. In general, non-smokers have fewer side effects from cancer treatment, and the side effects they do have tend to be less severe. Stopping smoking may also lower the risk of cancer coming back after treatment. Smoking is expensive, so quitting will also save you money. If you smoke twenty a day, you spend about 2,000 a year on Giving up smoking 4

5 cigarettes. Stopping means you ll have more money to spend on other things. Smoking causes premature skin ageing. Within a few weeks of stopping, your skin will look clearer and brighter. And straight away, your breath, hair and clothes will smell better. Smoking doesn t only harm your own health. People around you, who are exposed to second-hand smoke (called passive smoking), are also at a higher risk of getting smoking-related diseases. Making changes Children whose parents smoke are more likely to start smoking themselves. If you have children or grandchildren, you can become a good role model for them by quitting. Also, children of parents who smoke often worry about their parents health, so by giving up you ll be putting your children s minds at rest. There are three stages to giving up smoking, and we ll cover them all in this leaflet: 1. Preparing to stop. 2. Stopping. 3. Staying stopped. Giving up smoking 5

6 Preparing to stop Deciding to give up smoking and really wanting to succeed are important steps in becoming a non-smoker. Giving up smoking isn t easy. But you can increase your chances of success by preparing for possible problems in advance and making sure you have support in place to help you overcome them. It can help to: Make a list of your reasons for stopping. You can use this to motivate yourself at times when you feel tempted to smoke (see page 21). Set a specific date to stop. Smoke as normal and don t cut down on the number of cigarettes you smoke before that date. Then stop suddenly on your set date. Get support. Talk to people who can give you help and support to quit. This might include your family, friends and colleagues. Tell them you ve set a date when you ll stop smoking. Think about whether someone you know wants to give up too perhaps you could do it together and encourage and support one another. Your doctor or pharmacist is an important person to talk to they can offer practical help and advice and refer you to a free local stop smoking service. You could also call a stop smoking helpline. See pages for a list of helpful contacts. Giving up smoking 6

7 The consultant said, You need to quit smoking, which gave me the jolt I needed. And I thought, Oh I m going to do anything I can to just end all this. And my partner didn t have much choice because I said, Right, if I m stopping, you re stopping. Use medicines to help reduce any cravings. The first 3 4 days after you ve stopped, when your body is feeling the effects of nicotinewithdrawal, can be the most difficult. There are medicines (see pages 13 15) that can improve your chances of success in overcoming withdrawal effects. Your GP or NHS Stop Smoking Adviser can talk over the options with you. If you plan to use medicines to help you cope, make sure that you get them well in advance of the date you plan to give up on. It s best to start taking medicines like bupropion and varenicline (see pages 14 15) 1 2 weeks before you quit. Try to find other ways of dealing with stress. The shock of being diagnosed with cancer or coping with treatment can make it harder to quit, because many smokers use cigarettes to cope with stress. Other ways of coping with stress include exercising, using relaxation Giving up smoking 7

8 It may help you to talk things over with someone you trust. or meditation CDs, and talking things over with someone you trust. Some people use hypnotherapy or go to classes to learn relaxation or meditation techniques. If you think stress may be a problem for you, ask your specialist nurse or GP for advice. Our booklet Cancer and complementary therapies also has information on ways of coping with stress. Set yourself goals. These could include getting through the first day, week and month smoke-free. Plan rewards for yourself when you set your goals. Put aside the money you d otherwise have spent on smoking. Use it to treat yourself or your family instead. Get rid of cigarettes, ashtrays and lighters. Do this the day before you give up. Also check the house, the car and your clothes for any stray cigarettes. Buy a supply of healthy, nonfattening snacks. These could include fruit and sugar-free chewing gum. Plan your first smoke-free day. Decide what you re going to do instead of smoking during breaks at work or when you feel stressed. Giving up smoking 8

9 Giving up smoking 9

10 Stopping It may help to change your routine. If possible, stay away from places or situations that you associate with smoking. If you always want to light up when you have a cup of coffee, try drinking tea. Avoiding alcohol to begin with is also a good idea. People often find their willpower is weaker after a drink or two. You may be tempted to snack more once you ve stopped smoking. Eat whatever you like on the day you give up. It s better to focus your willpower on one issue at a time. If you re worried about weight gain, keep healthy, non-fattening snacks to hand. A stress ball may help if you need to do something with your hands. Or you could take up an activity, like knitting, gardening or playing computer games, to keep your hands occupied and take your mind off cigarettes. If your doctor has prescribed medicines to help you give up, use these as prescribed. Let your doctor know if you have any problems with them. Giving up smoking 10

11 Staying stopped It can take up to three months to become a non-smoker, but it usually takes less time. The physical and psychological withdrawal symptoms in the first few days can be very hard to cope with, but they ll improve every day that you don t smoke. Take things one day at a time. The following things can help: Choose to spend time with non-smokers and ex-smokers who will support your efforts to quit. Replace smoking with other activities that you enjoy. Remind yourself of your reasons for giving up. Carry the checklist of your reasons for stopping smoking (see page 21) with you, so you can refer to it if you need to. Quitting is a commitment that you have made to yourself and, while it requires strong willpower, it also has huge benefits. Mark off the days since you first stopped on your calendar, so you can see how well you re doing. Reward yourself. Use the money you would have spent on smoking to buy yourself something you ll enjoy. You might want to use some of the money to buy little treats each week, like CDs, going for a nice meal or having a massage. You might also want to save towards a bigger reward, like a special night out or a holiday. Giving up smoking 11

12 Be aware of temptations to smoke. Have nicotine gum or tablets available for social situations that might tempt you to smoke. Make a deliberate effort to avoid the shops where you used to buy your cigarettes. Don t be too hard on yourself if things don t go smoothly at first. Don t give up trying to stop smoking, even if you don t succeed the first time. Most people need several attempts before they stop completely. Remember that giving up smoking is hard enough for most people. But when you re giving up after a cancer experience it can seem even tougher. You may have side effects to cope with, or other worries caused by the cancer or its treatment for example problems with work, money or relationships. So don t be too hard on yourself if things don t go smoothly at first. Try to make sure you get as much support as possible. Giving up smoking 12

13 Using medicines to help reduce cravings Nicotine replacement therapy (NRT) It s often the physical craving for a cigarette that causes people to start smoking again. There s a range of different treatments available to help you cope with the symptoms of physical withdrawal. Using medicines to help reduce cravings can double your chances of success. And if you combine a stop smoking medicine with an NHS support service, you re up to four times more likely to become a non-smoker. NRT works by giving your body enough nicotine to ease withdrawal symptoms and cravings when you stop smoking. It comes as skin patches, chewing gum, tablets, lozenges, inhalers, mouth (oro-mucosal) sprays and nasal sprays. You can buy these products over the counter or you can get them on prescription from your GP or NHS Stop Smoking Service (see page 17). Using NRT doubles your chances of stopping smoking. I quit on my own for a week. And by the end of that week, I was really on edge. And I thought, Well if I don t get some sort of help, I m going to end up smoking again. So I rang the NHS, and I went on the patches. That was brilliant and I ve quit for nine months now. Giving up smoking 13

14 Bupropion (Zyban ) Zyban is a non-nicotine tablet that works by reducing the urge to smoke and other withdrawal symptoms. It s not suitable for everyone and is not recommended for people who have had brain or spinal cord tumours or a history of seizures (fits). You start taking the tablets 1 2 weeks before you stop smoking, and a course usually lasts for 7 9 weeks. The tablets are only available on prescription. Certain medicines should not be taken with Zyban, so it s important that it s prescribed by a doctor who knows your full medical history and which other medicines you re taking. Some people have reported feeling depressed whilst taking Zyban, but this could also be due to the symptoms of withdrawal from smoking. It s important that you tell your doctor if you feel depressed or have suicidal thoughts during treatment with Zyban. I went to my GP, I did a written programme of my intention to give up smoking and was started on Zyban, which personally I found marvellous. Giving up smoking 14

15 Varenicline (Champix ) This is another non-nicotine tablet that can help relieve craving and withdrawal symptoms when giving up smoking. Champix is only available on prescription. You start taking the tablets 1 2 weeks before you stop smoking. A course of treatment usually lasts for 12 weeks. As with Zyban, some people have reported feeling depressed while taking Champix. It s important that you tell your doctor if you feel depressed or anxious or have suicidal thoughts during treatment with Champix. Like all medicines, NRT, Zyban and Champix have potential side effects. Read the information leaflet that comes with the drugs. Your doctor or pharmacist can give you more information about these treatments. Giving up smoking 15

16 16

17 NHS Stop Smoking Services NHS Stop Smoking Services can really make a difference to your chances of success. Research shows that people who use them are twice as likely to succeed as people who try to give up on their own. Speak to your doctor or call a stop smoking helpline (see pages 19 20) for further advice and to find out where your local Stop Smoking Service is. NHS Stop Smoking Services provide specialist treatment for those wanting to quit. The staff who deliver these services: provide information about smoking and giving up help you prepare a plan for quitting give ongoing support prescribe medicines to help improve withdrawal symptoms arrange weekly meetings where you can meet other people who are trying to give up. I only went to a couple of meetings. I mean you could phone any time you want, but I didn t need that much help. I just knew that I needed something. Giving up smoking 17

18 Further information We hope this leaflet has helped you understand more about giving up smoking and how it can help your health. We have more information about cancer types, tests, treatment and living with and after cancer. We also have details of other helpful organisations and support groups in your area. You can contact us using the following details: Macmillan Cancer Support 89 Albert Embankment, London SE1 7UQ Questions about cancer? Call free on (Mon Fri, 9am 8pm) Alternatively, visit macmillan.org.uk Hard of hearing? Use textphone , or Text Relay. Non-English speaker? Interpreters available. Giving up smoking 18

19 Other support services NHS Smokefree England helpline Scotland helpline Wales helpline Northern Ireland helpline Isle of Man helpline All helplines are open Mon Fri, 9am 8pm, Sat Sun, 11am 5pm. Get free support, expert advice and tools including the Quit Kit to help you stop smoking. Watch videos from real quitters on what helped them stop. NHS Asian Tobacco Helpline Urdu helpline Punjabi helpline Hindi helpline Gujarati helpline Bengali helpline Speak to an adviser in your preferred language. All helplines are open Mon Fri, 9am 8pm, Sat Sun, 11am 5pm. Giving up smoking 19

20 NHS Smokefree Pregnancy Helpline Tel (Mon Fri, 9am 8pm, Sat Sun, 11am 5pm) smoking-and-pregnancy Get specialist advice and support when going smokefree during pregnancy. QUIT Curtain Road, London EC2A 3NF Helpline Bengali helpline Gujarati helpline Hindi helpline Punjabi helpline Urdu helpline Turkish and Kurdish helpline (Thurs and Sun, 1 9pm) Counselling Provides support and practical guidance to people who want to give up smoking. Giving up smoking 20

21 Notes You can use this page to list your reasons for wanting to give up smoking, and to motivate yourself at times when you feel tempted to smoke. Giving up smoking 21

22 Disclaimer We make every effort to ensure that the information we provide is accurate, but it should not be relied upon to reflect the current state of medical research, which is constantly changing. If you are concerned about your health, you should consult a doctor. Macmillan cannot accept liability for any loss or damage resulting from any inaccuracy in this information or third-party information, such as information on websites to which we link. We feature real-life stories in all of our articles. Some photographs are of models. Thanks This booklet has been written, revised and edited by Macmillan Cancer Support s Cancer Information Development Team. It has been approved by our medical editor, Dr Terry Priestman, Consultant Clinical Oncologist. With thanks to: Prof Tim Eisen, Professor of Medical Oncology, Cambridge University Hospitals NHS Foundation Trust; Maria Gaiger, Acting Service Manager, Sutton and Merton NHS Stop Smoking Service; Dr Nicholas Hopkinson, Honorary Consultant Chest Physician, Imperial College; Amanda Sandford, Research Manager, ASH; Vishnee Sauntoo, Marketing Director, No Smoking Day; and the people affected by cancer who reviewed this edition. Patient quotes sourced from Healthtalkonline Sources electronic Medicines Compendium. (accessed December 2011). Guide to quitting smoking. American Cancer Society. documents/webcontent/ pdf.pdf (accessed December 2011). National Comprehensive Cancer Network. smoking-makes-prostate-cancer-deadlier--study.html (accessed December 2011). Ostroff J, Dhingra L. Smoking cessation and cancer survivors. Handbook of cancer survivorship Springer. New York. Public health guidance 10, smoking cessation services in primary care, pharmacies, local authorities and workplaces, particularly for manual working groups, pregnant women Giving up smoking 22

23 and hard-to-reach communities. February National Institute for Health and Clinical Excellence (NICE). Schottenfield D. Cancer epidemiology and prevention. 3 rd edition USA. Oxford University Press. Smokefree. (accessed December 2011). Smokers have slimmer odds of surviving colon cancer. National Comprehensive Cancer Network. (accessed December 2011). Smoking cessation advice for adults over 18. Smoking cessation can reduce late side effects of radiotherapy. OncologySTAT. Radiotherapy_US.html (accessed December 2011). Varenicline for smoking cessation. July National Institute for Health and Clinical Excellence (NICE). Giving up smoking 23

24 Cancer is the toughest fight most of us will ever face. If you or a loved one has been diagnosed, you need a team of people in your corner, supporting you every step of the way. That s who we are. We are the nurses and therapists helping you through treatment. The experts on the end of the phone. The advisers telling you which benefits you re entitled to. The volunteers giving you a hand with the everyday things. The campaigners improving cancer care. The community supporting you online, any time. The fundraisers who make it all possible. You don t have to face cancer alone. We can give you the strength to get through it. We are Macmillan Cancer Support. Questions about living with cancer? Call free on (Mon Fri, 9am 8pm) Alternatively, visit macmillan.org.uk Hard of hearing? Use textphone , or Text Relay. Non-English speaker? Interpreters available. Printed using sustainable material. Please recycle. Macmillan Cancer Support, nd edition. MAC Next planned review Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604).

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