Dilemma of a doctor – A 44 year old tobacco chewer with advance stage of cancer – should he be asked to quit tobacco???
Author – Dr. Monalee Prasad, BDS(2007), PGD in Aesthetic Dentistry (2009),TII -IDA(2020) ,OCTC (2021), CTCS (2021).
This is a case of a 44 year-old male patient suffering from Stage IV recurrent oral cancer with extensive neck and systemic metastasis. He was being treated somewhere in Uttarakhand. He attended OPD for treatment. He has been a chronic chewer and smoker for years and he continues to do so even after being diagnosed with advanced cancer with a short life expectancy. Besides the palliative treatment, the big question is about his tobacco – Should we ask him to quit? Or should we not ask him to quit?
How should we plan his treatment with regards to tobacco cessation?
The case was put for discussion during the tutorial for Certified Tobacco Cessation Specialists were – different difficult cases that we come across in Tobacco Cessation practice and their treatment are planned. It was a mixed opinion with more suggesting that the patient should be told to quit tobacco.
The same question was put in the group who are actively working for tobacco control and the majority said that the above patient needs to quit so that the treatment will be helpful and the organs will respond better to treatment.
Now opinion from group of oncologists was seeked, unanimously they said there is no need for him to quit tobacco.
The argument put forth by was that with Stage IV cancer there is no hope of his long survival and it will not be of much help at this juncture to force him to quit. Also the handling of withdrawal symptoms is more difficult in this case along with the Palliative care that has to be provided. It will not improve the quality of life of this already dying patient.
Hence, it wouldn’t matter whether we advise him to quit or not. It would be his wish.
Also, in case we are able to convince him to quit; there are two case scenarios which were discussed and how we can use it as a positive messaging for the next generation.
One scenario is where he is able to quit completely and then the message that can be conveyed through him that even though he suffered from taking tobacco and has reached the last stage of his life, he could quit his habit with the help of our esteemed doctors. And if he can do it, anyone at any stage can do it and the sooner one quits, the better it is for health.
Second case scenario is when he is unable to quit despite all the efforts by the doctors and himself and he continues to smoke till his last breath. The message that we can pass on in this situation is that Tobacco is a deadly disease and really addictive one. Message is clear for the youngsters and family members – never to start such a habit and quit as early as possible. BE SMART DO NOT START and if you have then please QUIT.
So, an important learning was shared via this case by Dr. Pawan as to how to choose the messaging we need to convey to the society at large and always choose the treatment keeping the patient’s overall benefit in mind.
Medical treatment is available to quit tobacco and treatment from the cessation specialists should be seeked.
Do share your thoughts on this in the comments below? What would be your choice of treatment?