癌専門医は患者の禁煙を支援すべきである
米国臨床腫瘍学会（ASCO）は7月29日、約10億人と予想されている、今世紀中の全世界における喫煙による早期死亡者数を低減するための、広範な戦略の概要を発表した。ASCOの機関誌であるJournal of Clinical Oncologyに発表されたASCOの方針声明書は、社会政策の必要性、医療サービス提供者、ならびに、禁煙や禁煙のための介入に関する研究に焦点を合わせている。
禁煙指針の第一ステップとして、ASCOは、Tobacco Tax Equity Act（タバコ税公平法）案を支持する立場を表明した。これは、パイプタバコと紙巻タバコに対して平等に課税することによって、税金面での抜け穴をふさぐ法案である。研究では、タバコ製品の価格の上昇に伴って、喫煙者が禁煙する確率が高まることが明らかになってきている。
喫煙は、世界における予防可能な癌の主要な発症原因となっており、1999年から2004年までの期間中には、喫煙に起因する癌を発症した患者数は、約240万人に達していた。また、喫煙が、癌の診断後にも、治療の有効性を低下させ、第二の癌の発症リスクを増加させることも明らかになってきている。さらに、喫煙は、癌治療の副作用を増強する可能性もある。
ASCOの会長は、「喫煙が癌の発生率や癌患者の死亡に対して多大な影響を及ぼすことを示す、明白なエビデンスが得られてきていることから、患者による禁煙を支援することや、あらゆるタバコ製品の使用に反対することは、癌専門医としての我々の責務である」と述べている。
【関連リンク】
ASCO Announces Ambitious New Agenda for Tobacco Cessation and Control
ASCO Announces Ambitious New Agenda for Tobacco Cessation and Control
FOR IMMEDIATE RELEASE:
July 29, 2013
Contact:
Amanda Narod
571-483-1364
amanda.narod@asco.org
World's leading oncologists call for enhanced public policies, robust research agenda and provider leadership to combat global tobacco crisis
ALEXANDRIA, Va. - The American Society of Clinical Oncology (ASCO) today outlined a far-reaching strategy to reduce the premature deaths of nearly one billion people worldwide expected this century due to tobacco use. ASCO's Policy Statement, published in the Journal of Clinical Oncology, focuses on public policy needs, provider education and research on tobacco cessation and control interventions. This is ASCO's first update to its tobacco control statement since 2003.
As a first step toward implementation of its tobacco control agenda, ASCO also announced its endorsement of the proposed Tobacco Tax Equity Act, which would close tax loopholes by taxing pipe and cigarette tobacco equally. Research has shown that smokers are price sensitive, and are more prone to quitting tobacco use as the price of products rise.
ASCO's statement and legislative endorsement come at a time when nearly 85 percent of oncology providers believe tobacco cessation should be a standard part of cancer care, but cite barriers to facilitation including lack of training and patient resistance. These findings are the result of an ASCO member survey on provider attitudes toward tobacco cessation, published today in the Journal of Oncology Practice.
"Given the indisputable scientific evidence that tobacco poses a huge burden in cancer incidence and death worldwide, it is our responsibility as cancer doctors to help our patients quit and oppose tobacco use in all its forms," said Clifford A. Hudis, MD, FACP, President of ASCO. "We are deeply committed to proactive tobacco control and have set an aggressive agenda for moving forward in this critical area."
ASCO's Recommendations
Strengthen education of healthcare providers during medical school and through continuing medical education programs on proven strategies for tobacco cessation counseling;
Educate oncologists about the critical impact of persistent smoking by patients during their cancer care. Patients have longer progression free and overall survival if they are not smoking during their cancer treatment;
Close tax loopholes that tax cigarette and pipe tobacco differently;
Support legislative and regulatory efforts, such as an increase in excise taxes, clean indoor air policies to avoid second-hand smoke, and graphic warning labels on cigarette packages;
Support health plan coverage (with no co-pay or deductible ) and appropriate provider reimbursement for evidence-based tobacco cessation services, including counseling and quitlines (1-800-QUIT NOW in the USA), as well as FDA-approved cessation medications;
Expand tobacco cessation quality measurement and improvement efforts by healthcare providers, such as those included in ASCO's Quality Oncology Practice Initiative (QOPIR), which captures the integration of tobacco cessation into every day oncology practice;
Increase funding for research on tobacco control and more effective cessation interventions, as well as include tobacco use as a core data element in oncology clinical trials;
Increase global tobacco control through support of the Framework Convention on Tobacco Control (FCTC), the first public health treaty enacted worldwide by the World Health Organization.
"ASCO's recommendations provide a roadmap to stem the pandemic of tobacco-related cancers", said Carolyn Dresler, MD, chair of ASCO's tobacco control subcommittee. "This strategy will help significantly reduce human suffering improve cancer outcomes and ultimately save millions of lives from cancer besides many other tobacco related diseases over the next century."
Oncologists Must Lead by Example
ASCO's statement also calls upon all oncology professionals to refrain from using all tobacco products. Despite the overwhelming evidence about the dangers of tobacco use, the ASCO survey finds 24 percent of respondents reported smoking cigarettes at some point during their lifetime.
ASCO also urges providers to treat tobacco dependence as aggressively and compassionately as cancer, and to assist patients and their families to end tobacco dependency. To help oncologists implement these recommendations, last year ASCO released a tobacco cessation guide, which outlines evidence-based strategies to help patients quit tobacco use. The Society also offers providers scientific and educational sessions at its thematic and annual meetings on tobacco cessation counseling, impact of use on treatment, and policy and global implications related to smoking.
ASCO's patient website, Cancer.Net also provides patients and their family members with information on stopping tobacco use; the risk of pipes, smokeless tobacco and e-cigarettes; and the effects of secondhand smoke.
"Given that one-third of all cancer related deaths are caused by tobacco use and are preventable, ASCO is reaffirming its commitment to a tobacco-free world. We've made tremendous gains in cancer treatment and prevention. We can achieve even further progress by implementing stronger tobacco control policies and practices," Dr. Hudis said.
Tobacco use is the leading preventable cause of cancer in the world, contributing to nearly 2.4 million cases of cancer between 1999 and 2004. A growing body of evidence also suggests continued tobacco use after a cancer diagnosis reduces the effectiveness of cancer treatment and increase the likelihood of a second cancer. Smoking and use of other tobacco products may also worsen side effects related to cancer treatment.
Overall, tobacco kills more than 440,000 Americans each year - and more than four million people worldwide - shortening smokers' lives, on average, by more than seven years. If current trends continue, according to the World Health Organization and the World Bank, the global death toll from tobacco will grow to 10 million annually by 2030.
About ASCO
The American Society of Clinical Oncology (ASCO) is the world's leading professional organization representing physicians who care for people with cancer. With more than 30,000 members, ASCO is committed to improving cancer care through scientific meetings, educational programs and peer-reviewed journals. ASCO is supported by its affiliate organization, the Conquer Cancer Foundation, which funds ground-breaking research and programs that make a tangible difference in the lives of people with cancer. For ASCO information and resources, visit www.asco.org. Patient-oriented cancer information is available at www.cancer.net.
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