Nicotine is addictive and cigarette smoke kills. Episode 25
As much as PLN 4.5 billion is spent annually on treating lung cancer patients. As many as 90 per cent of these patients are long-term tobacco smokers. In the latest episode of the podcast 'Po pierwsze Pacjent', Monika Rachtan talks to radiotherapist Dorota Kiprian, MD, PhD, on the topics of nicotine addiction, the gross effects of smoking and the costs involved in treating lung cancer patients in Poland.
Lung cancer as a chronic disease
Chronic disease in the case of lung cancer means that patients need to be treated for an extended period of time, often for life. Despite medical advances, a full cure from lung cancer is still rare. Patients often go through cycles of treatment, which can include surgery, chemotherapy, radiotherapy immunotherapy and molecularly targeted therapies.
Long-term treatment has its consequences. Patients experience side effects from medication and therapy, which can significantly affect their quality of life. In addition, there is always the risk of relapse, which brings with it constant fear and uncertainty.This is why prevention and prevention of lung disease is so important, especially by quitting smoking, which is one of the main risk factors for lung cancer. Giving up smoking can help to avoid chronic disease and its difficulties.
Smoking is hugely damaging to both individual health and society as a whole. Also from an economic point of view, the costs of treating smoking-related diseases are significant. Combating smoking and promoting healthy lifestyles are important aspects of efforts to improve quality of life and public health.
Combination treatment
In an interview with Dorota Kiprian, MD, PhD, it was emphasised that the fight against lung cancer is a long and demanding process that often does not result in a full cure. Combined treatment, based on the cooperation of specialists from different medical disciplines, such as surgeon, radiotherapist and clinical oncologist , is a key element in the fight against this chronic disease.
Many people suffer from lung cancer due to smoking, and complex therapies are often the only hope of prolonging patients' lives. Despite modern techniques and sparing healthy tissue, treatment has its side effects and the disease often returns, which introduces constant fear and uncertainty into the lives of patients and their families.
Challenges and complications of radiotherapy
In an interview with Dr Dorota Kiprian, the topic of complications of radiotherapy that can affect patients undergoing this effective but also complex treatment for lung cancer was raised. Radiotherapy, although effective in destroying cancer cells, can unfortunately adversely affect healthy tissues around the irradiated area, including the oesophagus. As a result, patients may experience difficulty swallowing and feelings of heartburn, leading to the need for a special diet. The episode's guest pointed out that lung cancer patients who continue to smoke during treatment risk a reduction in the effectiveness of treatment by up to 15 per cent. The fight against lung cancer is not only a medical challenge. It also requires the patient's cooperation and giving up smoking to increase the chances of successful treatment.
Public acceptance
Dr Dorota Kiprian, in an interview with Monika Rachtan, raises important issues related to smoke-free policies in Poland and the problem of smoking in society. It seems that despite the existence of measures and regulations aimed at reducing smoking, there is still a certain social acceptance of this habit , with serious health and social consequences.
When comparing the situation in Poland to more educated European societies, such as Scandinavia, we see significant differences in attitudes towards smoking and nicotine dependence. In these societies, there is greater awareness of the consequences of smoking, both for smokers and for those passively exposed to tobacco smoke. This reflects a civic approach that emphasises concern for the health of the general public.
Nicotine is an addictive drug, but it is legal and generates excise revenue for the state. This raises important questions about the consequences of current policies and the need for education on the issue.
E-cigarettes
E-cigarettes, also known as electronic cigarettes, are devices that allow users to inhale vapour containing nicotine or other flavourings. They are often seen as an alternative to traditional cigarettes, but have their own controversies and health risks.
There are still no studies available on the composition of e-cigarettes, especially those with nicotine, which often come in different flavours and colours. The lack of full knowledge on this subject creates some concerns. E-cigarettes, although they appear attractive and less harmful, still deliver nicotine, which can lead to addiction.
The availability of e-cigarettes in grocery shops is also a matter of concern, and their attractive appearance can be misleading, especially to younger people. These products are often sourced from China, where there is no effective control over their contents, increasing health risks.
In the context of changing mores, the acceptance of smoking, especially among younger people, may lead to the daily use of e-cigarettes, which may have long-term consequences for the health and behaviour of society.
Saying goodbye to addiction
The guest of the episode emphasises that there are different approaches to quitting smoking, and the first step is to be aware of your desire to stop. There is also a difference between people who are addicted to nicotine and those who smoke occasionally.
As with other addictions, there are therapeutic methods that can help to get rid of the addiction. These include anti-smoking counselling centres, psychotherapeutic support, or drug treatment with anti-smoking patches or other preparations. The effectiveness of these methods can vary from person to person. For some, achieving success may mean stopping smoking altogether, while others may benefit from less harmful alternatives such as nicotine pouches or tobacco heating systems.
The role of family support and the awareness that smoking addiction is a disease, just like drug addiction, is also emphasised. The right approach to each addict can help them to recover their health and quality of life.
Harm reduction
Modern tobacco heating systems offer an alternative to traditional cigarette smoking. The introduction of these systems under medical supervision is currently being implemented in the Czech Republic and the UK. It is reimbursed, which means that people who want to give up smoking traditional cigarettes receive medical support.
Heated tobacco systems differ from traditional cigarettes in that they do not generate smoke or burnt flavours, making them less harmful to health. However, as with 'traditional' e-cigarettes, there is a lack of research into the long-term effects of heated counterparts, due to their relatively short time on the market.
Harm reduction, or a harm reduction approach, is the preferred method for quitting smoking, which can be a major stressor for some patients, especially for cancer and psychiatric patients.
In Poland, as in other countries, interest in alternative methods of smoking is growing, It is an important public health issue and understanding patients' needs and addictions is key to smoking cessation and risk reduction.
Transcription
Monika Rachtan
Did you know that treating people with lung cancer caused by smoking costs us all £4.5 billion a year? Did you know that as many as nine out of ten cases of lung cancer are caused by smoking? Did you know that nicotine is as addictive as drugs? We will talk about these questions and many more in the next episode of Patient First. Here I am with my guest, Dr Dorota Kiprian, a specialist in radiotherapy. I invite you to watch this programme.
Monika Rachtan
Good afternoon. Monika Rachtan. I would like to welcome you to another episode of the programme "Patient First". Incidentally, smoking cigarettes can cost you up to PLN 600 a year. Your family of four spends this money on treating people with lung cancer caused by smoking, even though we have access to modern drug therapies in Poland. Unfortunately, many of these patients do not live long and often die. The Polish Academy of Sciences reports that currently 29% of the population smoke cigarettes. A few years ago, this percentage was 22%. Will we have to pay billions in the future to treat more people with lung cancer? This is what I would like to discuss with my guest.
Monika Rachtan
It is my pleasure to host Dr Dorota Kiprian today. She is a specialist in clinical oncology and treats lung cancer patients at the National Cancer Institute in Warsaw.
Dorota Kiprian
Good morning, Madam Editor. Good morning, ladies and gentlemen. I would just like to correct that I am an oncologist and a radiotherapist, but of course I treat patients at the National Institute in Warsaw. As a chief radiotherapy specialist, I am actively involved in the treatment of these patients.
Monika Rachtan
Doctor, how does the dying process of a smoker work?
Dorota Kiprian
I wouldn't want to portray it too drastically, but it is certainly not a pleasant death. Most often, smokers die from shortness of breath, pulmonary oedema and breathing problems. It is like a drowning man who is unable to catch his breath. This is the way smokers die.
Monika Rachtan
How many people in Poland die annually from lung cancer?
Dorota Kiprian
Unfortunately, these statistics are frightening. Today, thanks to modern drug therapies, the treatment of lung cancer has improved somewhat, but there are still too many patients dying. There are now fewer deaths, but there is an increase in cases of chronic disease. This means that patients are living longer with active cancer. They are not dying immediately, which was the case a few years ago. It was higher before. Currently, the overall mortality rate for lung cancer is decreasing, but the number of chronic cases is increasing. This means that patients are treated proactively, have a certain period of peace of mind, but the disease returns, leading to long-term treatment. Unfortunately, such treatment has side effects that affect patients' quality of life.
Monika Rachtan
I recall that our programme is aimed at patients, so I would like to know more about how a patient goes through this difficult process of lung cancer treatment. I understand that he or she has to go through a lengthy diagnostic process and undergo intensive treatment that affects his or her entire body, as well as every cell in his or her body. In addition, unfortunately, this disease can lead to death. Does it follow from this that it is not worthwhile to smoke?
Dorota Kiprian
It definitely does not pay to smoke. It has negative consequences both economically and in terms of health. The costs of cigarettes are enormous. In addition, the health consequences are catastrophic. Diagnosis and getting a diagnosis are traumatic for both the patient and his or her family. I would like to emphasise that it is not only the patient who suffers from cancer, but the whole family. The fear, pain and side effects of treatment affect everyone. Patients often think that there is no chance of curing them and smoke even during treatment, which lowers their chances of recovery by 15%. This is irresponsible and the wrong approach. Cancer affects the whole family and the patient's life. Although treatment can help, the fear and uncertainty associated with the disease remains throughout.
Monika Rachtan
I just wanted to ask how cancer patients react when they find out they have cancer, a disease that no one wants to have and that no one suspected could affect them. When they come to the doctor's office, they are given a diagnosis and the doctor asks them if they have stopped smoking. Have you been smoking? I used to smoke. Do you still smoke? I smoke. You have cancer. Do you still smoke? Sometimes these patients lie that they don't smoke anymore.
Dorota Kiprian
Of course we do. Now, when we publish certain scientific articles, we always try to collect information on whether patients smoked or not. If we describe a particular group in our publications, we report that the data are incomplete because patients do not always tell the truth. This is a reality. There are patients who are more aware and try to help themselves. However, there are also those who think that since they already have cancer, they can afford to smoke and drink because they will die anyway. This is a mistake, as they should realise that working together with their doctor can help in effective treatment. Smoking during treatment reduces the effectiveness of treatment by 15%, which is a significant decrease, and also increases the risk of complications, especially with radiotherapy, where the skin is burned. Imagine a wound on the skin that is subjected to fire. Such a wound will never heal.
Dorota Kiprian
In addition, after radiotherapy, patients may experience oral and oesophageal mucositis and exposure to nicotine smoke.
Monika Rachtan
I find it hard to imagine someone going through such a difficult treatment and still having the strength to go smoke while opening a window on a hospital toilet.
Dorota Kiprian
That's what I call stupidity, sorry for the expression, but it's true. We can't be stupid, we have to help ourselves and we can do that. Besides, while loving ourselves, we should also take care of our family. We can't let our family worry more about our sick people once we get sick. We should care more about them. Sometimes I feel that patients lack this.
Monika Rachtan
At the beginning, we talked about the cost, that 4.5 billion or even 5 billion zloty is spent annually from the budget to treat lung cancer patients. Cigarettes do not only cause lung cancer, but also other diseases, such as heart disease. I would also like to raise the subject of head and neck cancers, the treatment of which is probably expensive. Is this budget significantly higher than what I mentioned at the beginning? We get sick and we have the possibility of effective treatment in the country thanks to great specialists and drug programmes that give access to modern therapies. Society supports our treatment. All of us, regardless of our illnesses, are committed to this treatment. However, we are acting unfairly by smoking because someone is paying for our treatment and we are harming ourselves. This is unfair. It is not just that we are cheating ourselves. We are being unfair to doctors, but also to society as a whole.
Dorota Kiprian
This is a problem of Polish society. Every society is different, but few of us think about the cost of treatment. Patients often don't understand this, and they also don't realise that quitting smoking can help not only with treatment, but also with reducing costs. Sometimes it seems that patients should pay higher health premiums if they continue to smoke. This would be more fair to people who are trying to live healthy and minimise the risk of disease. No one is immune to disease, but we can reduce the risk. Unfortunately, we often see a lack of reflection and nonchalance in the attitude that we will be treated anyway. We should be aware of how much our treatment costs.
Dorota Kiprian
Treatment is not free, someone has to pay for it.
Monika Rachtan
Of course. Some people argue that they pay excise duty when they buy cigarettes, so they get involved too. I'm not sure how much a packet of cigarettes costs, but it's probably around 20 zloty. If someone buys 7 packs a week, that's already a considerable amount, 140 zloty. That almost equals the cost of the treatment I mentioned earlier.
Dorota Kiprian
The excise duty is only a minimum revenue, and not all the money goes to health care. This is unfair behaviour on the part of the state, which derives revenue from it. This is true. I learned from a great psychiatrist professor that nicotine is the most addictive, comparable to drugs. This is not talked about in our country.
Monika Rachtan
Yes, in our country, the topic is rarely addressed in this way. Many countries have better smoking cessation results than in Poland. In our country, the percentage of smokers of traditional cigarettes is increasing, and young people are switching from e-cigarettes to traditional cigarettes.
Dorota Kiprian
Yes, e-cigarettes are also a big problem. I admit that I don't follow this topic, but I think e-cigarettes are just as harmful as traditional cigarettes, especially since most of them are made in China. We don't know exactly what we are smoking.
Monika Rachtan
Are there studies that consider this differently? If I would like to become an e-cigarette manufacturer, would I have to meet any special requirements to produce and distribute them in Poland?
Dorota Kiprian
This is precisely the problem that they do not. There are no studies that address those substances present in e-cigarettes, especially those containing nicotine, which are often coloured and have different flavours and aromas. There are no studies that determine exactly what is in them. A few years ago, there were high-profile incidents in the United States where e-cigarettes were linked to fatal incidents and lung damage caused by substances in which nicotine was dissolved. E-cigarettes heat up these substances, releasing nicotine. Nevertheless, I believe that we should try to avoid smoking cigarettes altogether. It is a disease and some people are addicted to nicotine, so we need to help these patients. There are methods that can help, but first of all you have to want to stop smoking.
Monika Rachtan
Can e-cigarettes and other smoking-related products be found in the chain grocery shops that are common in Poland? Parents may often not be aware of what is available in such shops.
Dorota Kiprian
Yes, unfortunately such products are available in grocery shops. I haven't looked at it closely, but I know that you can find e-cigarettes, often very colourful and attractive to young people. What surprised me, however, were the chewing gums shaped like cigarettes that mimic the gesture of smoking. This is very dangerous and available in grocery shops. These e-cigarettes are often imported from China, where there is a lack of proper control over quality and substance content. By smoking such e-cigarettes, we put ourselves at risk of unknown health effects.
Monika Rachtan
Children often convince their parents that e-cigarettes are not so bad, and parents may not realise the risks. I observe young people on the streets using these devices almost all the time, without even taking them out of their mouths. Do you have a similar impression?
Dorota Kiprian
Yes, I notice changes in customs. It used to be unacceptable for a woman to walk down the street with a cigarette. It is worth remembering good habits, such as looking after a healthy spine, which have been passed down from generation to generation. Nowadays, young people smoke in public, which is unacceptable. We need to ensure education and health awareness that life at 50 or 60 can be full of joy if we take care of our health. Smoking is just one of many harmful practices. Movement, healthy eating habits and avoiding alcohol abuse are equally important aspects.
Dorota Kiprian
Let us remember that anti-smoking campaigns that use drastic images on cigarette packets are no longer effective. It is important that we ourselves want to take care of our health. There are many methods to help you quit smoking, but the most important thing is the desire.
Monika Rachtan
Could you share with your audience one simple method that can help you quit smoking?
Dorota Kiprian
Of course, I will try. The first step is to realise that we want to stop smoking. There are different methods, but the choice depends on the degree of addiction. Some smokers are not addicted and can try to quit on their own. Others need support and may benefit from therapy or anti-smoking medication. The key, however, is a strong will and determination.
Monika Rachtan
How do you know if he is addicted? Because I think here, if we asked the ten people in front of us who among you smokes, they would all raise their hand, who is addicted to smoking. Well, I am. I can't quit. Tomorrow only, when it came down to it....
Dorota Kiprian What for? It turns out that some people can put down a cigarette because they stop feeling the need to smoke. Of course, it is pleasant to have a coffee and a cigarette, and even more pleasant at a party to have a glass of wine or a drink and a cigarette. It is such a pleasure. But there are also those who say, "OK, I'm not going to smoke, what's the problem?" They will go through two or three days, and they no longer feel the need for a cigarette. There are also those who have somatic complaints due to the lack of nicotine in the body. I have had friends who have had real difficulty quitting nicotine. There are anti-smoking counselling centres, but unfortunately there are not enough of them in Poland, only three, and they are not always available. The NFZ has also reduced reimbursement for anti-smoking counselling.
Monika Rachtan
They want to make money out of us.
Dorota Kiprian Yes, they are trying to make money out of us. They found that there were not enough people willing to stop smoking, so they decided to limit the availability of this advice. However, I think it should be done differently. Of course, there are also different methods of support, such as psychotherapy and family support, which is very important. It's worth it, isn't it? Family support? But it's not always enough. "Why do you smoke? Why do you need it?" This is not support for addicts because it's not such a simple matter. There are also medications and anti-smoking patches.
Monika Rachtan Do they work?
Dorota Kiprian They work for some, it is true. But they are expensive and not reimbursed. Their effect lasts for a few months, but unfortunately they stop working after that. They are also not effective for everyone. There are many different individual responses. With personalised medicine, we should approach each person individually. For some they help, for others they don't. But if they work for you, then great, you have succeeded in quitting smoking. There are also modern methods of delivering nicotine without burning tobacco. In Scandinavia, nicotine pouches that are placed in the mouth are popular. This delivers nicotine, but without smoke. Nevertheless, they are available in Poland, but unfortunately not reimbursed.
Monika Rachtan Government encourages.
Dorota Kiprian Yes, the government is encouraging people not to smoke regular cigarettes. What is happening in Sweden? There, 30% of the public use nicotine, but only 5% smoke traditional cigarettes.
Monika Rachtan That is, only 5% will die from lung cancer.
Dorota Kiprian Yes, and will spare their loved ones. Importantly, the Czech Republic and the UK are also following this path. Switching to heated tobacco systems is controlled by doctors there and reimbursed. However, it is not that simple, as some people still reach for traditional cigarettes. Therefore, there are modern methods of nicotine delivery that are safer and cheaper.
Monika Rachtan Still, the goal should be to quit smoking.
Dorota Kiprian Yes, quitting smoking should be a goal for every smoker. However, some people need support and substitutes to achieve this goal. It is also worth considering that some mentally ill or cancer patients smoke more. For them, smoking is a way to cope with stress and internal pain. Therefore, a 'quit immediately' approach does not always work. I am an advocate of the harm reduction approach, which is to say that if you already smoke, choose something less harmful. In the case of cancer patients who are going through difficult treatment, they should not be additionally forced to give up cigarettes. For some, this can be too much stress. It is important to offer them alternatives that are less harmful.
Monika Rachtan
However, this money can convince Poles. We always want to save, but now they are cheaper, aren't they?
Dorota Kiprian
No, they are not.
Monika Rachtan
So why are state policies failing?
Dorota Kiprian
Which state? Well, not really the state here. And yet, ladies and gentlemen, if you could see the garland of patients walking out of the National Cancer Institute to the nearest shops to buy cigarettes.
Monika Rachtan
This very car park is always overflowing outside the National Cancer Institute. That's where patients come, not only lung cancer patients, but also women with breast cancer. And this also has an impact on this smoking. Also just patients suffering from head and neck cancers. These are the kind of diseases that I think we didn't hear much about even 10-15 years ago. Cancer of the tongue, cancer of the throat, cancer of the larynx - these were not cancers that there were many of, and today there are a lot of them.
Dorota Kiprian
And one more thing. It should be mentioned that nicotine, that is to say normal cigarettes, because here we are talking about nicotine smoke, also causes bladder cancer, stomach cancer, oesophageal cancer and many other cancers. It's not just about lung cancer or laryngeal cancer. So, it's really a lot of different cancers that indirectly depend on smoking nicotine, traditional cigarettes. If we want to help ourselves, let's help ourselves wean ourselves off nicotine in general or harm reduction. That's what harm reduction is - reducing harm, not only to yourself but also to society, so that you don't expose others to smoke.
Monika Rachtan
What are the three most important things from our conversation today that everyone who watched the programme should remember? And I'm not just thinking of smokers here, but I'm thinking of society as a whole, including those people who don't have a nicotine addiction.
Dorota Kiprian
I believe, Madam Editor, that firstly, we should not look down on smokers with such acquiescence and pay attention in any place where a smoker may disturb others with this nicotine smoke. We have the right to live in clean air. Secondly, if there is no point in reaching for nicotine because it is indeed addictive, then everyone should understand that a person addicted to nicotine is simply a drug addict. Yes, it is the same thing. And you can fall into a very big addiction that slowly kills you, just like drugs. They kill faster and exclude you from family life very quickly. The third thing - it's worth living a long and healthy life, and that's something we can influence.
Monika Rachtan
I was still thinking about what the Doctor said, and I imagined such a Christmas family gathering. We're all sitting around the table, and someone says: "I'm going to go out for a cigarette", and everyone says: "Well he went out for a smoke", not like we would say: "I'm going out for a coke".
Dorota Kiprian
Or on the dash. Yes, yes.
Dorota Kiprian
Yes, this is something we should remember. Now watching old films, for example on an aeroplane, smoking cigarettes is unthinkable.
Dorota Kiprian
People were opening windows on buses and smoking.
Dorota Kiprian
So let us move in that direction so that we are a healthy society. We are not a civil society. Let's move in the direction of health. There are so many beautiful places to spend time instead of queuing to see a doctor. Let's do everything so that we don't have to go to the doctors.
Monika Rachtan
We also talk a lot about the humanisation of medicine in our programme. I think this whole conversation has been about the humanisation of medicine, humanisation in general. If you were to say, from the perspective of the specialty you practice, what is the humanisation of medicine?
Dorota Kiprian
I think what we have started to do now is about that. There has been a lot of talk recently about approaching the patient as a whole person. To make him or her feel cared for and to go through his or her treatment journey in the right way, with the involvement of qualified professionals. This is humanisation, treating the patient as a being and not just as a person to be treated. This is our approach.
Dorota Kiprian
This is what is called a comprehensive approach to the patient. Now at the National Cancer Institute we have a special team of radiotherapy technicians who explain the whole treatment process to patients so that they are not afraid. Everything is done in a nice environment, which is important. Let's get through these difficult stages so that we can recover later.
Monika Rachtan
You mentioned medical nutrition. I would like to remind our viewers who have not watched previous episodes of our programme that we also had as a guest Dr Aleksandra Kapala from the National Institute, who talked about nutrition in cancer. We recommend this episode if you are interested in this topic. Doctor, thank you very much for today's meeting. I hope we have convinced everyone that it is not worth smoking cigarettes and that we need to fight nicotine addiction. If you enjoyed today's episode, please feel free to subscribe to the channel and comment. If you have questions, I will pass them on to the Doctor and we will try to help.
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