Some cancer patients still smoke. Here’s how UNC is trying to change that.

Carean Neal of Graham smoked as much as a pack and a half of cigarettes a day before quitting. He quit once, but when depression set in, he began smoking again.

About three and a half years ago, Graham was in Texas doing contract work for the military, installing communications systems in Humvees. He felt something in his throat. “I knew something was wrong,” Neal said. He said he told his coworkers, “I think I have cancer.”

He was diagnosed with stage four throat cancer at UNC’s Lineberger Comprehensive Cancer Center. Now 60, he is a cancer survivor. He underwent gruelling chemo and radiation therapy as part of his treatment, and went on the smoking cessation drug Chantix. But Neal also attributes his success in quitting to the UNC Nicotine Dependence Program and to the support he gets through the Lineberger Center’s Patient and Family Resource Center.

Neal said he has not smoked in eight months and the Resource Center’s support has been crucial. It offers books, massages, legal help and counseling. “I can get in touch with anybody at any moment if I need someone to talk me through it,” he said. “I cannot say enough about Susan Trout,” one of the certified tobacco treatment counselors with the Nicotine Dependence Program. When he has follow-up appointments at UNC, Trout shows up to check on him, he said.

The Lineberger Center will be looking at how social and family support can be used to convince people who have cancer but also use tobacco, like Neal did, to stop. Lineberger is one of 22 cancer centers in the country (including Duke Cancer Center) to receive a $500,000 grant from the National Cancer Institute through its Cancer Center Cessation Initiative.

UNC will use the grant to expand programs that help patients at the N.C. Cancer Hospital who use tobacco to stop. Researchers also will be looking at a new way to reach out to patients’ family members who smoke. The Lineberger Center will hire more staff to offer counseling and medication guidance. Researchers also will make use of the online program CHART to help more patients quit.

Nicotine addiction “is one of the most powerful addictions known,” said Adam O. Goldstein, a professor in the UNC School of Medicine’s Department of Family Medicine and member of the Lineberger Center. Patients who continue to smoke often “are in very strong social networks that use tobacco products,” which can also include family members, Goldstein said. That fact led researchers to want to know more about whether giving families the resources they need to quit tobacco would also help cancer patients, he said.

Working to understand support networks and their effects on tobacco use is an issue cancer researchers have not addressed, Goldstein said. “We’re one of the only groups in the country that is starting to do this,” he said.

More people are beginning to recognize the true addictive power of nicotine, said Trout, a tobacco treatment counselor with the UNC Nicotine Dependence Program. “Historically, people recognize that you have an addition to alcohol,” as well as cocaine and other drugs, Trout said.

But people have not always realized the power of tobacco addiction.“With tobacco, it’s like everyone says, Just quit,” Trout said. Many smokers try to quit on their own, but with counseling and medication “your chances of being successful are going to increase,” she said.

The grant will allow UNC’s treatment program to reach more people and create “more awareness of the importance of providing the support for patients using tobacco who have a cancer diagnosis ….” Trout said.

The grant money will allow cancer centers “to increase their resources for smoking cessation, to implement more comprehensive cessation services, and to provide those services to more patients being treated at their centers — what we call ‘reach,’” stated Glen Morgan of the National Cancer Institute on the organization’s website.

Neal lost 60 pounds during his cancer treatment, along with his sense of smell and taste. He has kidney disease, and is subject to falls. “It’s unbelievable how [cancer] takes your life,” he said.

Neal credited the support of people as well as UNC for his success quitting tobacco. The church “is the number one thing in my life, but that support group is also important,” he said. He has frequent appointments at UNC Hospitals, and always stops by the Patient and Family Resource Center. The center “is one of the most fantastic places to be able to sit and talk to someone,” Neal said. “If it wasn’t for that team ... I wouldn’t be able to make it.”

Neal is not able to work now. He has a son, 25, and a daughter, 32, and a granddaughter, who he said “had an impact on me quitting smoking.”

“I want people to know it’s dangerous,” he said of smoking. “You’re playing Russian roulette with your life. That’s why I wanted people to know ... there is help for it.”

This story was originally published January 22, 2018 at 6:00 AM with the headline "Some cancer patients still smoke. Here’s how UNC is trying to change that.."