Catherine A. Hogan, MSN, ANP-C, CTTS, is a Duke Cancer Institute nurse practitioner, who treats esophageal and lung cancer patients and has been treating adult patients in the Lung Cancer Screening Clinic since it was launched by DCI in 2011.
“The whole goal of disease prevention is to decrease mortality,” Hogan said. “Primary prevention means just avoiding the risk altogether, in the case of lung cancer, avoid smoking. Primary prevention will save more lives than secondary prevention. We know that. Secondary prevention is what I do — lung cancer screening and smoking cessation counseling and treatment. Everybody I see in the lung cancer screening clinic has a high risk for lung cancer based on age and smoking history.”
In 2020, about 1,600 low-dose CTs for lung cancer screening were conducted across the Duke University Healthcare System; the majority at the two dedicated lung cancer screening clinics — Duke Cancer Center Durham and Duke Cancer Center Raleigh.
“When an individual is diagnosed with an early-stage lung cancer, the number one best treatment for that cancer is surgery,” explained Hogan, “but our thoracic surgeons will not operate on any individual who is currently smoking. So, patients are required to abstain from smoking a minimum of three weeks before any surgery will be scheduled for them.”
That’s because smoking is associated with poor wound healing, an increased rate of surgical wound infections, and post-surgical pulmonary complications. “Unfortunately, some do relapse after surgery and go back to smoking,” said Hogan. “We explain to them, and this is across the board, that anyone with a cancer diagnosis who is currently smoking has worse outcomes. We tell them that stopping smoking for good after a diagnosis of lung cancer is associated with increased survival, a decrease in treatment side effects, a better quality of life, and a lower risk of developing another primary cancer. We want to minimize their risk and maximize their outcome.”
As a certified tobacco treatment specialist, Hogan can recommend a tobacco cessation treatment plan — which could include nicotine replacement products, non-nicotine prescription drug options, counseling, and/or mindfulness training — to help these smokers facing a lung cancer diagnosis quit for good.
When Hogan speaks with current smokers about their cancer risk, she also educates them about how smoking affects vascular health, including that smoking can cause a heart attack or stroke, make hypertension worse, and contributes to erectile dysfunction. She also informs them that not only do smokers have a higher risk of developing diabetes, but if they have diabetes already smoking renders common diabetes drugs less effective.
“There's not one disease that does not benefit from quitting smoking,” said Hogan, who was part of a group at Duke Health that pushed for and succeeded in adding a smoking history section in 2008 to each patient’s clinical health record. “I believe that in our cancer centers — I don't care what kind of cancer you have — smoking cessation has to be part of the treatment.”
The good news is that smoking prevalence nationally has declined significantly. While the percentage of adult smokers reached an all-time high in 1965 at 42%, 2018 saw an all-time low, with only 13.7% of adults in America smoking. Even so, that means 34 million Americans are current smokers and 55 million are former smokers — many of whom could be at risk for lung cancer today.
Hogan said she’s had some smokers in her clinic tell her, “Oh, I used to smoke two packs a day, but for the last five years, I've gone down to half a pack, mostly due to cost.”
“A lot of them think it's better for them. And I do say, ‘You know, that is great. But again, no level, no level of smoking is safe,’” emphasized Hogan. “The accumulation of ‘pack years’ goes down over time, but their risk for lung cancer still remains high because they’re still smoking.”