Smoking Cessation Options
Cancer Information Service
Holden Comprehensive Cancer Center
University of Iowa Hospitals and Clinics
Creation Date: August 2006
Last Revision Date: August 2006
Peer Review Status: Internally Peer Reviewed
Smoking is the single most important cause of cancer. Tobacco use is responsible for nearly one in five deaths in the United States. It is estimated that smoking is related to 430,000 deaths per year in the United States and three million deaths worldwide; and these numbers continue to rise. Smoking has been linked to cancers of the lung, larynx, pharynx, esophagus, kidney, oral cavity, pancreas, bladder, and cervix.
Your risk of developing cancer is reduced by quitting smoking. After five years off cigarettes, your risk of developing cancer is greatly decreased. Even in those who have smoked for many years, life expectancy is increased after quitting smoking. After ten years the ex-smoker has nearly the same risk as a nonsmoker.
Many smokers want to quit. Finding the method that is best to meet your individual needs and styles can be difficult. The following information describes several options for quitting smoking.
With this method, individuals abruptly stop smoking cigarettes. Many quitters have used this method, although it may require several attempts before the individual is successful. It is simple, self-managed and low cost. The individual must be highly committed to his/her goal of quitting. Withdrawal symptoms may be severe for some people, especially if they have been smoking a brand of cigarette with a high nicotine level.
When using this method, individuals reduce the nicotine level of cigarettes smoked by 30/60/90 percent over a three week period and stop altogether during the fourth week. This method may help reduce the effects of nicotine withdrawal symptoms. The American Lung Association can provide a list of the nicotine levels of the cigarette brands. This method is simple, self-managed and inexpensive, but requires a high level of motivation and adherence.
Nicotine gum provides an alternate source of nicotine and helps reduce withdrawal symptoms. It requires smokers to discontinue the use of cigarettes when using the gum. Individuals who are highly addicted to cigarettes have a greater chance of becoming dependent on the gum. This method is self-managed but requires a high level of motivation and adherence. Smokers often need to chew 10 to 12 pieces of gum daily over a 3 to 6 month period. This can cost up to several hundred dollars, but is less expensive than smoking. Few insurance policies cover this expense. Nicotine gum is not recommended for use in pregnancy, for a person who has recently suffered a heart attack, persons with life-threatening heart rhythms, severe or worsening chest pain, or with active TMJ or joint disease of the jaw. Minor side effects from the gum include lightheadedness, nausea, mouth and throat irritation, hiccups, and an excess amount of saliva.
Nicotine Transdermal Patches
Transdermal patches are thin medicated patches, which are attached to the skin with adhesive. They provide an alternate source of nicotine, and so help reduce withdrawal symptoms. It requires smokers to discontinue the use of cigarettes when using the patch. This method is a good choice for a highly addictive smoker, particularly if they have been smoking a cigarette with a high level of nicotine. Each patch lasts 24 hours. In order to be successful, individuals must have a high level of motivation and adherence. Therapy with this method is usually recommended for 10 to 12 weeks. This method can cost up to several hundred dollars but is much cheaper than smoking. Transdermal patches are not recommended for use during pregnancy, for persons with a history of high blood pressure or other heart diseases. Minor side effects include skin redness where the patch is applied and restless sleep.
Nicotine Nasal Spray
This method helps to reduce cravings and withdrawal symptoms, allowing individuals to gradually reduce their dependence on nicotine. The dose delivered in one squirt is about the same as many of the low-tar filtered cigarettes. The spray is absorbed through the soft membranes in the nose and acts quickly to stop cravings. There is a risk individuals will become addicted to the nasal spray, so it should not be used longer than three months.
The nicotine inhaler provides about one-third the amount of nicotine in a cigarette. This method is about as effective as the nicotine patches. The inhaler should not be used any longer than six months because of the risk of addiction.
The filters attach to cigarettes and gradually reduce the amount of nicotine consumed. The filters usually reduce the nicotine by 25% the first week, 50% the second week, 70% the third week, and 90% the fourth week. Filtered cigarettes, those that come with the filter attached when purchased, are not the same as a cigarette filter. A cigarette filter to filter out nicotine is purchased separately from cigarettes and has to be attached to each new cigarette. This method does not require a doctor's prescription.
The newest method to help people stop smoking is the nicotine mouth lozenge. The lozenges, which are available over-the-counter, provides smokers with a temporary alternative source of nicotine that helps them avoid cigarette cravings and withdrawal symptoms while they try to quit. The lozenges are available in two strengths and include a method to determine a person's addiction to nicotine.
The "Time to First Cigarette" tool, instructs that a nicotine-deprived person who wakes up requiring a cigarette within 30 minutes of awakening should take the 4-milligram strength lozenge. Those who can wait at least 30 minutes before they succumb to their cravings are directed to use the 2-milligram strength lozenge.
The person uses fewer and fewer lozenges during the 12-week program until s/he is able to stop using the lozenges entirely. The new Commit Lozenges have been shown effective in helping people quit, including smokers who have tried quitting before. The benefits of the Commit Lozenge were even greater when quitters used the minimum recommended number of lozenges per day (9 per day) in the early part of their quit attempts.
The 72-count lozenge packs include a comprehensive users guide and free enrollment in Committed Quitters®, a personalized behavioral support program that has been clinically proven to increase a smoker's chance of quitting successfully by up to 26% when paired with nicotine patches, and by up to 50% when paired with nicotine gum. The 72-count pack of lozenges costs $39.95
Zyban is a prescription medicine to help people stop smoking. It does not contain any nicotine so it is very different from the nicotine replacement therapies such as the patches or gum. Although it is not known exactly how Zyban works, it has been shown to help individuals stop smoking, as well as reduce nicotine withdrawal symptoms and cravings. The most common side effects include dry mouth, insomnia, agitation and difficulty sleeping. Individuals should not increase the dosage of Zyban without their doctor's knowledge because it can cause seizures at higher than recommended dosages.
Zyban is not a new medicine. It has been manufactured and distributed as an anti-depressant medicine called Wellbutrin. Zyban was approved by the U.S. Food and Drug Administration (FDA) in 1997 as an aid to smoking cessation treatment.
Chantix is a prescription medicine to help adults stop smoking. Chantix acts at sites in the brain affected by nicotine and may help those who wish to stop smoking in two ways:
- by providing some nicotine effects to ease withdrawal symptoms, and
- by blocking the effects of nicotine from cigarettes if the patient resumes smoking.
Patients start taking Chantix 7 days before their quit date. This lets Chantix build up in the body. Patients can keep smoking during this time. Make sure that you try and stop smoking on your quit date. Most people will keep taking Chantix for up to 12 weeks. If you have completely quit smoking by 12 weeks, ask your doctor if another 12 weeks of Chantix can help you stay cigarette-free.
The most common side effects of Chantix include nausea, changes in dreaming, constipation, gas and vomiting. Tell your doctor about side effects that bother you or that do not go away. The U.S. Food and Drug Administration approved Chantix as an aid to quit smoking in 2006.
Studies show that smokers who use a combination of cessation aids greatly increase their chances of remaining smoke-free. Smokers who used a combination of a nicotine patch and nasal spray doubled their chances of remaining smoke free for six years. In another study, researchers compared the effects of treating smokers with Zyban alone, the patch alone, both Zyban and the patch, or a placebo (sugar pill). The group with the highest rate of success were those who used Zyban and the patch. Other studies have shown evidence that nicotine replacement therapy, in combination with behavioral or psychological support is more successful than drug therapy alone.
Your family physician can help advise you on which method of quitting might be best for you. All of these methods are most successful when combined with a support group or smoking cessation program that discusses stress management, weight control, resistance to social pressure, and suggestions for resisting the temptation to light up.
Where Can I Get More Information?
University of Iowa Resources
For more information about smoking and cancer or to obtain phone numbers to the above organizations, please contact The Holden Comprehensive Cancer Center's Information Service at 1-800-237-1225.