Article Topic: Cigarette Smoking

For Your Health: You’ve Got This. Don’t Give Up on Quitting Smoking

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It’s a number to celebrate: 3.9 million. That’s the likely number of Americans saved from lung cancer since 1970 with efforts to curb cigarette smoking. Seen another way, this translates to over 76 million years added to people’s lives. It’s truly astounding and doesn’t even include the impact from lower risks of many other cancers and diseases caused by smoking.

Looking ahead, these gains will only grow as fewer youth and young adults take up smoking — and as more people who currently smoke, quit.

Quitting, though, isn’t easy — as anyone who’s done it can tell you. But thousands of people do it every day, and right now in the U.S. there are more people who used to smoke than who currently smoke.

For those who want to quit — or are just thinking about it — getting support can really help, doubling the chances of success. This can include reaching out to your health care clinic or provider for assistance.

There’s also free support at 1-800-QUIT-NOW (1-800-784-8669) and smokefree.gov, which offers texting tools, an app and other services.

Support usually includes a mix of medication as well as in-person and virtual classes and programs. Medications can be prescription drugs, like bupropion, as well as nicotine replacement therapy, like gums and patches. These help with nicotine withdrawal and cravings. Programs and classes can help with developing skills and behaviors for staying smoke-free.

“Services like the smokefree.gov texting program provide encouraging, motivating daily messages,” said Dr. Li-Shiun Chen, director of smoking cessation at WashU Medicine and Siteman Cancer Center. “A lot of my patients love that. They wake up and get a text that says, ‘Hey, it’s a new day. Why don’t you take a walk outside instead of lighting a cigarette?’”

Along with such support, one of the most important approaches to quitting is simply to keep at it.

“On average, it takes a person seven to nine attempts to succeed,” Chen said. “One gentleman we worked with tried 13 times, but then he succeeded with help from a lifestyle coach and medicine. He said that support made all the difference. So, don’t worry about failure. It’s very important to keep trying, even just to reduce how much you smoke.”

FDA-approved products, like nicotine replacement therapy, have the best evidence for helping with quitting. But electronic cigarettes and vaping, which aren’t FDA-approved, may have a role in certain situations, Chen said. “In an adult who smokes cigarettes routinely, actually transitioning to safe vaping is harm reduction. ‘Safe vaping’ means just nicotine — not adding cannabis, not adding flavors. And this type of vaping can be an intermediate step to getting rid of tobacco.”

Vaping, though, is a double-edged sword, Chen warned. It has some inherent dangers, and kids should totally avoid it. Among other risks, it can lead to nicotine addiction and tobacco smoking. “If you’re a 12-year-old, vaping is really bad.”

No matter how long you’ve been smoking or how old or healthy you are — in almost any situation, really — there are important benefits to quitting. And these benefits start just days in and build over the years. Breathing quickly improves. Food starts tasting better. And wrinkles on the face from early aging can start to relax. Then, the risk of serious diseases like cancer, stroke, heart disease, lung disease and dementia begin to drop, with some eventually reversing to the same risk as someone who never smoked.

“Quitting smoking can add about 13 years of life back to a person, but it’s not only a longer life, it’s also a higher quality of life,” Chen concluded. “It’s an amazing opportunity to improve your health, and it’s the best thing you can do for yourself and your loved ones.”

Happy holidays, and happy New Year.

It’s never too late for those with cancer to quit smoking

Smoking cessation program developed by WashU Medicine researchers at Siteman Cancer Center is more effective at prolonging life than some chemotherapies

Around 25% of people with cancer in the U.S. are active smokers when they are diagnosed, and studies have found that many of them continue to smoke during treatment. This may be due in part to a common misconception — even among some doctors — that quitting won’t help much if a person already has cancer, particularly if it’s at an advanced stage.

Now, a study led by Li-Shiun Chen, MD, MPH, ScD, a professor of psychiatry at WashU Medicine in St. Louis, shows that kicking the habit after starting cancer treatment is well worth it — and what’s more, smokers with the most advanced cancers glean the biggest benefit from quitting, more than doubling their survival time.

Patients in Chen’s study had help quitting through a smoking cessation program developed and administered at Siteman Cancer Center, based at Barnes-Jewish Hospital and WashU Medicine. The program offers a unique approach to cancer care by integrating smoking cessation interventions into patients’ cancer treatment plans. Delivering all treatment on-site eliminates hurdles involving time and transportation.

Chen’s findings were published Oct. 9 in the Journal of the National Comprehensive Cancer Network.

“WashU Medicine and Siteman are the leading frontier to ensure every cancer patient is offered tobacco treatment as part of their cancer care, using a novel, informatics-enabled, point-of-care model,” said Chen, who also directs the Tobacco Treatment Program at Siteman. “By showing that it’s never too late, even for the sickest patients, we hope to inspire all cancer centers and patients to include smoking cessation support as part of routine cancer care to improve survival.”

In the study, Chen and her collaborators followed 13,282 adults who received outpatient oncology care during a six-month period at Siteman. The team recorded each participant’s smoking status at their initial visit, then tracked cessation rates over the next six months along with survival over the next two years. Of 1,725 patients who reported at their first visit that they smoked, about one-fifth of them quit within the following six months.

Across all cancer types and stages, the researchers found that the probability of survival two years after patients’ initial oncology visit was 74% among those who continued smoke, versus 85% among those who quit. This benefit was driven mainly by patients with late-stage cancers (stage 3 or stage 4), among whom quitting was associated with a bigger increase in survival rate over this time period compared to people with early-stage cancer (stage 1 or stage 2).

Examining the results another way, the researchers found that for patients with stage 3 or 4 cancer who kept smoking, 85% were alive at 210 days. In comparison, of those who quit, 85% were still alive at 540 days. That’s nearly a year of additional days of life.

“Advanced-stage cancer patients often feel hopeless,” said first author Steven Tohmasi, MD, a resident in the Department of Surgery at WashU Medicine. “If they feel they have limited time, some doctors might not actively encourage patients to quit smoking or may prioritize patient comfort over cessation efforts.

But when we’ve shown patients our data, it gives them hope and motivates them to want to quit. An extra year of life is a long time for patients who may have been told they only had months to live.”

The Fourth Pillar of Treatment

Siteman’s team-based approach to tobacco care was developed as part of the National Cancer Institute’s Cancer Center Cessation Initiative, which is focused on helping NCI-designated cancer centers incorporate evidence-based tobacco treatments into clinical care. The goal, in essence, is making smoking cessation “the fourth pillar of cancer treatment, alongside surgery, radiation and chemotherapy,” Tohmasi explained.

Siteman’s smoking-cessation program uses electronic health records to identify patients who smoke and gauge their interest in quitting. A nurse or medical assistant then offers assistance with quitting during their visit, such as access to phone- or text-based counseling, an app designed to help them quit, referral to a smoking-cessation group, and medications to support quitting.

In earlier research, Chen showed that the program helped more cancer patients quit successfully than previous methods had. In a related study, Chen also found evidence that quitting smoking could improve treatment efficacy and boost survival rates. But Chen said she faced some professional pushback at the idea of following that research thread further.

“People told us that we were wasting time — that we should work on smoking cessation in patients who aren’t already so sick,” Chen said. “Smoking is also highly addictive, and it’s hard for people to quit. So we needed to be sure the effort would be worthwhile for patients and for their care teams.”

In the new study, Chen and Tohmasi analyzed the outcomes of all Siteman patients seen over the designated six-month period — a group that included patients with all kinds of cancers at all stages who came from across the St. Louis metro area and southern Illinois, representing an array of demographic backgrounds. This differentiated the study from some previous research on smoking cessation in cancer patients that focused only on certain cancer types and never examined the benefit of smoking cessation on survival in people with advanced cancers.

By linking cancer survival to tobacco use for all cancer patients across severity levels and including patients who were never, former or current smokers, Chen and Tohmasi were able to gain a broad perspective on smoking cessation and the important role of Siteman’s integrated treatment program.


The program has been scaled and adapted for several of Siteman’s partner health centers. Based on the program’s success, the model was implemented in 14 clinics affiliated with Siteman Cancer Center across eastern Missouri and southern Illinois starting in July 2025. Nationally the program has been disseminated through EpicShare, where it continues to prove both cost-effective and successful in supporting smoking cessation.

Starting in September 2025 with the support of a $1.6 million NCI grant, Chen and colleagues Alex Ramsey, PhD, an associate professor of psychiatry at WashU Medicine, and Ross Brownson, PhD, the Steven H. and Susan U. Lipstein Distinguished Professor in WashU’s School of Public Health, launched a pragmatic clinical trial on tobacco treatment, including smoking cessation. The trial aims to compare how different care models can scale and sustain tobacco use treatment among cancer survivors in different care settings serving cancer survivors across eight states. The trial will be conducted with research partners at four regional hubs: WashU, the University of Pennsylvania, Vanderbilt University Medical Center and the St. Louis VA Medical Center.

Learn more about smoking cessation tools available to Siteman patients and members of our community.