Dr Sekeres on the Importance of Counseling Patients With MDS on the Benefits of Smoking Cessation

“We should have conversations with patients about stopping smoking, particularly when they have CCUS or lower-risk MDS, because we could have an impact on their disease advancing.”

Mikkael A. Sekeres, MD, a professor of medicine and chief of the Division of Hematology in the Leukemia Section at the University of Miami Health System and Sylvester Comprehensive Cancer Center, discussed the clinical implications of findings from a study evaluating the association between smoking intensity, genetic mutations, and disease progression in patients with myelodysplastic syndromes (MDS).

The National MDS Natural History Study, conducted by the National Heart, Lung, and Blood Institute and supported by the National Cancer Institute, included self-reported smoking data from patients with suspected or recently diagnosed MDS, as well as those with MDS/myeloproliferative neoplasm overlap and precursor conditions like clonal cytopenia of undetermined significance (CCUS). Investigators found that the prevalence of several gene pathway mutations and individual gene mutations was higher among smokers vs nonsmokers. Additionally, the cumulative incidence of disease progression was significantly higher among long-term smokers vs nonsmokers or patients with a shorter smoking history.

The principal clinical implication of this research pertains to the necessity of facilitating conversations about smoking cessation, particularly for patients with smoking-related malignancies, such as MDS or lung cancer, Sekeres said. Historically, many oncologists have been hesitant to initiate discussions about smoking cessation with patients who have already been diagnosed with cancer, based on the assumption that cessation would offer limited benefit once malignancy is established, he noted.

However, emerging data from this study support the assertion that smoking cessation remains clinically relevant and beneficial, even after a cancer diagnosis, he stated. The findings suggest that continued smoking may affect disease progression, including in patients with lower-risk MDS or CCUS, he explained. Therefore, intervention at this stage of disease could delay or prevent progression to more aggressive disease states, he reported. These data reinforce the clinical practice of proactively outlining the benefits of smoking cessation for all patients with cancer, irrespective of disease stage, to optimize treatment outcomes and potentially alter the natural history of their disease, he concluded.