Unpacking Smoking and Bladder Cancer

November 19, 2024

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Transcript

Voice over:

This is Bladder Cancer Matters, the podcast for bladder cancer patients, caregivers, advocates, and medical and research professionals. It’s brought to you by the Bladder Cancer Advocacy Network, otherwise known as BCAN. BCAN works to increase public awareness about bladder cancer, advances bladder cancer research, and provides educational and support services for bladder cancer patients and their loved ones. To learn more, please visit BCAN.org.

Rick Bangs:

Hi I’m Rick Bangs, the host of Bladder Cancer Matters, a podcast for, by, and about the bladder cancer community. I’m also a survivor of muscle invasive bladder cancer, the proud owner of a 2006 model year neobladder and a patient advocate supporting cancer research at the Bladder Cancer Advocacy Network, or as many call it, BCAN, producers of this podcast. I’m pleased to welcome today’s guest, Dr. Mark Bjurlin. Dr. Bjurlin is director of clinical trials and associate professor of urology at Lineberger Comprehensive Cancer Center at the University of North Carolina, Chapel Hill. Dr. Bjurlin’s clinical practice is focused on urologic oncology and he is a member of the integrated Multidisciplinary Genitourinary Oncology Group at the Lineberger Comprehensive Cancer Center.

Dr. Bjurlin has also worked national committees that establish care guidelines for the management of cancers of the urinary tract. His research interests include the molecular epidemiology of smoking and e-cigarette use-related bladder cancers and advanced surgical procedures, including the use of robotic surgery to maximize quality of life for people with urologic malignancies. Dr. Bjurlin was also panel co-chair at the 2024 BCAN Bladder Cancer Think Tank focused on smoking cessation, which is our topic today in honor of the Great American Smokeout. Welcome Dr. Bjurlin.

Dr. Marc Bjurlin:

Thank you so much for the kind invitation and the kind introduction. This is really a topic I’m passionate about and I’m excited to share and support our bladder cancer community and different ways we can promote quitting smoking.

Rick Bangs:

That’s excellent. We’re looking forward to it. So I want to start by talking about smoking in the fall of 2024 because the landscape has changed over the years. So can we start with whose smoking now and how has this changed?

Dr. Marc Bjurlin:

Absolutely. So the current kind of incidence of smoking in the American population is down to 11% and that is currently at all time lows. If we put this in kind of historical perspective, the highest rate of smoking in the United States was back in the mid-1960s where more than 40% of adults currently smoked cigarettes. So all good news that we’re trending down to a lower rate of smoking, but all the numbers don’t look quite as good. Specifically, there’s some age demographics where the numbers are actually rising. Some younger adults around age 18 to 24 has had shown an increase in smoking from about 8% around 2020, now up to about 11% in the current year.

And with the advent of e-cigarettes, there’s a higher use of high schoolers now trying and continuing to use e-cigarettes. So not all numbers are in the right direction, but hopefully we’ll continue to promote healthy lifestyle habits and drive those numbers down.

Rick Bangs:

So now what cancers are related to smoking?

Dr. Marc Bjurlin:

So there are a number of malignancies that are smoking related and when I talk to our patients, I kind of explain to them, “Follow where the inhaled smoke goes.” And what I mean by that is when someone smokes a cigarette and inhales the combustible tobacco smoke, one of the first places that smoke goes is into their mouth. So as you can imagine, mouth cancer is related to cigarette smoking. From the mouth, essentially the smoke can go one of two directions. One, it can go down the trachea into the lungs. So as you can imagine lung cancer is smoking related. Our lungs filter air into our blood, our blood then passes through our kidneys, and many of these cancer chemicals are then deposited into our kidneys.

So kidney cancer is smoking related, and then we know our kidneys filter urine. The carcinogens are then in our urine, they go down to our bladder and they sit in our bladder and we void every three four hours. And so the carcinogens are exposed to our bladder, which causes bladder cancer. If we essentially follow the other two coming out of our mouth, which is the esophagus, smoking causes esophageal cancer. Esophagus links up to our stomach, smoking causes stomach cancer. That follows down through our colon, colon cancer as well. And we’ve also seen smoking in pancreatic cancer. So there are a number of malignancies that are linked to cigarette smoking.

Rick Bangs:

It’s pretty pervasive, right? So how would the probability of getting cancer vary between smokers and non-smokers?

Dr. Marc Bjurlin:

Well, if it’s a smoking related malignancy, there is really a direct link, meaning that, for example, patients who smoke and develop a lung cancer essentially have a 15 to 30 times higher likelihood of developing that disease. Patients who smoke have a five to 10 times higher likelihood of developing throat or esophageal cancer. And then pancreatic and kidney cancer is about two times higher in those patients who smoke. And bladder cancer is about four times higher in those patients who smoke. And we also see what’s referred to as a dose dependent relationship. So the increased intensity of smoking and the duration of smoking is directly linked to the development of cancer.

Rick Bangs:

So the more I smoke and the longer I smoke, both of those things are going to increase my probability of getting cancer.

Dr. Marc Bjurlin:

Exactly.

Rick Bangs:

So you already mentioned, or we talked about e-cigarettes and they’ve kind of changed the landscape. Are they safer?

Dr. Marc Bjurlin:

So that is the million-dollar question. And really e-cigarettes has dramatically changed the landscape really based on consumer behaviors, some regulatory actions, ongoing public health discussions. And e-cigarettes as a whole has gained popularity in our younger patient demographic where about, as I mentioned, 30% of high schoolers have even tried an e-cigarette and about 20-25% vape on a regular basis. This is much lower in adults. Adults only about 10%, maybe up to 15% are actually using e-cigarettes. But since e-cigarettes are fairly new, the long-term health consequences of using e-cigarettes are really yet to be discovered. But what we do know is that when someone uses an e-cigarette device, essentially it heats this e-juice which contains nicotine.

There’s different humectants in the e-cigarette juice that prevents it from drying up and then there’s some other chemicals. And this juice is heated, so it’s not burned like conventional tobacco in a combustible cigarette. So there’s no carcinogens that come from a combustion process. But there are other toxins in chemical or cancer-causing agents that we found both in the e-cigarette juice and in the urine of e-cigarette users. Some of those chemicals that we found in the urine of e-cigarette users are the same chemicals that we see in conventional smokers and we know that those are linked to bladder cancer. So do we know that e-cigarettes are less dangerous than combustible cigarettes?

We probably think that because there’s less toxicants and carcinogens, but the long-term health consequences are still to be known.

Rick Bangs:

I hadn’t thought about the burning versus heating, but that’s interesting as somebody who doesn’t really know much about e-cigarettes. So it’s actually heating it.

Dr. Marc Bjurlin:

There’s not a combustion process that actually occurs, but what’s interesting is there is another new product on the market that some of our listeners may or may not have heard of. It’s called a heated tobacco product. And essentially this device has tobacco in it similar to a combustible cigarette, not e-juice, but it’s actually tobacco and it’s heated, not burned. So the tobacco product is heated to somewhere around 200 to 350 degrees Celsius.

So you still get the flavor and the nicotine from the tobacco without the combustion occurring. And these products, again, are also very new with a whole wide array of potential health consequences that we don’t know of and that we’ll find out over the next coming decades what consequences there are for using these new products on the market.

Rick Bangs:

So then many people are aware that secondhand smoke has some risks. So is it different from these other forms of directly intaking the tobacco?

Dr. Marc Bjurlin:

So a question that we get often, but we do know that secondhand smoke does contain greater than about 7,000 different chemicals, some of which are toxic and carcinogenic. Things like formaldehyde are still in the air of secondhand smokers, benzene, hydrogen cyanide. And then the patients who are exposed to secondhand smoke still have about a 20 to 30% higher likelihood of developing diseases like lung cancer and secondhand smoke may even elevate the risk of bladder cancer, nasal cancer. There’s been some data that suggests it may increase risk of breast cancer. So by no means is secondhand smoke benign.

Rick Bangs:

So let’s turn our attention now to smoking and bladder cancer. So what percentage of bladder cancer survivors have smoked?

Dr. Marc Bjurlin:

So the data supports that about 50% of all bladder cancer patients have a history of smoking. Studies have suggested, as we mentioned, that smoking is a major risk factor for developing bladder cancer. And smokers are somewhere around three to four times more likely to be diagnosed with this disease when compared to non-smokers.

Rick Bangs:

And are bladder cancers from smoking typically low or high grade?

Dr. Marc Bjurlin:

So bladder cancers associated with smoking are often higher grade, which means they are more aggressive and have potentially a worse prognosis compared to patients who develop disease that are not smoking related. As a result, unfortunately, our patients who smoke more commonly have muscle-invasive bladder cancer. And then there’s some histologic features that we often see in patients who have a history of smoking when they develop bladder cancer. Things like greater cellular atypia, increased mitotic activity, all kind of hallmarks of a more aggressive disease.

Rick Bangs:

So more aggressive. If I’m a smoker but I’ve never been diagnosed with bladder cancer, what actions might make sense for me that might not for somebody who’s never smoked?

Dr. Marc Bjurlin:

Great question. And I think in terms of screening for someone who has bladder cancer, our current guidelines do not endorse bladder cancer screening even in those patients who are at higher risk, for example, due to smoking. There’s several commercial risk-based urine tests that are available, but none of these have been yet adopted into national guidelines. As a result we don’t typically get them. Same thing, we don’t put someone through a cystoscopy just because they have a history of smoking. But what I would tell patients that currently smoke is they should be aware of potential signs that may point to bladder cancer, meaning that one of the first signs we see would be blood in the urine.

So if you’re someone with a history of smoking and you see blood in the urine, that’s really a sign you ought to be checked out. And then of course, anyone with a history of smoking, we strongly encourage them to quit smoking, reach out to your providers. There’s a plethora of cessation programs that can be offered. I always encourage our patients to really set a quit date, aim for a target where they really want to stop the smoking and then continue routine checkups. And in the same vein, we do encourage patients with a history of smoking to see their primary care about whether they should have a lung cancer screening test because there is some guidelines to say if you have a history of smoking, you may benefit from lung cancer screening.

Rick Bangs:

So I want to talk about this person who’s been diagnosed with bladder cancer and is going to continue to smoke. So what’s the impact of continuing to smoke during the treatment and even after the treatment, their impacts on the efficacy of chemotherapy or immunotherapy or maybe even BCG?

Dr. Marc Bjurlin:

Absolutely. We know that smoking impacts both the surgical management of bladder cancer as well as outcomes of several of these different drugs that you’ve just mentioned that are commonly used to treat bladder cancer. Smoking has been widely associated with increased surgical complications. There’s been documented increased rates of wound infections, increased cardiovascular complications, heart attack, stroke, increased pulmonary complications from smoking in patients who undergo surgery. And then when we shift gears a little bit and talk about the drugs, for example, BCG smoking impairs the immune response that BCG relies on to be effective.

That can potentially reduce the treatment outcomes in our patients with non-muscle invasive bladder cancer who get BCG. Smokers have a higher risk of BCG treatment failure. And there’s been some data that suggests that quitting smoking may actually improve the effectiveness of BCG. When we look at chemotherapy, smoking can reduce the effectiveness of different chemotherapy drugs, specifically cisplatin drugs, gemcitabine drugs. Essentially what smoking does is it alters the drug metabolism often leading to lower concentrations of the drug in the body and then potentially reducing how efficiently it works. And then smokers are noted to have higher rates of chemotherapy-related toxicity, which we do know can also relate to some complications for treatment.

And then interestingly in the immunotherapy space that paradoxically some data suggests that those patients who smoke actually have a better response to immunotherapy than the counterparts that do not smoke. And we think that the mechanism of why that potentially may be true is the patients who smoke may have a larger mutational burden in their disease and this is really how the immunotherapy drugs work. But we do know that there’s some more work ahead of us, more research needed to really tease out what is going on in those type of scenarios.

Rick Bangs:

So in general, there’s value in stopping smoking before you start your treatment.

Dr. Marc Bjurlin:

Absolutely.

Rick Bangs:

So it’s not too late. So we’re going to release this podcast on the day of the Great American Smokeout, which happens every year. And so we’re going to talk a little bit about some smoking cessation. So over the years, there’ve been some advances in this space. I’m going to talk about something that’s in your wheelhouse, which is current guidelines for smoking cessation. What are these current guidelines? Have you noted any difference in how these guidelines are integrated, for example, into bladder cancer guidelines versus how they might be integrated into lung cancer guidelines?

Dr. Marc Bjurlin:

Yes, a topic very near and dear to my heart. So typical guidelines suggest that there’s kind of two main strategies we use when we address smoking cessation. One avenue is pharmacotherapy, including prescription drugs as well as nicotine replacement, and then behavioral therapy, essentially providing support and strategies for our patients to cope with the quitting smoking process. And when we kind of take those strategies and look at two different smoking related malignancies, that being bladder cancer and lung cancer, you would think that there would be similar type of strategies adopted in both of these disease spaces.

But what we do know is there’s a stark contrast in terms of who understands that smoking is linked to bladder cancer and who understands that smoking is linked to lung cancer. So to get a better idea of the differences in guidelines, we actually looked at 19 different bladder cancer guidelines and we then compared those to 20 different lung cancer guidelines. And we looked at two things. One, does the guidelines say you should screen for tobacco use? And number two, do the guidelines actually say you should provide some type of smoking recommendation? And you would think both of these disease processes are smoking related.

But what we found stark differences, that 20% of lung cancer guidelines endorse tobacco screening and 65% of lung cancer guidelines suggest that you should have actually actively promote smoking cessation to our patients who smoke. And if you switch gears and look at bladder cancer guidelines, only a single guideline, one guideline out of 19 for bladder cancer. 5% actually included tobacco screening in their guideline. And 42%, which is almost half of the lung cancer one, actually endorsed smoking cessation recommendations. So I think that really shows there’s some work to be done in terms of educating our providers on opportunities to really support tobacco screening and smoking cessation to our patients who smoke.

Rick Bangs:

So there’s work for those of us who work on guideline panels left to be done. So I will take that to heart. All right, so what are my options for smoking cessation in 2024? And would e-cigarettes be one of the options?

Dr. Marc Bjurlin:

So typically there’s a number of strategies that we try to use to help our patients reduce smoking and ultimately quit smoking. At that top of the list is often nicotine replacement therapy. This comes in a number of various forms, patches, gum, lozenges and inhalers, nasal sprays. Prescription medication is another mainstay of tobacco cessation. There’s two main drugs, Zyban and Chantix, which are FDA endorsed for the use of tobacco cessation. Behavioral therapy and counseling is a key component of smoking cessation. There’s a number of support programs and resources available to our patients quit lines, mobile apps, online resources. So this is really kind of a wide array of strategies to help our patients quit smoking.

And then the million-dollar questions like we got at earlier is their role for e-cigarettes in promoting smoking cessation. And I think that the data is still kind of left to bore out, but we do know that e-cigarette effectiveness is varied by the individual itself and that in some patients, e-cigarette use has been shown to significantly improve smoking cessation, meaning that there’s been studies that says this actually works quite well. There’s been studies on the flip side saying, “You know what? This has not increased cessation at all.” But I think perhaps one of the take-home messages is that we see in patients who attempt to adopt e-cigarettes as a smoking cessation tool, unfortunately most commonly become dual users, meaning they’ve now adopted e-cigarette use.

They continue to smoke. They use e-cigarettes when they’re, for example, indoors or in places that prohibit traditional cigarettes and then they still smoke cigarettes while they’re essentially outdoors or at home. So that is kind of the mainstay that we see. But in some patients it’s been shown as a risk reduction strategy, so more fodder to come, but the verdict is still out yet whether e-cigarettes should be used as a smoking cessation tool.

Rick Bangs:

All right. We’ll look forward to more data maybe on a later Great American Smokeout podcast. So if I undertake smoking cessation, what side effects might I experience? And can you counterman these side effects with some other treatment?

Dr. Marc Bjurlin:

So probably the side effect that we see most common is just simply withdrawal from nicotine cravings. And that’s what we typically treat with the nicotine replacement therapy, the gums, the lozenges, the patches. There is often some irritability and mood changes that come along with quitting smoking. Behavioral therapy, counseling can be used for that. Support groups can be a really good smoking cessation. Coping strategies, like we said, there’s some online support groups that are very well received in our patient population. Physical activity and relaxation techniques have been well received.

Just simple deep breathing. Some of my patients actually do yoga that they say work quite well. There’s some concerns that there’s some weight gain and increased appetite as well in our patients who are trying to quit smoking. And we always highlight maintaining a balanced diet and regular exercise. But there are several ways that we can counteract the side effects of smoking cessation.

Rick Bangs:

So you had previously mentioned to me some current approaches to smoking cessation that are used specifically for patients that are about to go a radical cystectomy, and I think our listeners would like to hear about that.

Dr. Marc Bjurlin:

This is a really kind of interesting quality improvement project that we’ve taken at our university. In a sense, we know that surgical admission following a radical cystectomy is an ideal time to circumvent on multiple lifestyle risk factors, most importantly smoking cessation. But our patients can’t smoke in the hospital. Hospitals are a mandatory smoke-free environment, and then patients are kind of a captive audience. They’re not going anywhere. And now it’d be a good time for us to address smoking cessation in an environment that’s supporting their smoke-free nature.

So what essentially we did at our institution is we conducted a one-year prospective study where all of our patients who underwent a radical cystectomy and who smoked, were assessed in our inpatient setting, meaning our tobacco treatment program team came and saw them post-operative day number two while they’re in the hospital. We offered them nicotine replacement therapy in the hospital. We talked to them about support options, and then we looked at a couple of metrics to see if we were successful. One, did we actually increase the referrals of our tobacco treatment program to these patients? Did the patients accept nicotine replacement while they were in the hospital to curb their cravings?

Did they fill their nicotine replacement therapy upon discharge? And then we contacted them about four weeks later and asked them, “Hey, were you able to attempt to quit smoking? Were you successful in quitting smoking?” And we found some pretty astonishing data, at least I thought they’re astonishing. That prior to this advent, about 20% of our patients who underwent radical cystectomy were seen by our inpatient tobacco program after we instituted this initiative. A hundred percent, every single patient who smoked got seen by our tobacco treatment program. I think it was a large step forward. 40% of our patients accepted nicotine replacement therapy in the inpatient setting.

So they’re using patches, they’re using gums to curb their craving. 60% of our patients actually filled their nicotine replacement therapy upon discharge. And when we called them four weeks after they left the hospital from their cystectomy, that the average number of cigarettes per day was 13 prior to cystectomy. When we followed up with them, they cut that down to six. So good progress. The number of cigarettes were cut in half. 86% of our patients reported they attempted to quit in that first four weeks and 29%, almost a third of our cystectomy patients said they were successfully no longer smoking at that one month follow-up.

So I think this is kind of a program that works well for our patients and could be easily adopted to multiple institution across the country and really promoting smoking cessation in our bladder cancer patients who smoke.

Rick Bangs:

It sounds like some really promising results there.

Dr. Marc Bjurlin:

We’re happy to share them indeed.

Rick Bangs:

All right. Well, I look forward to hearing more about that as well. So tell me about my primary care physician. So should my primary care physician be involved in the smoking cessation process?

Dr. Marc Bjurlin:

I would say absolutely. Primary care providers can give tailored advice based on individual’s medical history, their current health status, and if they have other underlying conditions, they can create effective cessation plans that can be tailored to each individual patient. And each individual patient has different kind of side effects of quitting, physical changes, blood pressure changes, withdrawal symptoms, and I really think that regular check-ins with primary care providers can address some of those and provide motivation to continue to quit smoking.

Often, unfortunately, smoking is linked to other medical problems, asthma, COPD, heart disease, and that can also be keep in check by a primary care provider. So great to be linked in with your general doctors.

Rick Bangs:

If I had blood in the urine, might be a good time to remind my doctor that I was historically a smoker or currently am a smoker because that would change my risk factors.

Dr. Marc Bjurlin:

Absolutely, entirely endorse that.

Rick Bangs:

So when I’m in the doctor’s office, how is my smoking history being captured?

Dr. Marc Bjurlin:

Well, many clinics follow standard guidelines that mandate documenting tobacco use as part of a routine, kind of vital signs assessment. When they’re checking heart rate, blood pressure, they all ask patients, do you smoke? And then there’s some standardized questions that we commonly incorporate as part of these visits. Have you ever smoked? What age did you start? How many cigarettes do you use? What tobacco products do you use? Are you an e-cigarette user? Are you a heated, not burned user? Are you a combustible user?

Are you an oral chewing tobacco? And then we often ask patients, have you tried to quit before? How many times have you quit? What methods have you tried? And then lastly, when do you last smoke? So a number of these questions get a better idea of the status of the patient’s tobacco history and then lead into different ways that we can help support their smoking cessation efforts.

Rick Bangs:

So for a bladder cancer clinical trial versus a lung cancer clinical trial, I have heard that the way you record my smoking history might be different. So I’d be curious as to why that was and how it’s different.

Dr. Marc Bjurlin:

This is really an interesting concept. As we spoke about prior, that smoking is the leading cause of both lung cancer and bladder cancer. And you’d think that addressing smoking in the context of some clinical trial would be equally important in both of these diseases. But what we found that was not the case. So we did an interesting study. We essentially looked at, in the last 10 years, there have been nine new bladder cancer drugs that were approved by the FDA. And we looked at those clinical trials that led to the approval of those drugs, and then we compare that to FDA approved lung cancer drugs.

So we looked at the trials that were conducted in the lung cancer space that led to the approval of FDA lung cancer drugs. So there were 17 bladder cancer trials and then there were 10 FDA approved, what’s referred to as non-small cell lung cancer drugs. And four FDA approved small cell lung cancer drugs totaling of about 31 trials. So 17 trials of bladder cancer, 31 trials of lung cancer, and then smoking status was reported in only 41% of bladder cancer trials compared to almost 90% of lung cancer trials. So we know this drug impacts the treatment, it impacts the disease, but it’s just not being recorded in bladder cancer trials.

And then perhaps was even more striking is that there’s four different drugs that are approved for both bladder cancer and lung cancer, exact same drug that’s FDA approved for two different disease processes. And so we looked at those trials that got FDA approval of those drugs. 44% of the bladder cancer trials included some form of smoking documentation. A hundred percent of the lung cancer trials did exact same drug, totally different way of assessing smoking cessation. So ultimately I think there’s more work to do and when we design clinical trials, because we know that smoking is an important factor in terms of how the drug works, what are the outcomes, patient experience, quality of life, and often this isn’t being captured.

So again, more work for us to do.

Rick Bangs:

I mean just on the basis of the efficacy of the treatment, it would seem like this would be something we’d want to know. All right, well we got to keep our eyes on that. So how often are my clinic visits during smoking cessation and can I get a virtual follow-up in 2024?

Dr. Marc Bjurlin:

So great questions. Typically, when our patients are initially starting their journey for smoking cessation, we encourage them to kind of touch base weekly or every other week for maybe the first month or two in the process of quitting. This is really the most critical time for support. And once they’ve made it over that first few weeks of smoking cessation, then we can move on to a monthly aspect. This can shift to once a month or perhaps a little bit farther out as we become more comfortable with the patient smoking cessation plan and coping mechanisms.

And at least at our institution, our tobacco treatment program routinely sees people by telehealth, even telephone visits and patients who often don’t have access to the internet. And these can be video calls, phone calls. There’s some text messaging apps now that allows us to check in. So the intensity is much greater up front, kind of slows down when you get successful. And then by all means, there’s technology that allows us to keep in touch.

Rick Bangs:

It seems like these virtual kind of options would improve my compliance if I don’t have to come into clinic to have the visit. So that’s terrific. How successful is smoking cessation?

Dr. Marc Bjurlin:

So quitting is challenging. There is no doubt about that at all. And as providers, we want to help our patients every single step of the way. But in the short term research shows that about 30% of patients who attempt to quit smoking are successful for at least six months. That means unfortunately 70% are not successful. So it’s really more shots on goal, the more likelihood you’re going to score. So if in patients who aren’t successful the first time, it may take more than one time, it may take 10 times, it may take 20 times. And then the long-term success rates unfortunately are not super high either.

Somewhere around 15% of smokers who really kind of go all in on quitting will remain smoke-free for a year or longer. And that really highlights our need to continue to offer support at really all touch points, all hospital visits, all clinic visits to support smoking cessation.

Rick Bangs:

All right. So why is it so hard? And are there anything that can be done that make it easier?

Dr. Marc Bjurlin:

So I think there’s a number of barriers that patients run into, and then there’s some kind of facilitators that help smoking cessation. Some of the barriers that we commonly see are clearly nicotine addiction. It’s hard to overcome that addiction, psychological factors, there’s anxiety, stress, there’s depression associated with attempting to quit. Social influences. Our peer pressure in our social circle largely dictate what we do and who we hang out with. And if our friends all smoke, it’s really hard to quit smoking when we have an environment like that. Lack of support. If we don’t have someone on our side at all times saying, “Hey, you can do it.”

It becomes more challenging. And as we mentioned, there’s multiple times that patients often have to attempt to quit smoking and there’s some fear of failure. Previously, unsuccessful attempts may say, “You know what? I’ve tried this before. I wasn’t successful. I’m not going to try it again.” But ultimately, there’s a number of things that motivate people to quit smoking. One of them, for example, a cancer diagnosis. Specifically, there’s been some data that shows if you have newly diagnosed bladder cancer and you have a history of smoking and now it’s the time to capture that moment of quitting. You’re five times more likely to quit at the time of diagnosis.

Other things that are key, support systems, family, friends, health providers, behavioral strategies, coping mechanisms, and then things we’ve talked about, access to nicotine replacement therapy, access to some behavioral modification avenues, access to support groups. So number of things that we can kind of build in to help our patients quit smoking.

Rick Bangs:

So you mentioned someone on my side and family caregivers. I suspect they play an important role here. So we can also think that maybe the family dynamic could be counterproductive. So what guidance do you provide to the family of somebody who’s trying to stop smoking?

Dr. Marc Bjurlin:

The inner support of family I think is crucial for smoking cessation. And one of the things we highlight to our patients and their family is really spend a minute to educate ourselves, meaning that we’re going to understand the challenges of what smoking cessation is, the nicotine addiction, the withdrawal symptoms. Offer encouragement to all our patients, really positive enforcement. “You can do this. I know it’s not going to be easy.” One of the things I think is really unique is to create milestones. Celebrate small victories. “Hey, it’s been a day, I didn’t smoke today. It’s been a week. I didn’t smoke a week.” Things we mentioned to patients, you have to be patient.

This is a journey, this is a process. There’s going to be setbacks. And then in the environment of supportive nature that these things can be overcome. Communication is key. Be a good listener. Understand that there’s going to be some mood changes, some irritability while going through this. And then avoid blame or guilt. Don’t make people feel guilty because they weren’t able to maintain their smoking cessation quite as they hoped. There’s a number of ways that families can support appropriately someone who wants to attempt to quit smoking.

Rick Bangs:

So if the family thinks things are just not going well, is there somebody that they can interact with?

Dr. Marc Bjurlin:

Well, of course there’s always the healthcare providers, primary care providers are great resources to discuss and talk about ways that we can try to rewrite the ship. Smoking cessation counselors, like I mentioned, there’s a tobacco treatment program at our institution and almost all institutions have one and support groups and patients who, “You know what? I just don’t want to make an appointment with my primary care doctor.” There’s other support groups outside the regular work hours, and I mentioned there’s online forums. There’s some great groups that just discuss online, “Hey, I’m here to support you. You need anything, reach out.” So a number of aspects that the patients can address when things aren’t going quite as they had hoped.

Rick Bangs:

And a lot more options today than there have been in the past. So that’s great.

Dr. Marc Bjurlin:

Absolutely.

Rick Bangs:

Any final thoughts?

Dr. Marc Bjurlin:

Well, I think one thing I tell patients, quitting is a journey. It’s not going to happen overnight, and it’s often going to be filled with ups and downs. Relapse can happen. So just be aware of that. Seek support. This can’t really be overstated. The more team members you have, the better likelihood you’re going to be able to permanently quit smoking. There’s a number of available resources. Use everything at your hand.

The more resources you have, the more likely you’re going to tap into those and really be successful. And then perhaps lastly, be kind to yourself. Recognize that quitting is challenging. It’s okay to seek help. It’s okay to take things one time a day, and then really celebrate those small victories on the way. We know you can do it.

Rick Bangs:

All right, thanks. And be kind to yourself is always good advice. Dr. Bjurlin, I want to thank you for explaining the current status and thinking on smoking in 2024 and why it’s never too late to stop smoking and how to stop. If you’d more information on bladder cancer, please visit the BCAN website, www.bcan.org. In case people wanted to get in touch with you, could you share an email address or a Twitter handle?

Dr. Marc Bjurlin:

Absolutely. My email address is my first name, Marc M-A-R-C underscore, then my last name, B as in boy, J-U-R-L-I-N at med M-E-D.unc.edu. And my Twitter handle is at M-A-B-J-U-R-L-I-N.

Rick Bangs:

Thank you. Just a reminder, if you’d like more information about bladder cancer, you can contact the Bladder Cancer Advocacy Network at 1-888-901-2226. That’s all the time we have today. Be sure to like, comment and subscribe to this podcast so we have your feedback. Thank you for listening, and we’ll be back soon with another interesting episode of Bladder Cancer Matters. Thanks again Dr. Bjurlin.

Dr. Marc Bjurlin:

Thank you.

Voice over:

Thank you for listening to Bladder Cancer Matters, a podcast by the Bladder Cancer Advocacy Network or BCAN. BCAN works to increase public awareness about bladder cancer, advance bladder cancer research, and provide educational and support services for bladder cancer patients. For more information about this podcast and additional information about bladder cancer, please visit bcan.org.