title: Nicotine dependence and withdrawal in an oncology setting: a risk factor for psychiatric comorbidity and treatment non-adherence.
abstract: Highly nicotine dependent oncology patients are at high risk for psychiatric morbidity when they enter the medical care setting where smoking restrictions apply. Nicotine withdrawal symptoms exacerbate cancer-related distress as well as common physical side effects of cancer treatment. This case report illustrates the management of a patient whose ongoing treatment for bladder cancer was jeopardized as a result of nicotine dependence and withdrawal. Several associated complications are described, the most serious of which were his acute anxiety and non-adherence to medical recommendations. A short-term management approach that included anxiolytics and nicotine replacement was effectively used to reduce this patient's excessive anxiety and thus facilitate compliance with stressful treatments. The severity of complications that can result from untreated nicotine dependence and withdrawal underscores the importance of assessing and monitoring smoking status in every patient. Greater staff awareness of the clinical practice guidelines regarding the diagnosis and treatment of nicotine dependence will likely result in improved patient care and compliance.
authors.affiliation: Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA. moadel@aecom.yu.edu
authors.forename: A B
authors.initials: AB
authors.lastname: Moadel
authors.forename: M S
authors.initials: MS
authors.lastname: Lederberg
authors.forename: J S
authors.initials: JS
authors.lastname: Ostroff
mesh_terms: D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control*; D002295:Carcinoma, Transitional Cell / Q000150:complications* / Q000523:psychology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000627:therapeutic use; D010349:Patient Compliance; D055502:Secondary Prevention; D016540:Smoking Cessation / Q000379:methods; D013375:Substance Withdrawal Syndrome / Q000150:complications*; D014029:Tobacco Use Disorder / Q000150:complications* / Q000628:therapy*; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000150:complications* / Q000523:psychology / Q000628:therapy
chemical_list: D014151:Anti-Anxiety Agents; D009538:Nicotine