Health Report:

Smoking & Quality of Life

"A critical weekly review of important new research findings for health-conscious readers..."

By, Robert A. Wascher, MD, FACS

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Last Updated:  10/26/2008

The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author.  Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.


Denial is generally not looked upon as a positive trait.  When people engage in denial about lifestyle habits that are likely to expose them to great potential harm, however, the consequences of denial can be especially severe.  Unfortunately, smoking, the single greatest cause of preventable illness and death throughout much of the world, is often associated with considerable denial.  

Even conservative estimates suggest that nearly half a million premature deaths occur every year in the United States due solely to smoking tobacco.  Lung cancer, the number one cause of cancer-associated death in this country, afflicts more than 215,000 new victims every year, and causes more than 160,000 deaths per year (currently, 85 percent of patients who develop lung cancer will die of this horrific disease within 5 years of their initial diagnosis).  In addition to lung cancer, tobacco use has also been clearly linked to cancers of the oral cavity, larynx (voice box), esophagus, bladder, kidney, pancreas, stomach and bone marrow (leukemia).  

In addition to smoking-associated cancers, chronic lung diseases like emphysema and bronchitis also cripple and kill tens of thousands of smokers every year as well.  Moreover, in addition to the 35 million Americans who currently live with chronic lung diseases (the vast majority of whom are smokers), tens of thousands die prematurely every year from tobacco-associated coronary artery disease, peripheral vascular disease and stroke.  

One would think that grim statistics like these would result in the elimination of smoking from the world in fairly short order. However, more than four decades after the US Surgeon General declared smoking to be irrevocably linked to lung cancer, nearly 1 in 4 Americans continues to smoke (for a more thorough overview of lifestyle-associated cancer risks and cancer prevention strategies, please watch for my forthcoming book, “A Cancer Prevention Guide for the Human Race,” which should be completed in mid-2009).

When I gently remind patients of mine who smoke about these same smoking-related health consequences, and the importance of quitting, many of them will nod in agreement with me that they should indeed quit, although I already know that only a tiny percentage of them will ever achieve this goal.  Another common response is, “Hey Doc, we all gotta die of something!”  This latter response is usually said with a mischievous smile, and the message, which is always very clear to me, is that I am wasting my time in trying to coax such patients into quitting. 

It is also clear to me that many patients who smoke are indulging in a great deal of denial, preferring to believe that while they may indeed die a few years earlier, they are, at the same time, exchanging their nicotine-induced pleasures for a reasonably comfortable and healthy life until their time in this world is prematurely up.  Some patients, having made their deal with the devil that is tobacco, have actually tried to convince me that the quality of their lives will be improved by their decision to smoke as (or so they rationalize) they foresee themselves dying earlier, but in a state of better overall health because, in their minds, they will “go out” before the ravages and diseases associated with aging can strike them.

Most of us who care for patients with cancer, and for patients with other serious chronic illnesses, already know that death very often does not come quietly in the middle of the night to softly and humanely steal away smokers.  But, short of chaperoning smokers through cancer wards, lung failure clinics, cardiac ICUs, and the like, it can be frustratingly difficult to convey to many smokers just how harmful their smoking habit is to the human body (on the other hand, after more than 20 years as a physician, it is still always surprising to me to find smokers who already know that, on average, their lives will be cut short by an average of 7 to 10 years because of their smoking, and who nonetheless continue to puff away!).  Now, a newly published prospective clinical research trial, with extensive long-term follow-up, is painting a more detailed picture regarding the true health costs associated with chronic smoking, and with a particular emphasis on health-related quality-of-life issues in smokers.

This study was completed at the University of Helsinki, in Finland, and has just been published in the Archives of Internal Medicine.  In this prospective clinical research study, almost 1,700 middle-aged men participated in the Helsinki Businessmen Study.  At the time that these men enrolled in this study, in 1974, their average age was 48, and all were in good health.  Subsequently, after an average follow-up of 26 years, a previously validated health-related quality-of-life survey was administered to all study volunteers.  Death rates, and causes of death, for this group of patients were also evaluated, using mortality data from Finland’s national healthcare system records.  

Consistent with data from previous public health studies, the men in this study who had never smoked lived, on average, 10 years longer than the men who smoked more than 20 cigarettes per day.  Not only did the smokers die younger than the non-smokers, however, but contrary to what many current smokers would like to believe, the health-related quality-of-life was significantly worse among the smokers, and as these middle-aged men passed into the latter years of their lives, the smokers’ health and quality-of-life continued to deteriorate far more dramatically than their “never-smoking” peers.  In fact, the more cigarettes per day that were smoked, the more profound was the deterioration in health-related quality-of-life.

The RAND-36 health-related quality-of-life survey that was administered to the study volunteers contains 8 different areas (or scales) of focus.  In all 8 areas, the smokers rated their health and well-being as significantly worse when compared to the “never-smokers.”  In five areas, the differences between these two otherwise matched groups of older men were especially striking.  These five health-related areas included overall physical functioning, energy/vitality levels, social functioning, and two different measures of mental health and emotional health well-being.  Indeed, this study determined that the active smokers had levels of physical, emotional and mental disability that were, on average, comparable to “never-smokers” who were 10 years older in age!  (An important related finding was that, despite the long duration of follow-up in this clinical study, former smokers were never quite able to catch up with “never-smokers” in terms of their self-assessed health-related quality of life, although they still fared better than the men who continued to smoke more than 20 cigarettes per day over the long course of this study.)

While only about 15 percent of the “never-smokers” died during the 26-year course of this clinical study, over 44 percent of the men who were smoking more than 20 cigarettes per day when they enrolled in this study in 1974 had died by the year 2000.  And, contrary to the expectations of many current smokers, the quality-of-life of long-term smokers was uniformly and significantly poorer across important physical, emotional and mental health parameters when compared to a matched group of men who had never smoked.  In light of these findings, I shall end this column much as I began it.  Denial is, in general, not a desirable trait or behavior.  When the subject of one’s denial is focused upon rationalizing the short-term and long-term costs of smoking, the consequences can be catastrophic, both for the smoker and for his or her loved ones.  If you are a “never-smoker” who is thinking of taking up this enormously addictive habit, then you can not only expect to die, on average, 10 years earlier than your “never-smoking peers,” but you can also expect to spend the latter years of your life with the physical, emotional and mental health disabilities of “never-smokers” who are a decade older than you.  

Oh, I almost forgot to mention one additional smoking-related disease.  In addition to all of the horrific smoking-related conditions that I have mentioned thus far, smoking is also the most common preventable cause of impotence.  If you are a young man who is thinking of taking up smoking, or if you have already started smoking, then you might want to watch the following public health message from the UK:


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity.

Dr. Wascher is an oncologic surgeon, professor of surgery, a widely published author, and the Director of the Division of Surgical Oncology at Newark Beth Israel Medical Center


Send your feedback to Dr. Wascher at rwascher@doctorwascher.net

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Copyright 2008.  Robert A. Wascher, MD, FACS.  All rights reserved.

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