Journal of Thoracic Oncology · Nov 2026

Smoking and Cessation Across the Continuum of Cancer Care: 20 Years of Progress Toward Cessation as Standard Cancer Treatment

By Warren GW, Cummings KM

In the past 20 years, remarkable progress has been made to address smoking and smoking cessation across the continuum of cancer care. Long-term marketing, misrepresentation, and social engineering led to the substantial rise in smoking and adverse health during the 20th century. Although trends have started to reverse in developed nations in the past 20 years, many low- and middle-income countries have experienced rising tobacco prevalence. Among developed nations, much of the progress in cancer outcomes in the past 20 years can be attributed to reductions in smoking coupled with improved cancer treatments. Alternative products and harm reduction approaches have developed, particularly as related to the rise and use of electronic cigarettes. Continued smoking by patients with cancer and survivors results in continued biological and physiological activities that cause adverse cancer treatment outcomes, including increased overall and cancer-related mortality, risk of second primary cancer, associations with cancer treatment toxicity, and continued risks for non–cancer-related adverse health outcomes. Smoking cessation after a cancer diagnosis is a highly cost-effective adjunct to cancer treatment, resulting in improved survival, improved cancer treatment outcomes, and improved non-cancer health outcomes. Opt-out approaches to smoking cessation have markedly improved reach and overall effectiveness. Addressing smoking as early as possible in the screening, diagnostic, and treatment processes for cancer results in optimal health outcomes and survival benefits comparable to adjuvant cancer treatments. Ignoring or omitting smoking cessation in cancer screening or treatment is in direct opposition to the evidence base and will result in continued harm to patients with associated increased health care costs.

doi.org/10.1016/j.jtho.2026.106131PubMed 42988497Interventions