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Table of Contents
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 533-535

Healing the healers

Department of Head and Neck Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India

Date of Submission03-Sep-2021
Date of Decision11-Sep-2021
Date of Acceptance15-Sep-2021
Date of Web Publication08-Oct-2021

Correspondence Address:
Pankaj Chaturvedi
1227, Homi Bhabha Block, Tata Memorial Hosital, Dr. E Borges Marg, Mumbai - 400 012, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/crst.crst_216_21

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How to cite this article:
Singh AG, Chaturvedi P. Healing the healers. Cancer Res Stat Treat 2021;4:533-5

How to cite this URL:
Singh AG, Chaturvedi P. Healing the healers. Cancer Res Stat Treat [serial online] 2021 [cited 2022 May 23];4:533-5. Available from: https://www.crstonline.com/text.asp?2021/4/3/533/327797

While the world is collectively acting to stop the on-going coronavirus (pan-, epi-) “demics,” more than a decade ago, the World Health Organization (WHO) released the first report on the world's longest standing tobacco epidemic that still continues.[1] It is one of the biggest public health threats and is annually killing more than 8 million people globally.[2] While a majority of these deaths are the direct consequences of use, about 1.2 million tobacco-related deaths occur among non-smokers as a result of second-hand smoke.[2] All forms of tobacco are harmful, and there is no safe level of exposure. Cigarette smoking is the most common form of use worldwide, and over 80% of the 1.3 billion tobacco users live in low- and middle-income countries.[2] Tobacco use is highly addictive and even the most willful often find it very difficult to give up. Health-care workers promote smoking cessation and treat patients with related addictions and develop evidence-based guidelines for the same.[3],[4] However, in many countries worldwide, smoking has claimed a substantial place among the medical field, especially among students.[5] One of the most gruesome penalties of tobacco use is cancer, especially when it presents among the lower socioeconomic groups where the burden of illness and death is the heaviest. It would be logical to assume that after witnessing first-hand the suffering that tobacco engenders, the people who clean up this consequence of tobacco use, i.e. oncologists, must be extremely hostile towards tobacco use, but the reality is quite different.

A recent questionnaire-based study has reported the pattern and practice of smoking among oncologists in Eastern India.[6] Eastern India is known as the smoking capital of India, with almost every third person in Mizoram and Meghalaya being a smoker.[6] While various studies have been undertaken in India to understand the patterns of smoking among health-care workers, this study reported these practices among oncologists in this region.[6],[7],[8] This study was conducted between April and May 2017 at the Institute of PostGraduate Medical Education and Research in Kolkata, India. The questionnaire was sent through E-mail to 262 oncologists, and the responses were collected by an independent reviewer. The de-identified responses were then forwarded to the investigators. Valid responses were obtained from 50.4% of the participants with only 1.6% being female. The median age of smoking onset was found to be 19 years (range, 12–29 years), and the median duration of smoking was 78 months (range, 2–480 months). A total of 50 (38%) respondents were ever-smokers, and 82 (62%) were never-smokers. Out of the ever-smokers, 46% were moderate to heavy smokers and 28% were heavy smokers. A significant number (84%) were current smokers with 74% of them smoking daily. Peer pressure was found to be the most common reason cited by the respondents for initiation of the habit (around 55%), followed by a sense of adventure (33%). Out of the 43 smokers who attempted quitting, 30 (69.7%) were successful, of which 8 were former ever-smokers and 22 were never-smokers. Health concern was cited as the most common reason to quit, whereas mental stress was the most common cause of relapse.

Health-care workers are at the forefront of dealing with the tobacco menace and oncologists form an important cog in that wheel. However, the current study sheds light on how tobacco has pummelled the healers as well.[6] It highlights the alarmingly high prevalence of smoking among the oncologists of Eastern India. The study has used the standard definitions given by US Centers for Disease Control and Prevention and the WHO to describe the various types of smokers.[2],[9] Although one of the first to describe the smoking patterns among oncologists in Eastern India, the 50% response rate might not give a clear picture of the actual patterns, especially with an extremely low female representation. Moreover, the results might not be an apt representation of the generalized smoking patterns across the country, owing to the high age-standardized prevalence of smoking in West Bengal (as described in the Global Adult Tobacco Survey Fact sheet India 2016–2017).[6],[10]

Understanding smoking patterns among this specific demographic is essential as the health-care workers are the prime motivators for people attempting any form of prevention or cessation of tobacco use. The use of tobacco among health-care workers globally varies across nations and has been noted to be significantly higher than the general population in some.[5] Studies reporting international patterns have shown that doctors in Great Britain rarely smoke, while almost half of the health-care workers in Italy smoke, with high prevalence rates among students in Spain, Poland, and Germany.[5] In general, two patterns of smoking among health-care workers have been described in the literature. The first is among the most developed countries that are experiencing a decline over the years like the United States of America (USA), Australia, and the United Kingdom (UK), where doctors have notably been reducing their smoking rate, usually preceding a decrease in smoking rates among the general public. However, there are exceptions to this with countries such as Italy, France, and Japan, where the rates are as high as 44%.[5] The second scenario is the developing countries such as China, Turkey, and India that have high male smoking prevalence rates, at approximately 50%. One of the first large Indian studies assessing smoking patterns among health-care workers was undertaken in Kerala.[8] They collected information on tobacco use and quit attempts. They found that 42% of medical school faculty and physicians were current smokers. In addition, 51% of medical students had not attempted to quit over the course of the previous year. Around a third of the faculty and physicians, and one-sixth of the medical students had attempted to quit at least four times. Another study from Kashmir discussed the age and reasons for initiation of smoking.[7] They found that 70% of the smokers started between the ages of 11 and 20 years and 80% took it up by virtue of peer pressure, which are similar to the findings of the current study.

The primary goal of any tobacco cessation effort is to determine what it would take to get the target population to stop behaving in a manner that is harmful or to start doing something that would be beneficial. An interesting finding from the current study was that 10% of the respondents attempted to quit smoking because of the graphical warnings on the cigarette packages.[6] Other studies have also shown the positive impact in motivating users to quit due to the 85% pictorial warnings on the cigarette packages.[11] The present study also highlights the benefit of early intervention in this group, since the median age of the initiation of use was 19 years.[6] Research should also be focused on understanding the pattern of smoking among the various specialties of oncology. This stems from the fact that stress was deemed to be a major driver for relapse.[6] The understanding of the work-related mental exhaustion and the appropriate steps to tackle the same could go a long way in addressing the situation. Effective implementation of the tobacco control framework is likely to have an impact not only on the prevention of initiation but also on tobacco cessation.

The study helps to bring back the focus on the urgent need to incorporate tobacco education into the current Indian medical school curriculum, which was previously noted in the studies done in Kerala and Kashmir. This is a major problem from a public health perspective as the health-care worker is an important model for patients and tobacco use by the health-care workers will impair interactions with patients about smoking. In fact, cessation counseling delivered by non-smoking general practitioners resulted in higher rates of prolonged abstinence than when delivered by general practitioners that smoked.[5] It also reiterates the positive outcomes of the bold steps taken by the concerned authorities, whether in terms of introduction of tobacco cessation clinics across states or the graphical representation of the hazards of smoking.[2] The role of the media should not be underestimated, as demonstrated by the cult status attained by many tobacco-related advertisements shown on the Indian cinema screens. A greater involvement of various strata of authorities and implementation of the already existing laws is needed to ensure that health-care workers remain the role models of the society. They should play the role of healers in the society and not be the victims of the tobacco menace.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Flor LS, Reitsma MB, Gupta V, Ng M, Gakidou E. The effects of tobacco control policies on global smoking prevalence. Nat Med 2021;27:239-43.  Back to cited text no. 1
WHO | WHO Framework Convention on Tobacco Control. WHO. Available from: http://www.who.int/fctc/text_download/en/. [Last accessed on 2018 Mar 04].  Back to cited text no. 2
Raw M, Anderson P, Batra A, Dubois G, Harrington P, Hirsch A, et al. WHO Europe evidence based recommendations on the treatment of tobacco dependence. Tob Control 2002;11:44-6.  Back to cited text no. 3
Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel, Liaisons, and Staff. A clinical practice guideline for treating tobacco use and dependence: 2008 update. A U.S. Public Health Service report. Am J Prev Med 2008;35:158-76.  Back to cited text no. 4
Cattaruzza MS, West R. Why do doctors and medical students smoke when they must know how harmful it is? Eur J Public Health 2013;23:188-9.  Back to cited text no. 5
Chatterjee K, Ray A, Chakraborty A. Patterns of smoking among oncologists of eastern India: A questionnaire based survey. Cancer Res Stat Treat 2021;4:443-8.  Back to cited text no. 6
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Mohan S, Pradeepkumar AS, Thresia CU, Thankappan KR, Poston WS, Haddock CK, et al. Tobacco use among medical professionals in Kerala, India: The need for enhanced tobacco cessation and control efforts. Addict Behav 2006;31:2313-8.  Back to cited text no. 8
Schoenborn CA, Adams PE. Health behaviors of adults: United States, 2005-2007. Vital Health Stat 10 2010;245:1-132.  Back to cited text no. 9
Mohan P, Lando HA, Panneer S. Assessment of tobacco consumption and control in India. Indian J Clin Med 2018;9:1-8.  Back to cited text no. 10
Bincy M, Vidhubala E, Priyadharshini R. Does 85% pictorial health warning on the tobacco products have the impact among tobacco users in India? Tob Induc Dis 2018;16 Suppl 1:A758.  Back to cited text no. 11


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