Trying to Quit Smoking? One Patient Succeeded with Some ‘Totally Different’ Support
When Tracy Downs decided to quit smoking, she had little faith that it would actually happen. Having smoked for 26 years, including while she received treatment for breast cancer in 2020, she had tried a lot of tactics but nothing seemed to stick.
That changed when she met nurse practitioner Patricia Mallaber, ANP-BC, in Wilmot Cancer Institute’s Tobacco Dependence Treatment Program. Something felt different from the start.
Through the program, Mallaber helps patients who’ve been diagnosed with cancer quit smoking. The program started in 2015 with the knowledge that cancer patients who smoke tend to have worse outcomes compared to those who do not. Studies show people who smoke face more surgical complications and receive fewer benefits from chemotherapy treatment than nonsmokers.
From the start, the program has used a combination of researched-backed tactics to help patients, and it’s important to note that patients rarely quit on day one. It’s not a one-and-done visit but instead, Mallaber gets to meet patients over the course of six months to a year. In that time, some patients continue smoking, but Mallaber recently published a study in the Clinical Journal of Oncology Nursing showing that patients who had at least four visits had the most success in quitting. She hopes this data can help lead to establishing national guidelines for all oncology tobacco dependence programs.
For Downs, Mallaber didn’t force expectations onto her, but instead met her where she was from the beginning. Downs had just finished up the bulk of her breast cancer treatment, which included surgery and 16 cycles of chemotherapy. She began hormone therapy that she’ll be on for a while longer.
She felt ready to talk about breast reconstruction, but the plastic surgeon wouldn’t entertain it as an option while she still smoked. So Downs decided to meet with Mallaber, admittedly not excited about it, thinking this would be just like all the other times she’d tried to quit – except it wasn’t.
“I had no confidence I was going to quit smoking at all, but as Patty and I continued to talk and she came up with various things, I was able to actually start to cut down to the point where one day, I just forgot to go out and have a couple of puffs,” Downs says. “I haven’t gone out since.”
It’s been more than three months since she last had a cigarette.
But getting there wasn’t easy. They had to find what worked through trial and error. That meant talking about what Downs had tried before and why it hadn’t worked, including discussing a variety of nicotine replacement therapies to help with the withdrawal symptoms.
Downs started with the patch, but that didn’t help. They tried a nasal spray but that gave her bloody noses. Finally, Downs reluctantly agreed to try Chantix. She’d been on it before, but she’d experienced side effects. However, Mallaber helped her start slowly, and it worked, in combination with continued support from Mallaber and from a behavioral therapist.
“I still get cravings because I was a 26-year smoker and I’ll have the intention to go out and grab a cigarette with my boyfriend but the minute I walk out there, I smell it and I’m like oh gosh. I walk right back in. The smell now nauseates me,” she says.
Now that she’s quit smoking, she’s working on other aspects of her health, too, including upping her physical activity. Since her cancer treatment, she’s discovered she really likes nature walks and exercise, activities that have turned into healthy alternatives to smoking. She also has planned a bariatric surgery at Highland Hospital. And she’s now on a path toward getting her breast reconstruction done with Elaina Chen, M.D. She plans to have bariatric surgery followed by the first phase of reconstruction. It will take years, but she says it will be worth it.
“According to the plastic surgeon, this will give me the best aesthetic outcome,” she says. “I’m still not out of the woods on needing an implant, but I’m hoping I don’t.”
She’s grateful for the support Mallaber provided and would encourage anyone who wants to quit smoking to try the program.
“Give her a chance because you’d be surprised at what you can accomplish. She will encourage you without discouraging you from smoking. Because in the early days, I was still smoking about a half a pack and I was able to taper down with her encouragement and her ideas so it’s worth giving it a shot,” she says. “This is going to be something totally different from what you’ve tried in the past.”
Wilmot patients and family members who would like to work with Mallaber to quit smoking can talk to their oncologist or call (585) 275-5823. Wilmot’s Community Outreach & Engagement Office offers a fully remote smoking cessation program to help people quit smoking; to learn more or sign up, call (585) 504-9461 or email quitcenter@urmc.rochester.edu
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