[Tobacco use disorder should be considered an addiction, not lifestyle]. / Beschouw tabaksverslaving niet als leefstijl, maar als verslaving.

Tobacco use disorder is a major contributor to morbidity and mortality worldwide. Yet, in contrast to other substance use disorders, tobacco use disorder is often considered as an unhealthy lifestyle. In this article we argue that tobacco use disorder should be considered similar to other addictive disorders, and summarize supporting arguments from genetics, neuroscience, as well as treatment perspective. Considering Tobacco Use Disorder as an addictive disorder will facilitate awareness among health professionals that patients with this condition should receive proper treatment that should be reimbursed by health insurance. This will reduce the health burden of tobacco use disorder, improve quality of life of individual patients and reduce societal health care costs.

Smoking cessation and risk of recurrent cardiovascular events and mortality after a first manifestation of arterial disease.

AIMS: To quantify the relation between smoking cessation after a first cardiovascular (CV) event and risk of recurrent CV events and mortality. METHODS: Data were available from 4,673 patients aged 61 ± 8.7 years, with a recent (≤1 year) first manifestation of arterial disease participating in the SMART-cohort. Cox models were used to quantify the relation between smoking status and risk of recurrent major atherosclerotic cardiovascular events (MACE including stroke, MI and vascular mortality) and mortality. In addition, survival according to smoking status was plotted, taking competing risk of non-vascular mortality into account. RESULTS: A third of the smokers stopped after their first CV event. During a median of 7.4 (3.7-10.8) years of follow-up, 794 patients died and 692 MACE occurred. Compared to patients who continued to smoke, patients who quit had a lower risk of recurrent MACE (adjusted HR 0.66, 95% CI 0.49-0.88) and all-cause mortality (adjusted HR 0.63, 95% CI 0.48-0.82). Patients who reported smoking cessation on average lived 5 life years longer and recurrent MACE occurred 10 years later. In patients with a first CV event >70 years, cessation of smoking had improved survival which on average was comparable to former or never smokers. CONCLUSIONS: Irrespective of age at first CV event, cessation of smoking after a first CV event is related to a substantial lower risk of recurrent vascular events and all-cause mortality. Since smoking cessation is more effective in reducing CV risk than any pharmaceutical treatment of major risk factors, it should be a key objective for patients with vascular disease.

[Living with incurable cancer]. / Leven met niet meer te genezen kanker.

Anti-cancer treatments for various subtypes of cancer have significantly improved. As a result, the number of cancer patients who cannot be completely cured but may live for a considerable period of time is growing. A 72-year-old woman was diagnosed with metastatic EGFR-mutated non-small-cell lung cancer. She received anti-tumour treatment with gefitinib for almost two years and experienced only limited side effects. She was anxious about not knowing her prognosis but after visiting a psychologist she feels as if she can continue life. A 46-year-old woman started to experience symptoms of depression two years after treatment for metastatic breast cancer. A visit to a psycho-oncologist proved to be very helpful. She does not want to know her prognosis and is particularly happy that everything is going well at present. These two cases illustrate that patients living longer with incurable cancer may experience specific dilemmas. We make several recommendations for the care of this group of patients.

[Stopping smoking preoperatively: the surgeon's role]. / Iedereen rookvrij vóór de operatie: de chirurg is aan zet.

Recently a systemic review and meta-analysis of studies on preoperative smoking and postoperative complications was published. The meta-analysis showed that wound healing is better if patients do not smoke before surgery. Also, in major surgery there were fewer postoperative pulmonary complications, wound healing was better and patients who did not smoke stayed fewer days on Intensive Care. In bone surgery the consolidation process was better in non-smoking patients. We suggest that every surgeon should give well-founded and motivational advice on stopping smoking before every operation. If there is time to postpone the operation, as is the case in gastric bypass surgery for obesity, stopping smoking should generally be a conditio sine quanon for surgery. We require surgeons to be fit to operate. Likewise, for improvement of short term and long term results we should require patients to be as fit as possible to be operated on.