Claudia Marck, BSc, MSc, PhD, on Smoking Cessation in Patients With MS
Smoking is a well-known modifiable risk factor for patients with multiple sclerosis (MS). However, patients with MS who continue to smoke experience worse disease progression and report poorer health outcomes.
A new study, led by Claudia Marck, BSc, MSc, PhD, an academic at the Melbourne School of Population and Global Health at the University of Melbourne in Australia, aimed to highlight the detrimental outcomes of tobacco smoking in this population and the need for further research in order to maximize smoking cessation success. She answered our questions about her important research.1
NEUROLOGY CONSULTANT: Your research evaluated smoking cessation for patients with MS as a way to maximize health outcomes. Can you tell us more about the study and its findings?
Claudia Marck: Our topical review summarized some of the evidence of the effects of tobacco smoking on health outcomes for people with MS. Studies have consistently shown that smoking, including passive smoking, increases the risk for developing MS. Furthermore, once MS has been diagnosed, continued smoking also increases the risk for faster disease progression. There is also some evidence that tobacco smoking interacts with MS medication, decreasing its efficacy. Tobacco smoking is further associated with poorer quality of life, increased depression and anxiety, and increased risk for premature mortality.
People with MS who quit smoking decrease their risk for reaching disability milestones, compared with those who continue smoking. This shows that quitting smoking at any stage is beneficial, though the earlier the better. We argue that despite the evidence that tobacco smoking is an important risk factor for poor health outcomes, and one that is modifiable, there is unfortunately very little focus on studies in this area or on smoking cessation assistance offered by clinicians for people with MS.
NEURO CON: Smoking is a well-known modifiable risk factor for MS, yet cessation tools do not currently target this population. What tools can help target patients with MS who smoke?
CM: Due to the lack of research in this area, we do not know what smoking cessation tools may benefit people with MS specifically. It is possible that people with MS, who commonly experience symptoms of depression, pain, and cognitive problems, may need additional help with smoking cessation compared with the general population.
For instance, people with MS may think that the nicotine in tobacco is helping their symptoms in the short term, making it more difficult to quit. If this is the case, then nicotine replacement products and symptom management are very important in cessation assistance. We argue that research in this area is urgently needed to find out whether this is the case.
NEURO CON: A lot of smoking cessation programs and advertisements target adolescents and young adults. Do you think programs and advertisements targeting patients with MS (or other health conditions) would improve the smoking cessation rates?
CM: It is possible that there are MS-specific motivators to continue smoking, as well as MS-specific barriers to smoking cessation, and that interventions designed for the general population are not meeting the needs of people with MS. It is also likely that some people with MS are not aware of the health risks of smoking, particularly on their MS progression. Therefore, it is likely that cessation programs or educational advertising, specifically targeted at people with MS, may increase cessation success in this group, but evidence to prove this hypothesis is urgently needed.
NEURO CON: What is the next step in your research? What else are you currently investigating?
CM: We are currently planning to undertake qualitative research with people with MS to understand what sort of support people with MS who smoke are currently receiving and what support they would like to help them quit smoking. Understanding if there are MS-specific barriers to smoking cessation will help design cessation programs.
We are also planning to interview and survey MS clinicians (neurologists and nurses) to understand what their current practices are in assessing smoking behavior in people with MS and assisting them to quit (e.g., refer people to a quit service). MS clinicians may perceive barriers to assess and address smoking. We will be working closely with our partner organizations to address these barriers and design tools to help people with MS quit smoking.
NEURO CON: What is the key take-home message for neurologists?
CM: Several studies have argued that smoking cessation advice should be a routine part of clinical care for people with MS or those at risk for MS, but we do not know if this is currently common practice. Therefore, the take-home message for MS clinicians is to routinely ask people with (or those at risk for) MS whether they smoke or if they are exposed to passive smoking, and discuss the health risks. Referring people to local quit services and regularly following up can help people with MS quit and improve their health.
- Marck CH, das Nair R, Grech LB, Borland R, Constantinescu CS. Modifiable risk factors for poor health outcomes in multiple sclerosis: The urgent need for research to maximise smoking cessation success [published online June 20, 2019]. Mult Scler. https://doi.org/10.1177/1352458519858730.