Life in one hand, a cigarette in the other: post-cancer and post-surgery smokers

AMMAN — “Smoking has never killed anyone,” said Abu Mahmoud Ajarmeh, a 50-year-old smoker who is still recovering from open-heart surgery.

A long-time patient at the Royal Medical Services, with three lung surgeries and a recent open-heart surgery, Abu Mahmoud is still adamant in his belief that smoking had nothing to do with his current health condition.

When bombarded with scientific research and brought to a corner by his doctors, his concluding argument is: “If I’m going to live 10 more years without smoking, I’m willing to cut that in half with a cigarette in my hand.”

Abu Mahmoud is among thousands of nicotine-addicted patients who continue to smoke after serious surgeries directly caused by the very habit of smoking, according to Abdul Fatah Abu Huweileh, a medical consultant on Abu Mahmoud’s case.

When it comes to the more serious, malignant and deadly diagnosis of cancer, the attitude of patients rarely changes. The success rate of diagnosed or post-treatment patients who quit smoking after visiting the Tobacco Dependence Treatment Clinic stands at 30-40 per cent, according to Rasha Bader, Programme Manager on tobacco control at King Hussein Cancer Centre (KHCC).

She recalled: “I remember a patient who had just finished chemo and could barely stand, who then telephoned his son to bring him a bag of cigarettes. He stood there, his son holding him up on the stairs, smoking.”

Tobacco kills 46 Jordanian men and 15 Jordanian women every week, according to the Tobacco Atlas, an American Cancer Society guide.

Every year, more than 3,100 of the Kingdom’s people are killed by tobacco-caused diseases, the guide stated.

Many of the victims, according to Heart Surgeon at the Royal Medical Services Yousef Zurigat, are “not victims at all, but perpetrators”.

 “A large proportion of these patients have had several lung surgeries or have at least been incessantly advised to quit smoking immediately after a serious diagnosis. Many of them do not. It is a conscious decision to take their own life,” he added.

A study dating back to 1991 published at the University of Jordan’s Faculty of Medicine showed that males in the Kingdom smoke for an average of 16 years of their lives and females for an average of 13.4 years. 

“Throughout these long years, during which several visits to the doctor on nicotine-related causes have been made, not one session has been enough to convince a smoker to quit, which is exactly why a post-surgery advisory session of the same kind simply does not work unless the patient is willing,” said Zurigat.

Although smoking was found to be highest among unskilled workers and illiterate persons in the 1991 study, the phenomena has spread to all segments of society, according to a 2016 World Health Organisation (WHO) report that placed Jordan as the second most smoking-dependent country in the world and the first regionally.

“This is a health crisis,” WHO representatives told The Jordan Times at the launch of the report.

Zurigat said: “You would think that even if the intense scientific research, health campaigns and warnings has not been enough to stop the general public from nicotine in all its forms, then a serious health operation and the risk of losing one’s life would at the very least stop patients — but it has not.”

The reasons behind continuing to smoke are many, according to Bader, and include the fact that the nicotine found in tobacco is highly addictive. However, in the case of cancer-diagnosed patients, Bader said that an additional reason is that some feel that it is “too late anyways”.

Over 2,300 cancer patients at KHCC are smokers, and Doctor Asem Mansour said in an awareness-raising post that many of them “do not see the purpose of quitting after already being diagnosed with cancer”.

However, a study by the centre revealed that those who do not visit the Tobacco Dependence Treatment Clinic to start their quitting journey are three times more likely to die from cancer than to those who do.

“Only 21 per cent of patients refer to the clinic, meaning that an overwhelming 79 per cent do not,” it wrote.

While these patients might feel that quitting would be of no use, the study stated that a cancer patient has more reason than an average smoker to quit.

Lowering the effects of chemo treatment, intensifying the negative side effects of the treatment and increasing the chances of the tumour returning are among the many reasons that the study cited against smoking while being treated.

Nicotine addiction in all its forms, which caused Jordan to incur losses of JD1.6 billion in 2015, representing 6 per cent of its overall GDP, according to a WHO report, is a problem that has been vigorously fought in recent years.

“Put it down” campaigns, crackdowns on unlicensed shisha servers and increased taxes on tobacco are all measures that the government has taken to battle the health and economic effects of smoking.

According to the KHCC study, such measures are crucial, as increased awareness about the risks is one of the main factors that can help a patient quit.

Yet, in a recent a study by Professor Amjad Toukan, it has been found that the average adult male cigarette smoker with an income of JD100 to JD250 per month still spends approximately 25 times more on cigarettes than on health, approximately 10 times more on cigarettes than on education, approximately 2.5 times more on cigarettes than on housing and approximately 1.5 times more on cigarettes than on food.

Yousef Shawarbeh, Mayor of Amman, wrote to The Guardian that “even the legislators push back on implementation. They are often seen smoking in parliament, as are cabinet ministers at their workplaces — all in defiance of the law”.

With one in three deaths in Jordan being attributed to smoking, the United Nations humanitarian coordinator in Jordan, Anders Pedersen, said that the Kingdom “does not need campaigns or laws as much as it needs social mobilisation that understands that smoking is a thing of the past... I am hopeful the country will reach that vision by 2030”.