The National Comprehensive Cancer Network (NCCN) has developed new smoking cessation guidelines for cancer patients, and one author believes that “doing better” was the original intent of the guidelines. Peter G. Shields, chair of the guideline expert panel, explained that the NCCN guidelines fill a gap in the health establishment’s lack of “systematic and consistent mechanisms to promote smoking cessation in cancer patients,” with nearly 20-30 percent of cancer patients smoking. In his work, Shields found that about 50 percent of lung cancer patients are smokers. The benefits of quitting smoking are innumerable and there is so much evidence to support them. In particular, for cancer patients, quitting smoking improves prognosis. Not quitting increases the risk of death and also increases the risk of primary and secondary tumors. Less authoritative evidence suggests that smoking increases the risk of secondary tumors and may also lead to poor treatment efficacy, as well as an increased incidence of treatment-related toxic reactions. Shields explained that despite the health benefits of quitting smoking, only about 50% of oncologists advise patients to quit, even though diagnosing a tumor is “an opportunity to educate patients. Is there a benefit for clinicians to advise patients to quit? Related policies pay differently, the NCCN statement said. One of the messages of the guidelines is that there are multiple established ways to help patients quit smoking, but clinicians must first identify where patients who continue to smoke are at. The three broad categories include nonsmokers, current smokers and those with a history of smoking. For former smokers (including those who have not smoked within the previous 30 days), clinicians should stratify patients according to their risk of smoking again. High risk of relapse is indicated by the presence of one or more of the following criteria: intense cravings, increased stress, living with a smoker, less than 1 year of abstinence, currently in treatment for smoking cessation, and drug use (including marijuana). There are many interventions for patients at high risk of relapse, including pharmacotherapy and behavioral therapy. However, patients must be “ready to quit” and also have a definite quit date. Patients who are not ready should be given nicotine replacement therapy (NRT) or varenicline (Chantix, Pfizer) to help them understand the benefits of quitting. E-cigarettes and “adjuncts” such as acupuncture, hypnosis, and nutritional supplements are discouraged because of the lack of evidence for their effectiveness. However, pharmacotherapy is effective and recommended. There are three lines of pharmacotherapy. The first line is recommended in combination with NRT (nicotine patch plus short-acting lozenges, gum, inhalers or nasal sprays). Another option is varenicline. Two combination medication regimens are recommended for second line, varenicline plus NRT or bupropion plus NRT. Three options are recommended for third line medications, varenicline plus bupropion with or without NRT; nortriptyline (a tricyclic antidepressant); and also colistin, an alpha2-adrenergic agonist used to treat hypertension. Medication treatment requires some dosing precautions. The use of varenicline and bupropion should be monitored for the development of psychiatric symptoms or exacerbation of psychiatric symptoms. Bupropion is contraindicated in patients taking MOA inhibitors or tamoxifen, in patients with closed-angle glaucoma, and in patients at risk for epilepsy. Behavioral therapy is one of the foundations of smoking cessation and includes helping patients identify “risk” situations (e.g., stress, alcohol abuse, other smokers, and other impulse triggers). Patients need to develop some coping skills to avoid them as much as possible. It is clear that medication alone, without behavioral therapy, is less effective in quitting smoking in cancer patients. More intensive behavioral therapies with a quantitative-effect relationship are recommended over simple treatments. Persuasion to quit is done through private meetings, phone calls, or group discussions. Behavioral therapy is tailored to the patient’s level of nicotine dependence and history of cessation. A multipronged approach is the most effective strategy to promote cessation, which includes evidence-based medication interventions, behavioral counseling, and follow-up to ensure successful cessation.