Sarah started to smoke in high school and developed an addiction to tobacco that she carried with her through college, marriage, and two pregnancies.

She tried to quit a number of times over the years but found that she gained too much weight and felt depressed when she stopped smoking.

She had never spoken with her physician about her attempts to quit and changed the topic when it looked like it might be brought up at her physicals .

As Sarah turned 45 she noticed a morning cough and one respiratory infection after another. All of this curtailed her activity with her tennis group and affected her quality of life. Her family physician began to investigate this and when a chest x-ray revealed "a shadow on her lung" she arranged for a CT scan and referred her to a respirologist. After further investigations, including a CT scan and needle biopsy of the lesion, she was diagnosed with lung cancer.

Sarah could not believe that this was happening to her; she believed that smoking could not cause her any medical problems at her age and that only men got lung cancer. Sarah saw both medical and radiation oncologists who confirmed the diagnosis of lung cancer. Anger, then rage filled Sarah’s hours and days. Reality hit with the onset of her treatments: first she received radiation to shrink the tumour, then surgery to remove all possible cancerous tissue, and then a series of chemotherapy treatments and the accompanying side effects. Amazingly, through all of this, Sarah still wanted a cigarette, she had a massive craving for nicotine and found withdrawal from it one of the more difficult parts of the entire process. Sarah lost her battle against lung cancer 3 years after the original diagnosis. (Case modified from Kolander, Ballard, Chandler, 1999)