When a smoker becomes cancer patient loses every appeal for the market of tobacco products. We never read about programs or initiative of cigarette manufacturers to help smokers to live with cancer and to face with treatments. To be a cancer patient and to remain a tobacco consumer means to live in a very critical situation. The social stigma represents the smoker like the only person who choose consciously the risk of cancer and worse when also during the cancer treatments he is not able to cut the chain of tobacco addiction. Italian cancer centres usually don’t take specific care of cancer patients who smoke: NRT is available only in a few hospitals and other smoking cessation treatments and counselling are not dispensed with the National Health System. The patient who smokes is a very fragile person and we identify three main areas to develop his care: 1) Telling facts: today it is not adequate to recommend to stop smoking. Patients who smoke must know how smoking impacts the prognosis of her/his disease, in the outcome of surgery and in the efficacy of radiotherapy and drugs treatments. 2) Offering sensitive and effective smoking cessation like an instrument of patient’s empowerment that gives the possibility to achieve better QoL. 3) Assisting for nicotine withdrawal symptoms patients who want to stop or reduce smoking and also patients unwilling to quit. Conclusion: Cancer patients who smoke are the principal victims of tobacco epidemic and the alliance with them can enforce an effective tobacco control policy.