Tobacco use and socioeconomic status are related with each other and important determinants of disparities and inequalities to access to care. There is overall reduction in number of smokers but still most number of smokers is represented by people from low socioeconomic status, with less number of these people having an access to the treatment centers. Patients who are tobacco users have shown to be less likely to receive any form of treatment for lung cancer, whether that be chemotherapy, radiotherapy, or surgery. As there is less awareness about signs and symptoms of lung cancer, lower socioeconomic patients are likely to report to hospitals at advanced stages or many times as a medical emergency. We are well aware that patients with advanced lung cancer have lower chances of survival in view of incomplete response to treatment. As there is an intersection between tobacco use, health disparities, and inequalities and lung cancer treatment and survival, this issue needs better focus and attention to minimize disparities and inequalities in access to care and outcomes.

Development of immunotherapy agents has changed the cancer treatment paradigm with better outcomes and lesser side effects. Yet, there are adverse events associated with them. Owing to the increased stimulation of the immune system, the normal homeostatic mechanisms protecting the body from its own immune response can become disrupted, leading to a variety of side effects termed immune-related adverse effects (irAEs). irAEs can have significant associated morbidity and in many cases lead to discontinuation of therapies with unpredictable impact on the course of patients' disease. Few key articles laying out guidelines for the management of irAEs provide general treatment algorithms for the majority of the common irAEs. Nurses should have knowledge of the mechanism and adverse events associated with such therapies. Oncology nurses have a crucial role in identification of irAEs. irAEs may involve multiple systems, and thus, it is necessary to identify and manage these adverse events according to the case these at soon as possible.

Tobacco consumption, specially smoking and waterpipe, affect the lung capacity which may lead to difficulty in breathing, caused by long term harmful effect on cardiovascular and respiratory system leading to elevated risk of various kind of infectious diseases. SARS-CoV-2 infection, which primarily affects the lungs, is found to be associated with severe events in persons who consume tobacco either smokeless or with smoke. Many studies showed that smokers, either current or former, show the severe COVID-19 progression. Yet there is no strong evidence which establishes the link between tobacco smoking and COVID-19. Smoking causes increase in secretory cells of respiratory tract, subsequently increasing ACE-2 expression. Ageing is also associated with a higher expression of ACE-2 gene. This can possibly explain the vulnerability of aged people, smokers and patients with hypertension to coronavirus and also people who consume tobacco, either smokeless or smoke, as a potential vulnerable group for COVID-19.

The emergence of COVID-19 has now spread across 216 countries and territories worldwide. It has had detrimental effects on the delivery of cancer care and many therapeutic treatments have been paused as a result. Therefore, oncology communities have made two main adaptations so that patients can continue to receive their therapy. The first is to reduce the number of hospital visits and hospitalizations and the second is to prevent anticancer treatment induced complications of COVID-19. Oncologists must consider the published advice available in the absence of international guidelines and as the COVID-19 pandemic continues, approaches to treatment must adjust in order to be safely delivered.