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Cummings KM, Toll BA, Talbot V, Roberson A, Wilson D, Dunlap M, Ware EC, Palmer AM, Bliss AA, Anokye VS, Warren G. Implementation, enrollment, and engagement in an opt-out telehealth pharmacist-assisted tobacco treatment program for patients seen in oncology outpatient clinics. Cancer 2024; 130:2482-2492. [PMID: 38546445 PMCID: PMC11214603 DOI: 10.1002/cncr.35291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 02/07/2024] [Accepted: 02/29/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVE To describe the workflow, reach, cost, and self-reported quit rates for an opt-out tobacco treatment program (TTP) for patients seen in 43 oncology outpatient clinics. METHODS Between May 25, 2021, and December 31, 2022, adult patients (≥18 years) visiting clinics affiliated with the Medical University of South Carolina Hollings Cancer Center were screened for smoking status. Those currently smoking were referred to a telehealth pharmacy-assisted TTP. An attempt was made to contact referred patients by phone. Patients reached were offered free smoking cessation counseling and a 2-week starter kit of nicotine replacement medication. A random sample of 420 patients enrolled in the TTP were selected to participate in a telephone survey to assess smoking status 4 to 12 months after enrollment. RESULTS During the reference period 35,756 patients were screened and 9.3% were identified as currently smoking. Among the 3319 patients referred to the TTP at least once, 2393 (72.1%) were reached by phone, of whom 426 (12.8%) were ineligible for treatment, 458 (13.8%) opted out of treatment, and 1509 (45.5%) received treatment. More than 90% of TTP enrollees smoked daily, with an average of 13.1 cigarettes per day. Follow-up surveys were completed on 167 of 420 patients, of whom 23.4% to 33.5% reported not smoking; if all nonresponders to the survey are counted as smoking, the range of quit rates is 9.3% to 13.3%. CONCLUSION The findings demonstrate the feasibility of reaching and delivering smoking cessation treatments to patients from a diverse set of geographically dispersed oncology clinics.
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Affiliation(s)
- K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Benjamin A. Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Avery Roberson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Dianne Wilson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Martha Dunlap
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily C. Ware
- Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Amanda M. Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Asia A. Bliss
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Vincent S. Anokye
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Graham Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina, USA
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Fucito LM, Palmer AM, Baldassarri SR. A new perspective on mitigating lung cancer risks through smoking cessation and reduction. J Natl Cancer Inst 2024; 116:782-785. [PMID: 38497951 PMCID: PMC11160493 DOI: 10.1093/jnci/djae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/10/2024] [Accepted: 02/21/2024] [Indexed: 03/19/2024] Open
Affiliation(s)
- Lisa M Fucito
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
| | - Amanda M Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Stephen R Baldassarri
- Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
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Herbst E, Hoggatt KJ, Leonard S, Purcell N, Rossi N, Bialous S. Tobacco Cessation Prescription Utilization Rates Among Veterans with Cancer Who Smoke. J Gen Intern Med 2023; 38:3644-3647. [PMID: 37715093 PMCID: PMC10713503 DOI: 10.1007/s11606-023-08381-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/15/2023] [Indexed: 09/17/2023]
Affiliation(s)
- Ellen Herbst
- Mental Health Service (116B), San Francisco VA Health Care System (SFVAHCS), 4150 Clement St., San Francisco, CA, 94121, USA.
- Department of Psychiatry and Behavioral Sciences, University of California, 401 Parnassus Ave., San Francisco, CA, 94143, USA.
| | - Katherine J Hoggatt
- Research Service (152), San Francisco VA Health Care System, 4150 Clement St., San Francisco, CA, 94121, USA
- Department of Medicine, University of California, 401 Parnassus Ave., San Francisco, CA, 94143, USA
| | - Samuel Leonard
- Research Service (152), San Francisco VA Health Care System, 4150 Clement St., San Francisco, CA, 94121, USA
- Department of Medicine, University of California, 401 Parnassus Ave., San Francisco, CA, 94143, USA
| | - Natalie Purcell
- San Francisco VA Health Care System, Integrative Health Service, 4150 Clement Street, San Francisco, CA, 94121, USA
- Department of Social and Behavioral Sciences, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Nathan Rossi
- Mental Health Service (116B), San Francisco VA Health Care System (SFVAHCS), 4150 Clement St., San Francisco, CA, 94121, USA
- Department of Psychiatry and Behavioral Sciences, University of California, 401 Parnassus Ave., San Francisco, CA, 94143, USA
| | - Stella Bialous
- School of Nursing, University of California, 490 Illinois St. Floor 12, Box 0612, San Francisco, CA, 94143, USA
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Yang MJ, Martínez Ú, Fulton HJ, Maconi ML, Turner K, Powell ST, Chern JY, Brandon TH, Vidrine JI, Simmons VN. Qualitative evaluation of the implementation and future sustainability of an e-referral system for smoking cessation at a US NCI-designated comprehensive cancer center: lessons learned. Support Care Cancer 2023; 31:483. [PMID: 37480364 PMCID: PMC10577649 DOI: 10.1007/s00520-023-07956-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/18/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Promoting smoking cessation is recognized as an essential part of cancer care. Moffitt Cancer Center, supported by the National Cancer Institute Cancer Moonshot Cancer Center Cessation Initiative, developed and implemented an opt-out-based automatic electronic health record (EHR)-mediated referral (e-referral) system for Tobacco Quitline services along with options for local group cessation support and an in-house tobacco treatment specialist. This study evaluated barriers and facilitators for implementation of the e-referral system. METHOD Steering committee members (N=12) responsible for developing and implementing the new clinical workflow and nurses (N=12) who were expected to use the new e-referral system completed semi-structured interviews. Qualitative thematic content analyses were conducted. RESULTS Interviewees perceived the e-referral system as an effective strategy for identifying and referring smokers to cessation services. However, barriers were noted including competing demands and perceptions that smoking cessation was a low priority and that some patients were likely to have low motivation to quit smoking. Suggestions to improve future implementation and sustainability included providing regular trainings and e-referral outcome reports and increasing the visibility of the e-referral system within the EHR. CONCLUSION Initial implementation of the e-referral system was perceived as successful; however, additional implementation strategies are needed to ensure sustainability at both the clinician and system levels. Recommendations for future modifications include providing regular clinician trainings and developing a fully closed-loop system. Implications for cancer survivors Initial implementation of an e-referral system for smoking cessation for cancer patients revealed opportunities to improve the smoking cessation referral process at cancer centers.
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Affiliation(s)
- Min-Jeong Yang
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.
| | - Úrsula Martínez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Hayden J Fulton
- Participant Research, Intervention, and Measurements Core, Moffitt Cancer Center, Tampa, FL, USA
| | - Melinda Leigh Maconi
- Participant Research, Intervention, and Measurements Core, Moffitt Cancer Center, Tampa, FL, USA
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Sean T Powell
- Social Work and Patient Support Services, Moffitt Cancer Center, Tampa, FL, USA
| | - Jing-Yi Chern
- Gynecologic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Thomas H Brandon
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Jennifer I Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Vani N Simmons
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
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Reducing Chemotherapy-Induced DNA Damage via nAChR-Mediated Redox Reprograming-A New Mechanism for SCLC Chemoresistance Boosted by Nicotine. Cancers (Basel) 2022; 14:cancers14092272. [PMID: 35565402 PMCID: PMC9100082 DOI: 10.3390/cancers14092272] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 02/01/2023] Open
Abstract
Up to 60% of patients with small cell lung cancer (SCLC) continue to smoke, which is associated with worse clinical outcomes. Platinum-based chemotherapies, in combination with topoisomerase inhibitors, are first-line therapies for SCLC, with rapid chemoresistance as a major barrier. We provided evidence in this study that nicotine and its major metabolite, cotinine, at physiologically relevant concentrations, reduced the efficacy of platinum-based chemotherapies and facilitated chemoresistance in SCLC cells. Mechanistically, nicotine or cotinine reduced chemotherapy-induced DNA damage by modulating cellular redox processes, with nAChRs as the upstream targets. Surprisingly, cisplatin treatment alone also increased the levels of nAChRs in SCLC cells, which served as a self-defense mechanism against platinum-based therapies. These discoveries were confirmed in long-term in vitro and in vivo studies. Collectively, our results depicted a novel and clinically important mechanism of chemoresistance in SCLC treatment: nicotine exposure significantly compromises the efficacy of platinum-based chemotherapies in SCLC treatment by reducing therapy-induced DNA damage and accelerating chemoresistance acquisition. The results also emphasized the urgent need for tobacco cessation and the control of NRT use for SCLC management.
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Evans WK, Warren GW, Dresler C. Ignoring the Obvious: Smoking Cessation Improves Survival. J Thorac Oncol 2022; 17:596-598. [DOI: 10.1016/j.jtho.2022.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 12/17/2022]
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Leone FT, Evers-Casey S. Tobacco Use Disorder. Med Clin North Am 2022; 106:99-112. [PMID: 34823737 PMCID: PMC8630801 DOI: 10.1016/j.mcna.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Tobacco use disorder is highly prevalent; more than a billion individuals use tobacco worldwide. Popular views on the addictive potential of tobacco often underestimate the complex neural adaptations that underpin continued use. Although sometimes trivialized as a minor substance, effects of nicotine on behavior lead to profound morbidity over a lifetime of exposure. Innovations in processing have led to potent forms of tobacco and delivery devices. Proactive treatment strategies focus on pharmacotherapeutic interventions. Innovations on the horizon hold promise to help clinicians address this problem in a phenotypically tailored manner. Efforts are needed to prevent tobacco use for future generations.
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Affiliation(s)
- Frank T Leone
- Comprehensive Smoking Treatment Program, Penn Lung Center, Suite 251 Wright-Saunders Building, 51 North 39th Street, Philadelphia, PA, USA; Abramson Cancer Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
| | - Sarah Evers-Casey
- Comprehensive Smoking Treatment Program, Penn Lung Center, Suite 251 Wright-Saunders Building, 51 North 39th Street, Philadelphia, PA, USA
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Implementation Science to Improve Tobacco Cessation Services in Oncology Care. J Natl Compr Canc Netw 2021; 19:S12-S15. [PMID: 34872048 DOI: 10.6004/jnccn.2021.7094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022]
Abstract
Every patient with cancer deserves access to evidence-based tobacco cessation interventions as part of their routine oncology care. The NCI Cancer Moonshot funded the Cancer Center Cessation Initiative (C3I) to help establish and/or expand tobacco treatment programs at 52 NCI-designated Cancer Centers. Although this initiative has broadened the availability of tobacco treatment services across US cancer centers, the reach and utilization of these services remains low among patients. To help address the remaining gap between the availability and utilization of evidence-based treatments for tobacco use in the oncologic context, staff and investigators at C3I sites and the C3I Coordinating Center formed the C3I Implementation Science Working Group. The mission of this working group is to bring together clinicians, scientists, and policymakers who share a common interest in implementation science and treating tobacco use in the oncologic context to collaborate on projects aimed at shrinking the practice gap in this area. Through case study examples, we describe how the C3I Implementation Science Working Group is supporting efforts to identify effective ways to increase the utilization of evidence-based tobacco treatments within cancer treatment settings and promote the broader impact and long-term sustainability of C3I.
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Pipe A. Overcoming 'Cessation Stasis': The Need to Address Inertia. J Natl Cancer Inst 2021; 114:338-339. [PMID: 34850035 DOI: 10.1093/jnci/djab209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/11/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Andrew Pipe
- Division of Cardiac Prevention & Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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