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Walter AW, Lee JW, Streck JM, Gareen IF, Herman BA, Kircher SM, Carlos RC, Kumar SK, Mayer IA, Saba NF, Fenske TS, Neal JW, Atkins MB, Hodi FS, Kyriakopoulos CE, Tempany-Afdhal CM, Shanafelt TD, Wagner LI, Land SR, Ostroff JS, Park ER. The effect of neighborhood socioeconomic disadvantage on smoking status, quit attempts, and receipt of cessation support among adults with cancer: Results from nine ECOG-ACRIN Cancer Research Group trials. Cancer 2024; 130:439-452. [PMID: 37795845 PMCID: PMC10841845 DOI: 10.1002/cncr.35039] [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: 02/13/2023] [Revised: 06/23/2023] [Accepted: 07/31/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Tobacco use is associated with adverse outcomes among patients diagnosed with cancer. Socioeconomic determinants influence access and utilization of tobacco treatment; little is known about the relationship between neighborhood socioeconomic disadvantage (NSD) and tobacco assessment, assistance, and cessation among patients diagnosed with cancer. METHODS A modified Cancer Patient Tobacco Use Questionnaire (C-TUQ) was administered to patients enrolled in nine ECOG-ACRIN clinical trials. We examined associations of NSD with (1) smoking status, (2) receiving tobacco cessation assessment and support, and (3) cessation behaviors. NSD was classified by tertiles of the Area Deprivation Index. Associations between NSD and tobacco variables were evaluated using logistic regression. RESULTS A total of 740 patients completing the C-TUQ were 70% male, 94% White, 3% Hispanic, mean age 58.8 years. Cancer diagnoses included leukemia 263 (36%), lymphoma 141 (19%), prostate 131 (18%), breast 79 (11%), melanoma 69 (9%), myeloma 53 (7%), and head and neck 4 (0.5%). A total of 402 (54%) never smoked, 257 (35%) had formerly smoked, and 81 (11%) were currently smoking. Patients in high disadvantaged neighborhoods were approximately four times more likely to report current smoking (odds ratio [OR], 3.57; 95% CI, 1.69-7.54; p = .0009), and more likely to report being asked about smoking (OR, 4.24; 95% CI, 1.64-10.98; p = .0029), but less likely to report receiving counseling (OR, 0.11; 95% CI, 0.02-0.58; p = .0086) versus those in the least disadvantaged neighborhoods. CONCLUSIONS Greater neighborhood socioeconomic disadvantage was associated with smoking but less cessation support. Increased cessation support in cancer care is needed, particularly for patients from disadvantaged neighborhoods.
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Affiliation(s)
- Angela Wangari Walter
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Ju-Whei Lee
- ECOG-ACRIN Biostatistics Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Joanna M. Streck
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry and Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ilana F. Gareen
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Benjamin A. Herman
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | | | - Ruth C. Carlos
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Ingrid A. Mayer
- Vanderbilt University, Nashville, Tennessee, USA
- AstraZeneca, Wilmington, Delaware, USA
| | - Nabil F. Saba
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Joel W. Neal
- Stanford Cancer Institute, Stanford University, Palo Alto, California, USA
| | - Michael B. Atkins
- Georgetown Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - Frank S. Hodi
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | | | - Tait D. Shanafelt
- Stanford Cancer Institute, Stanford University, Palo Alto, California, USA
| | - Lynne I. Wagner
- Gillings School of Global Public Health, University of North Carolina – Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Jamie S. Ostroff
- Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Elyse R. Park
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry and Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Li S, Kuo T, Robles B. The association between provider encouragement and sodium consumption behaviors. PATIENT EDUCATION AND COUNSELING 2023; 110:107671. [PMID: 36827881 DOI: 10.1016/j.pec.2023.107671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 02/01/2023] [Accepted: 02/11/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To explore and describe the associations between provider encouragement and four sodium consumption behaviors. METHODS We analyzed a 2016 Internet panel survey dataset of 954 socio-demographically diverse adults (age ≥18 years) living in Los Angeles County. Behaviors analyzed were current status of watching one's salt/sodium intake, frequency of adding salt to food, frequency of using a food/Nutrition Facts label to decide what food to purchase, and frequency of changing one's mind about buying a food product due to its sodium content. Multivariable logistic regression analyses examined the relationship between doctor/health professional (provider) encouragement and these sodium-related behaviors, controlling for self-reported health status and sociodemographic characteristics. RESULTS Provider encouragement was positively associated with three of the four sodium consumption behaviors examined: currently watching salt/sodium intake (AOR=7.27, 95% CI=3.97-13.34); frequently using a food/Nutrition Facts label (AOR=1.70, 95% CI=1.09-2.64); and frequently changing one's mind about buying a food product due to its sodium content (AOR=2.29, 95% CI=1.45-3.63). CONCLUSIONS Provider encouragement appears to have a salutary impact on sodium consumption among residents. PRACTICE IMPLICATIONS Provider encouragement may represent an underutilized strategy for counseling patients about cardiovascular health and about the benefits of reducing sodium consumption.
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Affiliation(s)
- Stephen Li
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Tony Kuo
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA; Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Population Health Program, UCLA Clinical and Translational Science Institute, Los Angeles, CA, USA
| | - Brenda Robles
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain.
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Increasing clinician participation in tobacco cessation by an implementation science-based tobacco cessation champion program. Cancer Causes Control 2023; 34:81-88. [PMID: 36224501 PMCID: PMC9555700 DOI: 10.1007/s10552-022-01619-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/08/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND We designed a process to increase tobacco cessation in an academic center and its widely distributed network community sites using clinical champions to overcome referral barriers. METHODS In 2020 a needs assessment was performed across the City of Hope Medical Center and its 32 community treatment sites. We reviewed information science strategies to choose elements for our expanded tobacco control plan, focusing on distributed leadership with tobacco cessation champions. We analyzed smoking patterns in patients with cancer before and following program implementation. We evaluated the champion experience and measured tobacco abstinence after 6 months of follow-up. RESULTS Cancer center leadership committed to expanding tobacco control. Funding was obtained through a Cancer Center Cessation Initiative (C3I) grant. Multi-disciplinary leaders developed a comprehensive plan. Disease-focused clinics and community sites named cessation champions (a clinician and nurse) supported by certified tobacco treatment specialists. Patient, staff, clinician, and champion training/education were developed. Roles and responsibilities of the champions were defined. Implementation in pilot sites showed increased tobacco assessment from 80.8 to 96.6%, increased tobacco cessation referral by 367%, and moderate smoking abstinence in both academic (27.2%) and community sites (22.5%). 73% of champions had positive attitudes toward the program. CONCLUSION An efficient process to expand smoking cessation in the City of Hope network was developed using implementation science strategies and cessation champions. This well-detailed implementation process may be helpful to other cancer centers, particularly those with a tertiary care cancer center and community network.
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DiGiacomo M, Simoes dos Santos P, Furestad E, Hearnshaw G, Nichols S, Chang S, Scott N. Cancer care clinicians' provision of smoking cessation support: A mixed methods study in New South Wales, Australia. Asia Pac J Clin Oncol 2022; 18:723-734. [PMID: 35362249 PMCID: PMC9790659 DOI: 10.1111/ajco.13769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 01/31/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Given the importance of supporting cancer patients to quit smoking, we sought to ascertain cancer care clinicians' beliefs and practices regarding providing smoking cessation brief interventions. METHODS We used a cross-sectional sequential explanatory mixed method design, including a survey of multidisciplinary cancer care clinicians and semistructured interviews. RESULTS One hundred and sixty-five cancer care clinicians completed the survey and 21 participated in interviews. Over half of survey respondents (53%) said they do not regularly undertake smoking cessation brief interventions and 40% rarely or never advise quitting. Nonmetropolitan clinicians were more likely to discuss medication options and refer to the Quitline. Physicians were more likely to do brief interventions with patients and radiation therapists were least likely. Barriers were lack of training and experience, lack of knowledge of the Quitline referral process, lack of role clarity, lack of resources and systems, and perceived psychological ramifications of cancer for patients. CONCLUSION There is a need to upskill cancer clinicians and improve systems to provide smoking cessation brief interventions as part of routine clinical practice. All cancer care clinicians should complete brief intervention smoking cessation training relevant to the cancer context, including making referrals to Quitline, and be supported by systems to record and follow-up care.
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Affiliation(s)
- Michelle DiGiacomo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of HealthUniversity of Technology Sydney (UTS)BroadwayNew South WalesAustralia
| | - Paula Simoes dos Santos
- Institute for Public Policy and Governance (IPPG)University of Technology Sydney (UTS)BroadwayNew South WalesAustralia
| | - Erin Furestad
- Cancer Institute New South WalesAlexandriaNew South WalesAustralia
| | - Gemma Hearnshaw
- Cancer Institute New South WalesAlexandriaNew South WalesAustralia
| | - Shirlee Nichols
- Cancer Institute New South WalesAlexandriaNew South WalesAustralia
| | - Sungwon Chang
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of HealthUniversity of Technology Sydney (UTS)BroadwayNew South WalesAustralia
| | - Nicola Scott
- Cancer Institute New South WalesAlexandriaNew South WalesAustralia
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Hawari FI, Abu Alhalawa MA, Alshraiedeh RH, Al Nawaiseh AM, Khamis A, Dodin YI, Obeidat NA. Supporting Smokers in Difficult Settings: Suggestions for Better Education and Counseling in Cancer Centers in Jordan. Curr Oncol 2022; 29:9335-9348. [PMID: 36547146 PMCID: PMC9776699 DOI: 10.3390/curroncol29120732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 12/02/2022] Open
Abstract
Continued smoking in cancer patients is commonly observed in Jordan. In a country that exhibits some of the highest smoking rates globally, enhancing patient education regarding the value of smoking cessation for cancer care is vital. The objectives of our study were to describe sociodemographic and clinical factors associated with continued smoking in Jordanian smokers after a cancer diagnosis; to identify reasons for smoking and knowledge regarding smoking's impact on care; to examine in a multivariable manner the factors associated with continued smoking, and to accordingly generate patient counseling recommendations. An interviewer-administered survey using the Theoretical Domains Framework was employed. Among 350 subjects (mean age 51.0, median 52.7), approximately 38% of patients had quit or were in the process of quitting; 61.7% remained smokers. Substantial knowledge gaps with regard to the impact of continued smoking on cancer care were observed. Remaining a smoker after diagnosis was associated with being employed, not receiving chemotherapy or surgery, having lower confidence in quitting, and having a lower number of identified reasons for smoking. Interventions to promote cessation in Jordanian cancer patients who smoke should focus on enhancing patient awareness about the impact of smoking in cancer care and raising perceived self-efficacy to quit.
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Affiliation(s)
- Feras I. Hawari
- Cancer Control Office, King Hussein Cancer Center, Amman 11941, Jordan
- Section of Pulmonary and Critical Care, Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan
| | | | - Rasha H. Alshraiedeh
- Faculty of Pharmacy, The University of Jordan, Amman 11972, Jordan
- Volunteer Research Program at King Hussein Cancer Center, Amman11941, Jordan
| | - Ahmad M. Al Nawaiseh
- Volunteer Research Program at King Hussein Cancer Center, Amman11941, Jordan
- Faculty of Medicine, The University of Jordan, Amman 11972, Jordan
| | - Alia Khamis
- Volunteer Research Program at King Hussein Cancer Center, Amman11941, Jordan
- Faculty of Medicine, The University of Jordan, Amman 11972, Jordan
| | - Yasmeen I. Dodin
- Cancer Control Office, King Hussein Cancer Center, Amman 11941, Jordan
| | - Nour A. Obeidat
- Cancer Control Office, King Hussein Cancer Center, Amman 11941, Jordan
- Correspondence: ; Tel.: +962-6-5300460 (ext. 2204); Fax: +962-6-5345567
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Goshe BM, Rasmussen AW, Wagner LI, Sicks JD, Gareen IF, Carlos RC, Herman BA, Walter AW, Regan S, Levy DE, Mahon I, Muzikansky A, Neil JM, Lui M, Dilip D, Malloy L, Gonzalez I, Finkelstein-Fox L, McCann C, Perez E, Ostroff JS, Park ER. Study protocol for a hybrid type 1 effectiveness-implementation trial testing virtual tobacco treatment in oncology practices [Smokefree Support Study 2.0]. BMC Public Health 2022; 22:1359. [PMID: 35841024 PMCID: PMC9284951 DOI: 10.1186/s12889-022-13631-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Persistent smoking among patients diagnosed with cancer is associated with adverse clinical outcomes, yet an evidence-based tobacco use intervention has not been well-integrated into cancer care in community oncology settings. This paper describes the protocol of a nation-wide clinical trial conducted by the ECOG-ACRIN National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base to assess the effectiveness of a virtual tobacco treatment intervention and the process of implementing tobacco treatment in NCORP community oncology settings. METHODS/DESIGN This two-arm, multisite (n: 49 NCORP sites) hybrid type 1 effectiveness-implementation randomized controlled trial compares the effectiveness of a Virtual Intervention Treatment (VIT) versus an Enhanced Usual Control (EUC) among English and Spanish speaking patients recently diagnosed with cancer, reporting current smoking and receiving care at a participating NCORP Community or Minority/Underserved Site. The VIT includes up to 11 virtual counseling sessions with a tobacco treatment specialist and up to 12 weeks of nicotine replacement therapy (NRT). The EUC arm receives a referral to the NCI Quitline. The primary study outcome is biochemically confirmed 7-day point prevalence smoking abstinence. Moderators of treatment effect will be assessed. The study evaluates implementation processes from participating NCORP site staff via survey, administrative, and focus group data, including reach, acceptability, appropriateness, fidelity, feasibility, adoption, cost and sustainability outcomes. DISCUSSION This trial will generate findings about the effectiveness of an evidence-based virtual tobacco treatment intervention targeting patients diagnosed with cancer and illuminate barriers and facilitators that influence implementing tobacco treatment into community oncology settings nationally. In the era of COVID-19, virtual care solutions are vital for maximizing access and utilization of tobacco treatment delivery. TRIAL REGISTRATION ClinicalTrials.gov (NCT03808818) on January 18th, 2019; Last update posted: May 21st, 2020.
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Affiliation(s)
- Brett M Goshe
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA.
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA.
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Autumn W Rasmussen
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Lynne I Wagner
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - JoRean D Sicks
- ECOG-ACRIN Biostatistics Center, Brown University, Providence, RI, USA
| | - Ilana F Gareen
- Department of Epidemiology and the Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Ruth C Carlos
- Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin A Herman
- ECOG-ACRIN Biostatistics Center, Brown University, Providence, RI, USA
| | - Angela Wangari Walter
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA, USA
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Susan Regan
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Douglas E Levy
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Irene Mahon
- ECOG-ACRIN Cancer Research Group, American College of Radiology, Philadelphia, PA, USA
| | - Alona Muzikansky
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Jordan M Neil
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA, USA
- Department of Family and Preventative Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Michelle Lui
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Deepika Dilip
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laura Malloy
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Irina Gonzalez
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Lucy Finkelstein-Fox
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Caitlin McCann
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Elissa Perez
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Jamie S Ostroff
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elyse R Park
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Relationship between smoking and postoperative complications of cervical spine surgery: a systematic review and meta-analysis. Sci Rep 2022; 12:9172. [PMID: 35654928 PMCID: PMC9163175 DOI: 10.1038/s41598-022-13198-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 05/10/2022] [Indexed: 11/08/2022] Open
Abstract
To determine whether smoking has adverse effects on postoperative complications following spine cervical surgery (PROSPERO 2021: CRD42021269648). We searched PubMed, Embase, Cochrane Library, and Web of Science through 13 July 2021 for cohort and case–control studies that investigated the effect of smoking on postoperative complications after cervical spine surgery. Two researchers independently screened the studies and extracted data according to the selection criteria. The meta-analysis included 43 studies, including 27 case–control studies and 16 cohort studies, with 10,020 patients. Pooled estimates showed that smoking was associated with overall postoperative complications (effect estimate [ES] = 1.99, 95% confidence interval [CI]: 1.62–2.44, p < 0.0001), respiratory complications (ES = 2.70, 95% CI: 1.62–4.49, p < 0.0001), reoperation (ES = 2.06, 95% CI: 1.50–2.81, p < 0.0001), dysphagia (ES = 1.49, 95% CI: 1.06–2.10, p = 0.022), wound infection (ES = 3.21, 95% CI: 1.62–6.36, p = 0.001), and axial neck pain (ES = 1.98, 95% CI: 1.25–3.12, p = 0.003). There were no significant differences between the smoking and nonsmoking groups in terms of fusion (ES = 0.97, 95% CI: 0.94–1.00, p = 0.0097), operation time (weighted mean difference [WMD] = 0.08, 95% CI: −5.54 to 5.71, p = 0.977), estimated blood loss (WMD = −5.31, 95% CI: −148.83 to 139.22, p = 0.943), length of hospital stay (WMD = 1.01, 95% CI: −2.17 to 4.20, p = 0.534), Visual Analog Scale-neck pain score (WMD = −0.19, 95% CI: −1.19 to 0.81, p = 0.707), Visual Analog Scale-arm pain score (WMD = −0.50, 95% CI: −1.53 to 0.53, p = 0.343), Neck Disability Index score (WMD = 11.46, 95% CI: −3.83 to 26.76, p = 0.142), or Japanese Orthopedic Association Scores (WMD = −1.75, 95% CI: −5.27 to 1.78, p = 0.332). Compared with nonsmokers, smokers seem to be more significantly associated with overall complications, respiratory complications, reoperation, longer hospital stay, dysphagia, wound infection and axial neck pain after cervical spine surgery. It is essential to provide timely smoking cessation advice and explanation to patients before elective cervical spine surgery.
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Bhattacharyya R, Gozi A, Sen A. Management of Psychiatric Disorders in Patients with Respiratory Diseases. Indian J Psychiatry 2022; 64:S366-S378. [PMID: 35602365 PMCID: PMC9122161 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_25_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Ranjan Bhattacharyya
- Department of Psychiatry, Murshidabad Medical College and Hospital, Berhampore, West Bengal, India
| | - Anirban Gozi
- Specialist Medical Officer, West Bengal Health Service, India E-mail:
| | - Aratrika Sen
- Department of Psychiatry, Murshidabad Medical College and Hospital, Berhampore, West Bengal, India
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Smoking Status and Health Beliefs Related to Smoking of Nurses in Working a Cancer Hospital, in Turkey. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2021. [DOI: 10.30621/jbachs.915542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Effects of a Brief E-Learning Resource on Sexual Attitudes and Beliefs of Healthcare Professionals Working in Prostate Cancer Care: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910045. [PMID: 34639350 PMCID: PMC8508566 DOI: 10.3390/ijerph181910045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/10/2021] [Accepted: 09/16/2021] [Indexed: 01/22/2023]
Abstract
Sexual issues and treatment side effects are not routinely discussed with men receiving treatment for prostate cancer, and support to address these concerns is not consistent across settings. This study evaluates a brief e-learning resource designed to improve sexual wellbeing support and examine its effects on healthcare professionals' sexual attitudes and beliefs. Healthcare professionals (n = 44) completed an online questionnaire at baseline which included a modified 12-item sexual attitudes and beliefs survey (SABS). Follow-up questionnaires were completed immediately after the e-learning and at 4 weeks. Data were analysed using one-way, repeat measures ANOVAs to assess change in attitudes and beliefs over time. Significant improvements were observed at follow-up for a number of survey statements including 'knowledge and understanding', 'confidence in discussing sexual wellbeing' and the extent to which participants felt 'equipped with the language to initiate conversations'. The resource was seen as concise, relevant to practice and as providing useful information on potential side effects of treatment. In brief, e-learning has potential to address barriers to sexual wellbeing communication and promote delivery of support for prostate cancer survivors. Practical methods and resources should be included with these interventions to support implementation of learning and long-term changes in clinical behaviour.
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Martínez C, Feliu A, Castellano Y, Fu M, Fernández P, Cabrera-Jaime S, Puig-Llobet M, Galimany J, Guydish J, Fernández E. Factors associated with receipt of the 5As model of brief intervention for smoking cessation among hospitalized patients. Addiction 2020; 115:2098-2112. [PMID: 32297373 DOI: 10.1111/add.15076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/18/2019] [Accepted: 04/01/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Guidelines recommend the 5As model of brief intervention for providing smoking cessation support in clinical settings. This study assessed patient and hospital characteristics associated with self-reported receipt of the 5As (ask, advise, assess, assist and arrange). DESIGN Multi-center cross-sectional study. SETTING AND PARTICIPANTS Adult inpatients (n = 1047) were randomly selected from 13 hospitals in the Barcelona province of Spain in 2014-2015. MEASUREMENTS We explored participants' receipt of the 5As through a questionnaire. Given the progressiveness of the 5As, we recoded the fulfillment of the intervention as: A0 : no intervention; A1 : ask; A2 : ask and advise; A3 : A2 and assess; A4 : A3 and assist; and A5 : A4 and arrange a follow-up. We explored patient (e.g. age, sex, comorbidities) and hospital (e.g. type of hospital, unit) characteristics. We adjusted multi-level robust Poisson regression models to estimate the adjusted prevalence ratios (aPR) of the association between the recoded 5As intervention received. FINDINGS A total of 60.4% (n = 624) of patients had been asked (A1 ) about their smoking status. Among smokers, 46.5% (n = 90) were advised (A2 ), 26.6% (n = 48) assessed (A3 ) and 4.6% (n = 10) received all the components of the 5As (A5 ). Middle-aged smokers [aPR = 3.63; 95% confidence interval (CI) = 1.69-7.79] with a respiratory disease (aPR = 2.19; 95% CI = 1.11-4.34) were most likely to have been asked, advised and assessed (A3 ). The cessation intervention was most frequently performed by physicians. CONCLUSIONS In the Barcelona province of Spain, it appears that fewer than half of hospitalized patients who smoke were advised to quit and few received the full 'five As' brief intervention for smoking cessation.
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Affiliation(s)
- Cristina Martínez
- Tobacco Control Unit, Institut Català d'Oncologia (ICO), L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Sciences, Campus of Bellvitge. University of Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain.,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Ariadna Feliu
- Tobacco Control Unit, Institut Català d'Oncologia (ICO), L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Sciences, Campus of Bellvitge. University of Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Yolanda Castellano
- Tobacco Control Unit, Institut Català d'Oncologia (ICO), L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Sciences, Campus of Bellvitge. University of Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Marcela Fu
- Tobacco Control Unit, Institut Català d'Oncologia (ICO), L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Sciences, Campus of Bellvitge. University of Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Paz Fernández
- School of Medicine and Health Sciences, Campus of Bellvitge. University of Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain.,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Sandra Cabrera-Jaime
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Montse Puig-Llobet
- School of Medicine and Health Sciences, Campus of Bellvitge. University of Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Jordi Galimany
- School of Medicine and Health Sciences, Campus of Bellvitge. University of Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Esteve Fernández
- Tobacco Control Unit, Institut Català d'Oncologia (ICO), L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Sciences, Campus of Bellvitge. University of Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
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12
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Neil JM, Price SN, Friedman ER, Ponzani C, Ostroff JS, Muzikansky A, Park ER. Patient-Level Factors Associated with Oncology Provider-Delivered Brief Tobacco Treatment Among Recently Diagnosed Cancer Patients. Tob Use Insights 2020; 13:1179173X20949270. [PMID: 32874095 PMCID: PMC7436840 DOI: 10.1177/1179173x20949270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 05/31/2020] [Indexed: 12/25/2022] Open
Abstract
Background: A cancer diagnosis is seen as a “teachable moment” for patients to consider changing their behavioral risk factors, such as smoking. It also offers an opportunity for oncology providers to engage in a dialogue about how they can support patients changing their smoking behaviors. Brief, evidence-based tobacco cessation treatment delivered by oncology providers through the 5As (Ask, Advise, Assess, Assist Arrange) model is recommended, but provision to cancer patients remains suboptimal. Aim: Explore patient-level factors associated with 5As receipt among current smokers with a newly diagnosed cancer. Method: A total of 303 patients self-reported whether they received each of the 5As during their most recent oncology care visit. Multivariable regression analyses were conducted to identify patient-level factors associated with 5As receipt. Results: Oncology provider-delivered 5As rates ranged from 81.5% (Ask) to 30.7% (Arrange). 5As receipt was associated with: reporting lower illness-related stigma, diagnosis of a comorbid smoking-related disease, diagnosis of a smoking-related cancer, and diagnosis of a non-advanced cancer. Conclusion: Findings support previous literature in which smoking-related diagnoses were associated with greater receipt of 5As; however, disparities in the receipt of 5As existed for patients with more advanced cancer diagnoses and illness-related stigma. Inequities in the provision of quit assistance may further decrease treatment effectiveness and survival expectancy among certain patient populations. These findings are, therefore, important as they identify specific patient-level factors associated with lower 5As receipt among newly diagnosed cancer patients.
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Affiliation(s)
- J M Neil
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - S N Price
- University of Arizona, Tucson, AZ, USA
| | | | - C Ponzani
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - J S Ostroff
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - A Muzikansky
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - E R Park
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
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13
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Ramsey AT, Baker TB, Pham G, Stoneking F, Smock N, Colditz GA, James AS, Liu J, Bierut LJ, Chen LS. Low Burden Strategies Are Needed to Reduce Smoking in Rural Healthcare Settings: A Lesson from Cancer Clinics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1728. [PMID: 32155775 PMCID: PMC7084618 DOI: 10.3390/ijerph17051728] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 12/26/2022]
Abstract
Rural populations face significant smoking-related health disparities, such as a higher prevalence of lung cancer and cancer mortality, higher prevalence of smoking, and lower likelihood of receiving cessation treatment than urban counterparts. A significant proportion of health disparities in rural populations could be eliminated with low-barrier, easy-access treatment delivery methods for smoking cessation. In this study, we assessed treatment engagement among patients in rural and urban settings. Then, we examined the effect of an electronic health record-based smoking cessation module on patient receipt of evidence-based cessation care. As part of a quality improvement project, we retrospectively observed 479,798 unique patients accounting for 1,426,089 outpatient clinical encounters from June 2018-March 2019 across 766 clinics in the greater St. Louis, southern Illinois, and mid-Missouri regions. Smoking prevalence was higher in rural versus urban clinics (20.7% vs. 13.9%, 6.7% [6.3, 7.1], odds ratio = 1.6 [1.6, 1.6], p < 0.0001), and yet rural smokers were nearly three times less likely than their urban counterparts to receive any smoking cessation treatment after adjusting for patients clustering within clinics (9.6% vs. 25.8%, -16.2% [-16.9, -15.5], odds ratio = 0.304 [0.28, 0.33], p < 0.0001). Although not yet scaled up in the rural setting, we examined the effects of a low-burden, point-of-care smoking module currently implemented in cancer clinics. After adjusting for patient clustering within clinics, patients were more likely to receive smoking treatment in clinics that implemented the module versus clinics that did not implement the module (31.2% vs. 17.5%, 13.7% [10.8, 16.6], odds ratio = 2.1 [1.8, 2.6], p < 0.0001). The point-of-care treatment approach offers a promising solution for rural settings, both in and outside the context of cancer care.
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Affiliation(s)
- Alex T. Ramsey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.P.); (F.S.); (N.S.); (L.J.B.); (L.-S.C.)
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.A.C.); (A.S.J.); (J.L.)
| | - Timothy B. Baker
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA;
| | - Giang Pham
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.P.); (F.S.); (N.S.); (L.J.B.); (L.-S.C.)
| | - Faith Stoneking
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.P.); (F.S.); (N.S.); (L.J.B.); (L.-S.C.)
| | - Nina Smock
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.P.); (F.S.); (N.S.); (L.J.B.); (L.-S.C.)
| | - Graham A. Colditz
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.A.C.); (A.S.J.); (J.L.)
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Aimee S. James
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.A.C.); (A.S.J.); (J.L.)
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jingxia Liu
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.A.C.); (A.S.J.); (J.L.)
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Laura J. Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.P.); (F.S.); (N.S.); (L.J.B.); (L.-S.C.)
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.A.C.); (A.S.J.); (J.L.)
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.P.); (F.S.); (N.S.); (L.J.B.); (L.-S.C.)
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.A.C.); (A.S.J.); (J.L.)
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14
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Zou G, Wei X, Deng S, Yin J, Ling L. Factors influencing the implementation of a pilot smoking cessation intervention among migrant workers in Chinese factories: a qualitative study. BMC Public Health 2019; 19:870. [PMID: 31269929 PMCID: PMC6609399 DOI: 10.1186/s12889-019-7223-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/21/2019] [Indexed: 12/03/2022] Open
Abstract
Background Tobacco control intervention with Chinese internal migrants, especially those working in factories has rarely been investigated. This study aims to identify aids and barriers to implementing a comprehensive pilot intervention aimed at reducing smoking among migrant workers working in factories in China. Method Twenty in-depth interviews were conducted 3 months into the intervention, with managers, migrant workers and team leaders in two factories, where the pilot intervention was implemented, in Zhongshan city in Guangdong, a southern Chinese province. Data analysis was based on the thematic approach. Results This study identifies the societal, individual and programmatic factors that could influence the implementation of a pilot smoking cessation intervention among migrant workers in the two Chinese factories. At the societal level, social customs and relationships where smoking is seen as essential in social communications was the most important barrier to the implementation of smoking cessation intervention. At the individual level, migrant-related features such as low education, high mobility and poor integration with local residents, together with poor health beliefs and attitudes added to the challenges of implementing smoking cessation intervention. At the programmatic level, the role of small-team leaders was generally positive, although limited due to their busy work patterns and poor powers of enforcement. Conclusion Achieving successful smoking cessation intervention in factories could be challenging with many migrants, as multi-level factors including social context, intervention delivery, individual and migrants’ characteristics play an important role in shaping the implementation of the intervention. Our study suggests the importance of tailoring interventions for the migrant factory workers. Trial registration ChiCTR-OPC-17011637 at Chinese Clinical Trial Registry. Retrospectively registered on 12th June 2017.
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Affiliation(s)
- Guanyang Zou
- School of Economics and Management, Guangzhou University of Chinese Medicine, Guangzhou, 510000, Guangdong, China.,Centre for Migrant Health Policy, Sun Yat-sen University, Guangzhou, 510000, Guangdong, China
| | - Xiaolin Wei
- Division of Clinical Epidemiology &Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, M2J 4A6, Canada
| | - Simin Deng
- Kangning Hospital, Shenzhen, 518000, Guangdong, China
| | - Jia Yin
- School of Health Policy and Management, Shandong University, Jinan, 250000, Shandong, China
| | - Li Ling
- Centre for Migrant Health Policy, Sun Yat-sen University, Guangzhou, 510000, Guangdong, China. .,Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510000, Guangdong, China.
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15
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Price SN, Studts JL, Hamann HA. Tobacco Use Assessment and Treatment in Cancer Patients: A Scoping Review of Oncology Care Clinician Adherence to Clinical Practice Guidelines in the U.S. Oncologist 2018; 24:229-238. [PMID: 30446582 DOI: 10.1634/theoncologist.2018-0246] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 10/16/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Smoking after a cancer diagnosis negatively impacts health outcomes; smoking cessation improves symptoms, side effects, and overall prognosis. The Public Health Service and major oncology organizations have established guidelines for tobacco use treatment among cancer patients, including clinician assessment of tobacco use at each visit. Oncology care clinicians (OCCs) play important roles in this process (noted as the 5As: Asking about tobacco use, Advising users to quit, Assessing willingness to quit, Assisting in quit attempts, and Arranging follow-up contact). However, OCCs may not be using the "teachable moments" related to cancer diagnosis, treatment, and survivorship to provide cessation interventions. MATERIALS AND METHODS In this scoping literature review of articles from 2006 to 2017, we discuss (1) frequency and quality of OCCs' tobacco use assessments with cancer patients and survivors; (2) barriers to providing tobacco treatment for cancer patients; and (3) the efficacy and future of provider-level interventions to facilitate adherence to tobacco treatment guidelines. RESULTS OCCs are not adequately addressing smoking cessation with their patients. The reviewed studies indicate that although >75% assess tobacco use during an intake visit and >60% typically advise patients to quit, a substantially lower percentage recommend or arrange smoking cessation treatment or follow-up after a quit attempt. Less than 30% of OCCs report adequate training in cessation interventions. CONCLUSION Intervention trials focused on provider- and system-level change are needed to promote integration of evidence-based tobacco treatment into the oncology setting. Attention should be given to the barriers faced by OCCs when targeting interventions for the oncologic context. IMPLICATIONS FOR PRACTICE This article reviews the existing literature on the gap between best and current practices for tobacco use assessment and treatment in the oncologic context. It also identifies clinician- and system-level barriers that should be addressed in order to lessen this gap and provides suggestions that could be applied across different oncology practice settings to connect patients with tobacco use treatments that may improve overall survival and quality of life.
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Affiliation(s)
- Sarah N Price
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Jamie L Studts
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Heidi A Hamann
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
- Department of Family and Community Medicine, University of Arizona, Tucson, Arizona, USA
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16
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Chai W, Zou G, Shi J, Chen W, Gong X, Wei X, Ling L. Evaluation of the effectiveness of a WHO-5A model based comprehensive tobacco control program among migrant workers in Guangdong, China: a pilot study. BMC Public Health 2018; 18:296. [PMID: 29486753 PMCID: PMC6389256 DOI: 10.1186/s12889-018-5182-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 02/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As a vulnerable population in China, migrant workers have a higher smoking rate than the general population. This study aims to assess the effectiveness of a WHO-5A based comprehensive tobacco control program in workplaces aggregated with migrants. METHODS Using a controlled before and after design, four purposely selected manufacturing factories were assigned to either intervention or control groups. Participants in the intervention arm received adapted 5A group counseling regularly supported by social-media and traditional health education approaches. The primary outcome was the change of smoking rate based on salivary cotinine concentration at three-month follow-up as compared to the control arm. Secondary outcomes were changes in smoking-related knowledge and attitudes assessed using questionnaires. Difference-in-differences approach (DID) and generalized estimating equations (GEE) models were used to conduct the effectiveness analysis. RESULTS 149 and 166 workers were enrolled in the intervention and control arm respectively. The multiple imputed and adjusted GEE models demonstrated that, compared to those in the control arm, participants in the intervention arm had nearly 2.4 times odds of improving smoking-related knowledge (OR = 2.40, 95% CI = 1.32-4.36, P = 0.02) and three times the odds of improving smoking-related attitude (OR = 3.07, 95% CI = 1.28-7.41, P = 0.03). However, no significant difference was found regarding the change of smoking rate between the two arms (P > 0.05). The regression analysis showed that attendance at the 5A group counseling sections was an important determinant of stopping smoking or improving smoking-related knowledge and attitudes in the intervention group. CONCLUSIONS This WHO-5A comprehensive intervention was effective in improving migrant workers' knowledge of smoking and anti-smoking attitudes. A large-scale, long-term trial is recommended to determine the effectiveness of this intervention. TRIAL REGISTRATION ChiCTR-OPC-17011637 at Chinese Clinical Trial Registry. Retrospectively registered on 12th June 2017.
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Affiliation(s)
- Wenxin Chai
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Guanyang Zou
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, People's Republic of China.,Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Jingrong Shi
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wen Chen
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiao Gong
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiaolin Wei
- Division of Clinical Public Health and Institute for Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Li Ling
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China. .,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, People's Republic of China.
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17
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Carroll AJ, Veluz-Wilkins AK, Blazekovic S, Kalhan R, Leone FT, Wileyto EP, Schnoll RA, Hitsman B. Cancer-related disease factors and smoking cessation treatment: Analysis of an ongoing clinical trial. Psychooncology 2018; 27:471-476. [PMID: 28636795 PMCID: PMC5958302 DOI: 10.1002/pon.4483] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 05/05/2017] [Accepted: 06/19/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Smoking cessation treatment should be an important aspect of cancer care. In this study, we evaluated whether cancer-related disease factors adversely influence smoking cessation treatment. METHODS Smokers with cancer (within 5 years of diagnosis, any tumor site) were recruited for an ongoing trial of varenicline for smoking cessation. Disease factors, assessed at baseline, included tumor site, cancer treatment, time since diagnosis, and health-related quality of life. Medication adherence was defined by 132 of 165 pills taken and counseling adherence was defined by 4 of 4 behavioral counseling sessions attended. Abstinence was bioverified at Week 12. Using logistic regression analysis, we assessed the relationship between disease factors and 12-week medication adherence, counseling adherence, and abstinence. RESULTS Of 144 participants, 56% were medication adherent, 74% were counseling adherent, and 39% were abstinent. Health-related quality of life predicted medication adherence (OR: 1.08, 95% CI, 1.01-1.16, P = .019, d = 0.20) but not counseling adherence or 12-week abstinence. Tumor site, cancer treatment, and time since diagnosis did not predict any smoking cessation treatment outcomes. CONCLUSIONS Cancer-related disease factors did not predict cancer survivors' engagement or success in smoking cessation treatment. Findings support National Comprehensive Cancer Network Clinical Practice guidelines that recommend smoking cessation treatment for all smokers with cancer, regardless of time since diagnosis.
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Affiliation(s)
| | | | | | - Ravi Kalhan
- Northwestern University Feinberg School of Medicine
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18
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Luberto CM, Hyland KA, Streck JM, Temel B, Park ER. Stigmatic and Sympathetic Attitudes Toward Cancer Patients Who Smoke: A Qualitative Analysis of an Online Discussion Board Forum. Nicotine Tob Res 2016; 18:2194-2201. [PMID: 27613953 PMCID: PMC5103935 DOI: 10.1093/ntr/ntw166] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 06/27/2016] [Indexed: 12/28/2022]
Abstract
INTRODUCTION A significant minority of patients continue to smoke after a cancer diagnosis. Cancer patients who smoke experience stigma that can negatively impact health outcomes. We explored publicly shared perspectives about cancer patients who continued to smoke post-diagnosis. METHODS An online news article, published in January 2012, summarized the findings of smoking prevalence among patients with lung cancer and colorectal cancer enrolled in the Cancer Care Outcomes Research and Surveillance Consortium trial. In response, written comments were posted on the articles' public discussion board. Applying principles of grounded theory, we conducted a document analysis and established a conceptual framework to develop a model by which to explain factors underlying stigmatic and sympathetic attitudes toward cancer survivors who continue to smoke. RESULTS Personal experiences with cancer, smoking, and statistical literacy were found to influence beliefs about cancer and smoking, which in turn influenced stigmatic or sympathetic attitudes. More sympathetic attitudes were expressed by individuals who had personal experiences with smoking, believed cancer is multicausal, identified smoking as an addiction, or considered extrinsic factors responsible for smoking. Individuals who did not have personal experiences with cancer or smoking, had low statistical literacy, believed that smoking necessarily and directly causes cancer, and focused on intrinsic responsibilities for smoking tended to express more stigmatic attitudes. CONCLUSIONS The current findings raise awareness and provide insight into stigma against cancer survivors who smoke and can help inform strategies for reducing stigma against this vulnerable group. IMPLICATIONS This study helps raise awareness of stigma toward cancer patients who smoke and provides insight into the processes that may influence stigmatic as compared to sympathetic attitudes toward these patients. Results suggest that population-based strategies to educate the public regarding the nature of nicotine addiction, difficulty of quitting, and benefits of quitting for cancer patients may be useful for reducing stigma against cancer patients with a smoking history.
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Affiliation(s)
- Christina M Luberto
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA;
- Harvard Medical School, Boston, MA
| | - Kelly A Hyland
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA
| | - Joanna M Streck
- Vermont Center on Behavior and Health, Department of Psychological Science, University of Vermont, Burlington, VT
| | - Brandon Temel
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA
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19
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Fang CY, Heckman CJ. Informational and Support Needs of Patients with Head and Neck Cancer: Current Status and Emerging Issues. CANCERS OF THE HEAD & NECK 2016; 1. [PMID: 28670482 PMCID: PMC5488795 DOI: 10.1186/s41199-016-0017-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The objective of this article is to review and summarize the extant literature on head and neck cancer (HNC) patients’ informational needs and to characterize emerging issues in this patient population in order to define priorities for future research. HNC patients may undergo challenging treatment regimens and experience treatment-related alterations in primary daily functions such as speech and eating. These changes often persist following treatment and may lead to significant deficits in quality of life and interpersonal relations. Despite empirical evidence demonstrating that receipt of adequate information and support is predictive of improved outcomes post-treatment, relatively limited attention has been paid to the informational and support needs of HNC patients. This review focuses primarily on three topic domains: (1) managing treatment-related side effects; (2) addressing alcohol and tobacco dependence; and (3) informational needs in the areas of human papillomavirus (HPV) and clinical trials. While there is increasing awareness of the rehabilitation and survivorship needs in this patient population, patients note that the impact of treatment on social activities and interactions is under-discussed and of key concern. In addition, there is a significant gap in addressing communication and informational needs of caregivers and family members who are integral for promoting healthy behaviors and self-care post-treatment. Greater integration of programs that address tobacco or alcohol dependency within a comprehensive treatment and support plan may increase patient motivation to seek help and enhance patient success in maintaining long-term abstinence. Finally, emerging patient-provider communication needs, particularly in the context of decision making about clinical trials or surrounding an HPV-related diagnosis, have been noted among both patients and healthcare providers. Future research on the development of novel programs that offer feasible and acceptable methods for addressing unmet informational and support needs is warranted and may yield benefit for improving patient-reported outcomes.
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Affiliation(s)
- Carolyn Y Fang
- Fox Chase Cancer Center, 333 Cottman Ave., Philadelphia, PA
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20
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Simmons VN, Pineiro B, Hooper MW, Gray JE, Brandon TH. Tobacco-Related Health Disparities Across the Cancer Care Continuum. Cancer Control 2016; 23:434-441. [PMID: 27842333 PMCID: PMC5972388 DOI: 10.1177/107327481602300415] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Use of tobacco is the leading preventable cause of death in the United States. Racial/ethnic minorities and individuals of low socioeconomic status disproportionately experience tobacco-related disease and illness. Unique challenges and circumstances exist at each point in the cancer care continuum that may contribute to the greater cancer burden experienced by these groups. METHODS We reviewed tobacco-related disparities from cancer prevention to cancer survivorship. We also describe research that seeks to reduce tobacco-related disparities. RESULTS Racial/ethnic minorities and low-income individuals experience unique social and environmental contextual challenges such as greater environmental cues to smoke and greater levels of perceived stress and social discrimination. Clinical practice guidelines support the effectiveness of pharmacotherapy and behavioral counseling for racial and ethnic minorities, yet smoking cessation rates are lower in this group when compared with non-Hispanic whites. Superior efficacy for culturally adapted interventions has not yet been established. CONCLUSIONS To reduce health disparities in this population, a comprehensive strategy is needed with efforts directed at each point along the cancer care continuum. Strategies are needed to reduce the impact of contextual factors such as targeted tobacco marketing and social discrimination on smoking initiation and maintenance. Future efforts should focus on increasing the use of evidence-based cessation treatment methods and studying its effectiveness in these populations. Attention must also be focused on improving treatment outcomes by reducing smoking in diverse racial and ethnic patient populations.
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Affiliation(s)
- Vani Nath Simmons
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA.
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Liao J, Winickoff JP, Nong G, Huang K, Yang L, Zhang Z, Abdullah AS. Are Chinese pediatricians missing the opportunity to help parents quit smoking? BMC Pediatr 2016; 16:135. [PMID: 27542600 PMCID: PMC4992316 DOI: 10.1186/s12887-016-0672-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 08/10/2016] [Indexed: 11/16/2022] Open
Abstract
Background Secondhand smoke (SHS) exposure of children due to parental tobacco use is a particularly prevalent health issue and is associated with adverse health outcomes. Following the US Clinical Practice guidelines, pediatricians in the United States deliver 5A’s (ask, advise, assess, assist, and arrange) counseling to smoking parents which has proven to be effective. We examined Chinese pediatricians’ adherence to the clinical practice guidelines for smoking cessation (i.e. 5A’s counseling practices) with smoking parents, and identified factors associated with these practices. Methods A cross-sectional paper-and-pencil survey of pediatricians was conducted in twelve conveniently selected southern Chinese hospitals. Factors associated with any of the 5A’s smoking cessation counseling practices were identified by logistic regression. Results Of respondents (504/550), only 26 % routinely provided 5A’s smoking cessation counseling to smoking parents. More than 80 % of pediatricians didn’t receive formal training in smoking cessation and had not read China smoking cessation guidelines; 24 % reported being “very confident” in discussing smoking or SHS reduction with parents. Pediatricians who had never smoked (OR: 2.29, CI:1.02-5.12), received training in smoking cessation (OR: 2.50, CI:1.40-4.48), had read China smoking cessation guidelines (OR: 2.17, CI:1.10-4.26), and felt very (OR: 7.12, CI:2.45-20.70) or somewhat (OR: 3.05, CI:1.11-8.37) confident in delivering cessation counseling were more likely to practice 5A’s. Pediatricians who reported “it is hard to find a time to talk with parents” (OR: 0.32, CI: 0.11-0.92) or “lack of a standard of care requiring pediatricians to provide smoking cessation or SHS exposure reduction intervention” (OR: 0.45, CI: 0.21-0.98) as a barrier were less likely to follow the 5A’s guidelines. Conclusions Smoking cessation counseling to address parental smoking is infrequent among Chinese pediatricians. There is a need to develop and test intervention strategies to improve the delivery of 5A’s smoking cessation counseling to parental smokers.
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Affiliation(s)
- Jing Liao
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Jonathan P Winickoff
- MGH Center for Child and Adolescent Health Research and Policy, Harvard Medical School, Boston, USA
| | - Guangmin Nong
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Kaiyong Huang
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Li Yang
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Zhiyong Zhang
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Abu S Abdullah
- Duke Global Health Institute, Duke University, Durham, NC, 27710, USA. .,Global Health Program, Duke Kunshan University, Kunshan, Jiangsu Province, 215347, China. .,Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
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Liu J, Chadder J, Fung S, Lockwood G, Rahal R, Halligan M, Mowat D, Bryant H. Smoking behaviours of current cancer patients in Canada. ACTA ACUST UNITED AC 2016; 23:201-3. [PMID: 27330349 DOI: 10.3747/co.23.3180] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Evidence shows that continued smoking by cancer patients leads to adverse treatment outcomes and affects survival. Smoking diminishes treatment effectiveness, exacerbates side effects, and increases the risk of developing additional complications. Patients who continue to smoke also have a higher risk of developing a second primary cancer or experiencing a cancer recurrence, both of which ultimately contribute to poorer quality of life and poorer survival. Here, we present a snapshot of smoking behaviours of current cancer patients compared with the non-cancer patient population in Canada. Minimal differences in smoking behaviours were noted between current cancer patients and the rest of the population. Based on 2011-2014 data from the Canadian Community Health Survey, 1 in 5 current cancer patients (20.1%) reported daily or occasional smoking. That estimate is comparable to findings in the surveyed non-cancer patient population, of whom 19.3% reported smoking daily or occasionally. Slightly more male cancer patients than female cancer patients identified as current smokers. A similar distribution was observed in the non-cancer patient population. There is an urgent need across Canada to better support cancer patients in quitting smoking. As a result, the quality of patient care will improve, as will cancer treatment and survival outcomes, and quality of life for these patients.
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Affiliation(s)
- J Liu
- Canadian Partnership Against Cancer, Toronto, ON
| | - J Chadder
- Canadian Partnership Against Cancer, Toronto, ON
| | - S Fung
- Canadian Partnership Against Cancer, Toronto, ON
| | - G Lockwood
- Canadian Partnership Against Cancer, Toronto, ON
| | - R Rahal
- Canadian Partnership Against Cancer, Toronto, ON
| | - M Halligan
- Canadian Partnership Against Cancer, Toronto, ON
| | - D Mowat
- Canadian Partnership Against Cancer, Toronto, ON
| | - H Bryant
- Canadian Partnership Against Cancer, Toronto, ON;; Departments of Community Health Sciences and of Oncology, University of Calgary, Calgary, AB
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Hospital doctors' smoking behavior and attitude towards smoking cessation interventions for patients: a survey in an Italian Comprehensive Cancer Centre. TUMORI JOURNAL 2016; 2016:244-51. [PMID: 27079902 DOI: 10.5301/tj.5000501] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE Tobacco control guidelines recommend all healthcare professionals to ask patients about their smoking status and to offer them at least minimal cessation advice. However, few data are available about the daily practice of hospital clinicians who work with smoking cancer patients. This study assesses, in a comprehensive cancer center, the physicians' smoking habit, their clinical practice in offering a smoking cessation intervention to patients who smoke, and the training they received in this field. METHODS A Web-based survey was sent to 285 physicians. RESULTS The survey response rate was 75%. Sixty-two percent, 24%, and 14% of responders were never, former, and current smokers, respectively. Six percent of all responding physicians have already participated in smoking cessation training and 43% of them declared their willingness to be trained. Eighty-six percent of all responding physicians asked about the patients' smoking status, 50% routinely advised patients to quit smoking, and 32% assessed their motivation to do so. Smoking cessation guidelines were not followed mostly for lack of time, fear to increase patients' stress, and lack of smoking cessation training. Ninety-four percent of responding physicians knew the smoking cessation service for outpatients and 65% referred at least one patient, 66% of responding physicians knew the service for inpatients, and 36% of them asked for at least one intervention in the ward. CONCLUSIONS This study pointed out partial adherence of the physicians working in a leading cancer center to the smoking cessation guidelines. The clinicians' smoking habits did not influence the training and the clinical practice in offering patients smoking cessation interventions.
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Recovering function and surviving treatments are primary motivators for health behavior change in patients with head and neck cancer: Qualitative focus group study. Palliat Support Care 2015; 14:364-75. [DOI: 10.1017/s1478951515001005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:Against medical advice, head and neck cancer (HNC) patients have been shown to continue to smoke and misuse alcohol post-diagnosis and treatment. This study aimed to better understand the barriers to and facilitators of health behavior change (HBC) in HNC patients.Method:We conducted nine focus groups following a standard protocol. Eligible patients were diagnosed less than three years previously with a primary HNC and selected using maximum variability sampling (gender, age, cancer stage, smoking, and alcohol misuse). Thematic analysis was conducted using NVivo 10 software.Results:Participants were mostly men (79%), 65 years of age (SD = 10.1), and married/common-law (52%, n = 15). Mean time from diagnosis was 19 months (SD = 12.3, range = 5.0–44.5), and most had advanced cancer (65.5%, n = 19). Participants provided a larger than anticipated definition of health behaviors, encompassing both traditional (smoking, drinking, diet, exercise, UV protection) and HNC-related (e.g., dental hygiene, skin care, speech exercises, using a PEG, gaining weight). The main emerging theme was patient engagement, that is, being proactive in rehabilitation, informed by the medical team, optimistic, flexible, and seeking support when needed. Patients were primarily motivated to stay proactive and engage in positive health behaviors in order to return to normal life and reclaim function, rather than to prevent a cancer recurrence. Barriers to patient engagement included emotional aspects (e.g., anxiety, depression, trauma, demoralization), symptoms (e.g., fatigue, pain), lack of information about HBC, and healthcare providers' authoritarian approach in counseling on HBC. We found some commonalities in barriers and facilitators according to behavior type (i.e., smoking/drinking/UV protection vs. diet/exercise).Significance of Results:This study underlines the key challenges in addressing health behaviors in head and neck oncology, including treatment-related functional impairments, symptom burden, and the disease's emotional toll. This delicate context requires health promotion strategies involving close rehabilitative support from a multidisciplinary team attentive to the many struggles of patients both during treatments and in the longer-term recovery period. Health promotion in HNC should be integrated into routine clinical care and target both traditional and HNC-related behaviors, emphasizing emotional and functional rehabilitation as key components.
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Warren GW, Ward KD. Integration of tobacco cessation services into multidisciplinary lung cancer care: rationale, state of the art, and future directions. Transl Lung Cancer Res 2015; 4:339-52. [PMID: 26380175 DOI: 10.3978/j.issn.2218-6751.2015.07.15] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 07/16/2015] [Indexed: 12/31/2022]
Abstract
Tobacco use is the largest risk factor for lung cancer and many lung cancer patients still smoke at the time of diagnosis. Although clinical practice guidelines recommend that all patients receive evidence-based tobacco treatment, implementation of these services in oncology practices is inconsistent and inadequate. Multidisciplinary lung cancer treatment programs offer an ideal environment to optimally deliver effective smoking cessation services. This article reviews best practice recommendations and current status of tobacco treatment for oncology patients, and provides recommendations to optimize delivery of tobacco treatment in multidisciplinary practice.
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Affiliation(s)
- Graham W Warren
- 1 Department of Cell and Molecular Pharmacology and Experimental Therapeutics and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA ; 2 Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Kenneth D Ward
- 1 Department of Cell and Molecular Pharmacology and Experimental Therapeutics and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA ; 2 Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
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Gritz ER, Toll BA, Warren GW. Tobacco use in the oncology setting: advancing clinical practice and research. Cancer Epidemiol Biomarkers Prev 2014; 23:3-9. [PMID: 24420982 DOI: 10.1158/1055-9965.epi-13-0896] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although tobacco is a well-established causal agent for many human cancers, less emphasis has been placed on translating this evidence by evaluating the effects of continued tobacco use after a cancer diagnosis. A broad assessment of the effects of continued tobacco use demonstrates that tobacco increases cancer treatment toxicity, recurrence, second primary tumors, and mortality in patients with cancer. Few studies report the potential benefits of cessation after a cancer diagnosis, but data suggest improved treatment outcomes in patients with cancer who quit smoking. Improving tobacco cessation treatment efficacy and access to cessation support has been sparsely researched in the oncology setting compared with the general population; however, patients with cancer are receptive to standard evidence-based tobacco cessation guidelines. Several studies demonstrate moderate tobacco cessation success in patients with cancer using the general principles of evidence-based tobacco cessation support. Several systems-level issues and research efforts are needed to standardize tobacco use definitions, increase access to tobacco cessation support, improve tobacco cessation efficacy, understand the time-dependent effects of tobacco and cessation on cancer biology, and realize the potential benefits of tobacco cessation for patients with cancer.
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Affiliation(s)
- Ellen R Gritz
- Authors' Affiliations: The University of Texas MD Anderson Cancer Center, Houston, Texas; Yale University School of Medicine; Yale Cancer Center; Smilow Cancer Hospital at Yale-New Haven, New Haven, Connecticut; and Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
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Bloom EL, Oliver JA, Sutton SK, Brandon TH, Jacobsen PB, Simmons VN. Post-operative smoking status in lung and head and neck cancer patients: association with depressive symptomatology, pain, and fatigue. Psychooncology 2014; 24:1012-9. [PMID: 25257853 DOI: 10.1002/pon.3682] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 07/24/2014] [Accepted: 08/21/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE An estimated 35-50% of lung and head and neck cancer patients are smoking at diagnosis; most try to quit; however, a substantial proportion resumes smoking. As cancer treatments improve, attention to the effects of continued smoking on quality of life in the survivorship period is increasing. The current study examines if smoking abstinence following surgical treatment is associated with better quality of life. METHODS Participants were 134 patients with head and neck or lung cancer who received surgical treatment. Smoking status and indices of quality of life (depressive symptoms, fatigue, and pain) were assessed at the time of surgery (baseline) and at 2, 4, 6, and 12 months post-surgery. Analyses were performed using a generalized estimating equations approach. A series of models examined the correlation between smoking status and post-surgery quality of life while adjusting for demographics, clinical variables, and baseline smoking status and quality of life. RESULTS Continuous post-surgery abstinence was associated with lower levels of depressive symptoms and fatigue; however, the relationship with fatigue became nonsignificant after adjusting for baseline fatigue and income. There was no significant relationship observed between smoking status and pain. CONCLUSIONS Findings add to a growing literature showing that smoking cessation is not associated with detrimental effects on quality of life and may have beneficial effects, particularly with regard to depressive symptoms. Such information can be used to motivate smoking cessation and continued abstinence among cancer patients and increase provider comfort in recommending cessation.
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Affiliation(s)
- Erika Litvin Bloom
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Butler Hospital, Providence, RI, USA
| | - Jason A Oliver
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Steven K Sutton
- Department of Psychology, University of South Florida, Tampa, FL, USA.,Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center, Tampa, FL, USA.,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Thomas H Brandon
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA.,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Paul B Jacobsen
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA.,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Vani Nath Simmons
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA.,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
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Assessing the extent to which healthcare workers advised and assisted smokers to quit based on patient motivation levels. J Addict Nurs 2014; 25:81-6; quiz 87-8. [PMID: 24905757 DOI: 10.1097/jan.0000000000000025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Smoking remains the leading cause of preventable death in the United States. Although healthcare workers play a key role in helping patients quit smoking, the degree to which they provide help varies. This study assesses the extent to which smokers report that their healthcare worker advised and assisted them with quitting based on their level of readiness to make a change. The 2006 Hawaii Adult Tobacco Survey asked questions regarding smoking status and if advice and assistance with quitting was given from a healthcare worker. Percentages for reporting healthcare worker's advice and assistance were compared among the three levels of motivational readiness using the chi-square test of association for 331 current, everyday smokers (56% women; 38% in the age group of 45-54 years). Most smokers are given advice to quit smoking. However, only about half of those motivated to quit are given assistance to do so. Most smokers across all motivation levels received advice to quit smoking with no significant difference between levels of readiness to quit. Less than half of smokers received any type of assistance with quitting smoking, with higher motivated smokers significantly receiving more assistance with cessation medication or nicotine replacement therapy and setting a quit date. This is a call to action for healthcare workers to address smoking with every patient. Adjustments to protocols for addressing smoking cessation and readiness to quit may be warranted.
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Williams RJ, Masica AL, McBurnie MA, Solberg LI, Bailey SR, Hazlehurst B, Kurtz SE, Williams AE, Puro JE, Stevens VJ. Documentation of the 5 as for smoking cessation by PCPs across distinct health systems. THE AMERICAN JOURNAL OF MANAGED CARE 2014; 20:e35-e42. [PMID: 24773327 PMCID: PMC6358171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Physicians can help patients quit smoking using the 5 As of smoking cessation. This study aimed to (1) identify the proportion of known smokers that receive smoking cessation services in the course of routine clinical practice; (2) describe demographic and comorbidity characteristics of patients receiving the 5 As in these systems; and (3) evaluate differences in performance of the 5 As across health systems, gender, and age categories. STUDY DESIGN Electronic medical records of 200 current smokers from 6 unique health systems (N = 1200) were randomly selected from 2006 to 2010. Primary care encounter progress notes were hand coded for occurrences of the 5 As. METHODS Bivariate comparisons of delivery of the 3 smoking-cessation services by site, gender, and age category were analyzed using χ² tests. RESULTS About 50% of smokers were advised to quit smoking, 39% were assessed for their readiness to quit, and 54% received some type of assistance to help them quit smoking. Only 2% had a documented plan for follow-up regarding their quitting efforts (arrange). Significant differences were found among sites for documentation of receiving the 5 As and between age groups receiving assistance with quitting. There was no statistically significant difference between genders in receipt of the 5 As. CONCLUSIONS Documentation of adherence to the 5 As varied by site and some demographics. Adjustments to protocols for addressing cessation and readiness to quit may be warranted. Health systems could apply the methodology described in this paper to assess their own performance, and then use that as a basis to guide improvement initiatives.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Victor J Stevens
- Kaiser Permanente Center for Health Research Northwest, 3800 N Interstate Ave, Portland, OR 97227. E-mail:
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Simmons VN, Haura EB, Brandon TH. Oncology healthcare providers’ pivotal role in smoking cessation and relapse prevention. Lung Cancer Manag 2013. [DOI: 10.2217/lmt.13.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Vani Nath Simmons
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Health Outcomes & Behavior, H Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Eric B Haura
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Thoracic Oncology, H Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Thomas H Brandon
- Department of Health Outcomes & Behavior, H Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
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Nayan S, Gupta MK, Strychowsky JE, Sommer DD. Smoking Cessation Interventions and Cessation Rates in the Oncology Population. Otolaryngol Head Neck Surg 2013; 149:200-11. [DOI: 10.1177/0194599813490886] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objectives To evaluate tobacco smoking cessation interventions and cessation rates in the oncology population through a systematic review and meta-analysis. Data Sources The literature was searched using PubMed, Google Scholar, Medline, EMBASE, and the Cochrane Library (inception to October 2012) by 3 independent review authors. Review Methods Studies were included if they were randomized controlled trials (RCTs) or prospective cohort (PCs) studies evaluating tobacco smoking cessation interventions with patients assigned to a usual care or an intervention group. The primary outcome measure was smoking cessation rates. Two authors extracted data independently for each study. When applicable, disagreements were resolved by consensus. Results The systematic review identified 10 RCTs and 3 PCs. Statistical analysis was conducted using StatsDirect software (Cheshire, UK). Pooled odds ratios (ORs) for smoking cessation interventions were calculated in 2 groups based on follow-up duration. The therapeutic interventions included counseling, nicotine replacement therapy, buproprion, and varenicline. Smoking cessation interventions had a pooled odds ratio of 1.54 (95% confidence interval [CI], 0.909-2.64) for patients in the shorter follow-up group and 1.31 (95% CI, 0.931-1.84) in the longer follow-up group. Smoking cessation interventions in the perioperative period had a pooled odds ratio of 2.31 (95% CI, 1.32-4.07). Conclusion Our systematic review and meta-analysis demonstrate that tobacco cessation interventions in the oncology population, in both the short-term and long-term follow-up groups, do not significantly affect cessation rates. The perioperative period, though, may represent an important teachable moment with regard to smoking cessation.
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Affiliation(s)
- Smriti Nayan
- Division of Otolaryngology–Head and Neck Surgery, McMaster University, Ontario, Canada
| | - Michael K. Gupta
- Division of Otolaryngology–Head and Neck Surgery, McMaster University, Ontario, Canada
| | - Julie E. Strychowsky
- Division of Otolaryngology–Head and Neck Surgery, McMaster University, Ontario, Canada
| | - Doron D. Sommer
- Division of Otolaryngology–Head and Neck Surgery, McMaster University, Ontario, Canada
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Simmons VN, Litvin EB, Jacobsen PB, Patel RD, McCaffrey JC, Oliver JA, Sutton SK, Brandon TH. Predictors of smoking relapse in patients with thoracic cancer or head and neck cancer. Cancer 2012; 119:1420-7. [PMID: 23280005 DOI: 10.1002/cncr.27880] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 08/21/2012] [Accepted: 10/04/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cancer patients who continue smoking are at increased risk for adverse outcomes including reduced treatment efficacy and poorer survival rates. Many patients spontaneously quit smoking after diagnosis; however, relapse is understudied. The goal of this study was to evaluate smoking-related, affective, cognitive, and physical variables as predictors of smoking after surgical treatment among patients with lung cancer and head and neck cancer. METHODS A longitudinal study was conducted with 154 patients (57% male) who recently quit smoking. Predictor variables were measured at baseline (ie, time of surgery); smoking behavior was assessed at 2, 4, 6, and 12 months after surgery. Analyses of 7-day point prevalence were performed using a Generalized Estimating Equations approach. RESULTS Relapse rates varied significantly depending on presurgery smoking status. At 12 months after surgery, 60% of patients who smoked during the week prior to surgery had resumed smoking versus only 13% who were abstinent prior to surgery. Smoking rates among both groups were relatively stable across the 4 follow-ups. For patients smoking before surgery (N = 101), predictors of smoking relapse included lower quitting self-efficacy, higher depression proneness, and greater fears about cancer recurrence. For patients abstinent before surgery (N = 53), higher perceived difficulty quitting and lower cancer-related risk perceptions predicted smoking relapse. CONCLUSIONS Efforts to encourage early cessation at diagnosis, and increased smoking relapse-prevention efforts in the acute period following surgery, may promote long-term abstinence. Several modifiable variables are identified to target in future smoking relapse-prevention interventions for cancer patients.
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Affiliation(s)
- Vani Nath Simmons
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL 33647, USA.
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