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Bhatt G, Goel S, Yadav SK, Patial A, Medhi B, Grover S, Attri S, Kaur R, Singh G, Gill SS. A randomised controlled trial to evaluate the effectiveness of a culture and disease-specific, patient-centric multi-component tobacco cessation intervention package for the patients attending non-communicable disease clinics in Punjab, India. Psychol Health 2024:1-18. [PMID: 38619313 DOI: 10.1080/08870446.2024.2333896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/15/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Developing an infrastructure to support tobacco cessation through existing systems and resources is crucial for ensuring the greatest possible access to cessation services. The present study aims to evaluate the effectiveness of a newly developed multi-component cessation among tobacco users in Non- Communicable Disease (NCD) clinics, functioning under the National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases, & Stroke (NPCDCS) of the Government of India. METHODS The intervention package consisting of culture- and disease-specific four face-to-face counselling sessions, pamphlets, and short text messages (bilingual) with follow-ups at 3rd, 6th, and 9th months with an endline assessment at 12th months was delivered to the intervention arm of the two-arm- parallel group randomised controlled trial at two selected NCD clinics. Self-reported seven-day abstinence, frequency of use, expenditure in seven days at each follow-up, FTND score, stage of change and plasma cotinine values were assessed at baseline, follow-ups, and endline (using Liquid Chromatography -Mass Spectrometry), as applicable. RESULTS The intervention arm reported a significantly more reduction in self-reported frequency of tobacco use at 6 months (mean: 13.6, 95% CI (7.8-19.4)), 9 months (mean: 20.3, 95% CI (12.2-28.4)) and 12 months (mean: 18.7, 95% CI (8.7-28.7)). The plasma cotinine concentration at endline in the intervention arm was statistically significantly lower than the baseline concentration. CONCLUSION Strengthening existing health systems is crucial for offering cessation support in the resource-restraint setting of LMICs to assist in quitting sustainably.
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Affiliation(s)
- Garima Bhatt
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sonu Goel
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
- School of Medicine, Faculty of Education & Health Sciences, University of Limerick, Limerick, Ireland
- Faculty of Human & Health Sciences, Swansea University, Swansea, United Kingdom
| | - Subodh Kumar Yadav
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ajay Patial
- Pediatric Biochemistry, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bikash Medhi
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Savita Attri
- Pediatric Biochemistry, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajbir Kaur
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Gurmandeep Singh
- Department of Health & Family Welfare, Government of Punjab, National Health Mission, Chandigarh, India
| | - Sandeep Singh Gill
- Department of Health & Family Welfare, Government of Punjab, Chandigarh, India
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Ramani VK, Mhaske M, Naik R. Assessment of Carbon Monoxide in Exhaled Breath using the Smokerlyzer Handheld Machine: A Cross- Sectional Study. Tob Use Insights 2023; 16:1179173X231184129. [PMID: 37384051 PMCID: PMC10293515 DOI: 10.1177/1179173x231184129] [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: 11/09/2022] [Accepted: 06/07/2023] [Indexed: 06/30/2023] Open
Abstract
Introduction Nicotine dependence is known to be a chronic remitting and relapsing addictive disorder. Among cancer patients who smoke, nicotine addiction has been found to be more when compared with smoking healthy individuals. Smokerlyzer machine can be used to test smoking substance use and de-addiction services can be provided at Preventive Oncology units. The objectives of the study include: (i) To assess eCO using a Smokerlyzer hand-held machine and correlate it with the smoking status, (ii) To assess the cut-off value for smoking use, and discusses the benefits of this method. Methods In this cross-sectional study, healthy individuals at the workplace were tested for exhaled CO (eCO), which is used as a biological marker for monitoring the tobacco smoking. We discuss the feasibility of testing and its implications for cancer patients. The Bedfont EC50 Smokerlyzer machine was used to measure the concentration of CO in the end-tidal expired air. Results Among 643 study subjects, we found a statistically significant difference (P < .001) of median (IQR) eCO (measured in ppm) among smokers and non-smokers 2(1,5) vs 1(1,2). A significant and moderate positive correlation (Spearman rank correlation coefficient: .463) was observed between eCO and subjects who used cigarettes (measured in pack years). The ROC curve shows a cut off value for eCO as 2.5 with sensitivity 43.6% and 1 - specificity 2.76% (Specificity: 97.24%), which was rounded to 3. The area under the curve is 74.9%, which indicates a moderate discrimination performance of the test. The diagnostic accuracy of the test is 82.89%, which shows the proportion of correct test results. Conclusion Estimating eCO in health care settings will enable monitoring the smoking substance use which has important impact on clinical outcomes. In cancer hospitals, when the goal is complete abstinence a stringent CO cutoff in the range of 3-4 ppm should be used.
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Affiliation(s)
- Vinod K Ramani
- Preventive Oncology, Healthcare Global Enterprise Ltd., Bangalore, India
| | - Manohar Mhaske
- Technology Healthcare Bigdata analytics, Gurugram, India
| | - Radheshyam Naik
- Medical Oncology, Healthcare Global Enterprise Ltd., Bangalore, India
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Does neighborhood or residence influence continued smoking among cancer patients: a spatial-ecological and descriptive analyses brief report. Cancer Causes Control 2023; 34:389-398. [PMID: 36447032 DOI: 10.1007/s10552-022-01655-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/11/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE Continued smoking after a cancer diagnosis is causally linked to cancer-specific and all-cause mortality. Additionally, smoking, in particular after a cancer diagnosis, increases risk for poor therapeutic outcomes, chronic disease and even COV19 infection. METHODS In order to better understand and address continued smoking among cancer patients, this research applied geospatial mapping analysis to explore the potential association of dedicated smoke/vape shops density and smoking among cancer patients. RESULTS Our findings suggest that there is an association between dedicated smoke/vape shops density and continued tobacco product use among cancer patients who live in areas with greater numbers of smoke/vape shops and higher percentage of African Americans and low socioeconomic persons. In the City of Hope-Antelope Valley Center region with an average of 1.4 dedicated smoke/vape shops per sq ml, cancer patients continue to smoke at a rate of almost 10%. This rate is almost twice the 5.2% cancer patient smoking rate of the main cancer center with an average of < 1 dedicated smoke/vape shops per sq ml. CONCLUSION Our study may inform cessation-related research, practice and policies so that researchers, clinicians and policymakers are well-aware of these disparities in dedicated smoke/vape shops proliferation that is disproportionately affecting minority patient, in particular cancer population.
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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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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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Tamí-Maury I, Garcia H, Onigbogi M, Ismael J, Manrique J, Vazquez V, Rojas C, Suchil L. Smoking cessation knowledge and perceptions of cancer care providers at six Latin American cancer institutions. Rev Panam Salud Publica 2022; 46:e121. [PMID: 36177301 PMCID: PMC9512687 DOI: 10.26633/rpsp.2022.121] [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: 11/10/2021] [Accepted: 06/20/2022] [Indexed: 11/24/2022] Open
Abstract
Objective. To assess the characteristics, self-reported tobacco use, knowledge, and perceptions about smoking cessation among cancer care providers (CCPs), as well as perceived barriers to inform interventions that can potentially improve quitting rates and the prognosis of cancer patients in Latin America. Methods. A cross-sectional study was conducted among 996 CCPs in six cancer institutions located in Argentina, Brazil, Colombia, Mexico, and Peru. An online survey consisting of 28 close-ended questions adapted from the 2012 International Association for the Study of Lung Cancer survey and the Global Adult Tobacco Survey was administered. Results. The majority of CCPs, ranging from 86.1% in Mexico to 95.9% in Brazil, agreed or strongly agreed that smoking cessation should be integrated into cancer treatment. However, inadequate training on smoking cessation was reported by 66.9%, 69.4%, 70.4%, 72.9%, 85.8%, and 86.4% in Mexico, Colombia (Floridablanca), Argentina, Peru, Brazil, and Colombia (Medellín), respectively, and this difference was statistically significant (p < 0.001). Moreover, current cigarette smoking prevalence among CCPs was 2.5% in Brazil, 4.6% in Peru, 6.3% in Colombia (Floridablanca), 10.4% in Colombia (Medellín), 11.5% in Mexico, and 15.1% in Argentina, showing a statistically significant difference (p < 0.001). Conclusions. Efforts in Latin America should be geared toward assisting CCPs with their quitting efforts and training in smoking cessation practices aimed at achieving a better prognosis and improving cancer patients’ quality of life.
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Affiliation(s)
- Irene Tamí-Maury
- The University of Texas Health Science Center at Houston HoustonTexas United States of America The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Hector Garcia
- Cancer Institute Las Americas Auna Medellín Colombia Cancer Institute Las Americas Auna, Medellín, Colombia
| | - Modupe Onigbogi
- The University of Texas Health Science Center at Houston HoustonTexas United States of America The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Julia Ismael
- National Cancer Institute Buenos Aires Argentina National Cancer Institute, Buenos Aires, Argentina
| | - Javier Manrique
- National Institute of Neoplastic Diseases Lima Peru National Institute of Neoplastic Diseases, Lima, Peru
| | - Vinicius Vazquez
- Cancer Hospital Barretos Brazil Cancer Hospital, Barretos, Brazil
| | - Carlos Rojas
- FOSCAL Cancer Center Bucaramanga Colombia FOSCAL Cancer Center, Bucaramanga, Colombia
| | - Laura Suchil
- National Cancer Institute Mexico City Mexico National Cancer Institute, Mexico City, Mexico
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Ryan A, Young AL, Tait J, McCarter K, McEnallay M, Day F, McLennan J, Segan C, Blanchard G, Healey L, Avery S, White S, Vinod S, Bradford L, Paul CL. Building staff capability, opportunity, and motivation to provide smoking cessation to people with cancer in Australian cancer treatment centres: development of an implementation intervention framework for the Care to Quit cluster randomised controlled trial. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2022; 23:1-33. [PMID: 36193179 PMCID: PMC9517978 DOI: 10.1007/s10742-022-00288-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 07/26/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022]
Abstract
Few rigorous studies provide a clear description of the methodological approach of developing an evidence-based implementation intervention, prior to implementation at scale. This study describes the development, mapping, rating, and review of the implementation strategies for the Care to Quit smoking cessation trial, prior to application in nine cancer services across Australia. Key stakeholders were engaged in the process from conception through to rating, reviewing and refinement of strategies and principles. An initial scoping review identified 21 barriers to provision of evidence-based smoking cessation care to patients with cancer, which were mapped to the Theoretical Domains Framework and Behaviour Change Wheel (BCW) to identify relevant intervention functions. The mapping identified 26 relevant behaviour change techniques, summarised into 11 implementation strategies. The implementation strategies were rated and reviewed against the BCW Affordability, Practicality, Effectiveness and cost-effectiveness, Acceptability, Side-effects/safety, and Equity criteria by key stakeholders during two interactive workshops to facilitate a focus on feasible interventions likely to resonate with clinical staff. The implementation strategies and associated intervention tools were then collated by form and function to provide a practical guide for implementing the intervention. This study illustrates the rigorous use of theories and frameworks to arrive at a practical intervention guide, with potential to inform future replication and scalability of evidence-based implementation across a range of health service settings. Supplementary Information The online version contains supplementary material available at 10.1007/s10742-022-00288-6.
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Affiliation(s)
- Annika Ryan
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, John Hunter Hospital, Level 4 West, New Lambton Heights, Newcastle, NSW Australia
| | - Alison Luk Young
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW Australia
| | - Jordan Tait
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, John Hunter Hospital, Level 4 West, New Lambton Heights, Newcastle, NSW Australia
| | - Kristen McCarter
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, John Hunter Hospital, Level 4 West, New Lambton Heights, Newcastle, NSW Australia
- Priority Research Centre for Cancer Research, Innovation and Translation, University of Newcastle, 2308, Callaghan, NSW Australia
- Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW Australia
| | - Melissa McEnallay
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, John Hunter Hospital, Level 4 West, New Lambton Heights, Newcastle, NSW Australia
- Priority Research Centre for Cancer Research, Innovation and Translation, University of Newcastle, 2308, Callaghan, NSW Australia
- Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW Australia
| | - Fiona Day
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW Australia
- Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW Australia
- Calvary Mater Newcastle, Corner Edith and Platt Streets, Waratah, NSW 2289 Australia
| | - James McLennan
- St Vincent’s Hospital Sydney, 390 Victoria Street, Darlinghurst, NSW 2010 Australia
| | - Catherine Segan
- Cancer Council Victoria, Melbourne, VIC Australia
- School of Population and Global Health, Centre for Health Policy, The University of Melbourne, MelbourneMelbourne, VIC Australia
| | - Gillian Blanchard
- Calvary Mater Newcastle, Corner Edith and Platt Streets, Waratah, NSW 2289 Australia
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW Australia
| | - Laura Healey
- Calvary Mater Newcastle, Corner Edith and Platt Streets, Waratah, NSW 2289 Australia
| | - Sandra Avery
- South Western Sydney Local Health District, Elizabeth Street, Liverpool, NSW 2170 Australia
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW Australia
| | - Sarah White
- Department of Health Quitline, 615 St Kilda Rd, Melbourne, VIC 3004 Australia
| | - Shalini Vinod
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW Australia
- South Western Sydney Clinical School and Ingham Institute for Applied Medical Research, Liverpool, NSW Australia
| | - Linda Bradford
- The Alfred, 55 Commercial Rd, Melbourne, VIC 3004 Australia
| | - Christine L. Paul
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, John Hunter Hospital, Level 4 West, New Lambton Heights, Newcastle, NSW Australia
- Priority Research Centre for Cancer Research, Innovation and Translation, University of Newcastle, 2308, Callaghan, NSW Australia
- Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW Australia
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Does Smoking Explain the Association Between Use of E-Cigarettes and Self-Reported Periodontal Disease? J Dent 2022; 122:104164. [DOI: 10.1016/j.jdent.2022.104164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 02/07/2023] Open
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Streck JM, Walter AW, Temel JS, Jawahri AE, Shin HJ, Regan S, Muzikansky A, Ponzani CJ, Ostroff JS, Park ER. Investigating documentation of alcohol and non-medical substance use in oncology treatment: an electronic health record review. Support Care Cancer 2022; 30:4275-4281. [PMID: 35088148 DOI: 10.1007/s00520-021-06688-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/07/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE Little is known about non-tobacco substance use (SU) and its treatment in cancer patients. National guidelines address tobacco only, and assessment of SU in cancer patients is not standardized. It is not clear how oncology clinicians assess, document, and follow-up on SU. METHODS We conducted an electronic health record review of patients enrolled in a smoking cessation trial at one large hospital site (N = 176). Chart review of oncology treatment notes assessed whether SU assessment was documented, the content of the documentation/assessment (e.g., frequency of use), and details about documentation (e.g., where/who documented). RESULTS Sixty-nine percent (121/176) of cancer patients had SU documented. Many patients (42%, 74/176) had only one substance documented; 66% (116/176) had alcohol use documented. For a substantial minority of patients (43/176; 24%), the provider did not specify the substance assessed (e.g., "drug use," "illicits"). SU was primarily documented by physicians (84%, 102/121), in routine progress notes (56%, 68/121), in the "social history" section of the note (84%, 102/121). Only 4 patients had a documented SU follow-up plan. When examining the subset of patients who reported problematic alcohol use (N = 27), the content of documentation was inconsistent (e.g., number of drinks/day vs. qualitative descriptors of use). CONCLUSIONS About 1/3 of oncology patients did not have SU assessment documented. SU other than alcohol use was infrequently documented, many clinicians documented SU but did not specify substance type, and few clinicians documented a follow-up plan for problematic SU. Oncology settings should utilize standardized assessment and referral for SU treatment.
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Affiliation(s)
- Joanna M Streck
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, MA, USA. .,Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA. .,Health Promotion and Resiliency Intervention Research Program, The Mongan Institute, MGH, Boston, MA, USA.
| | - Angela W Walter
- Health Promotion and Resiliency Intervention Research Program, The Mongan Institute, MGH, Boston, MA, USA.,Department of Public Health, University of Massachusetts, Lowell, MA, USA
| | | | | | - Hyo Jin Shin
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, MA, USA
| | - Susan Regan
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Colin J Ponzani
- Health Promotion and Resiliency Intervention Research Program, The Mongan Institute, MGH, Boston, MA, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elyse R Park
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, MA, USA.,Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Health Promotion and Resiliency Intervention Research Program, The Mongan Institute, MGH, Boston, MA, USA
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Santi SA, Conlon MSC, Meigs ML, Davidson SM, Mispel-Beyer K, Saunders DP. Rates of Smoking Cessation at 6 and 12 Months after a Clinical Tobacco Smoking Cessation Intervention in Head and Neck Cancer Patients in Northern Ontario, Canada. Curr Oncol 2022; 29:1544-1558. [PMID: 35323330 PMCID: PMC8947430 DOI: 10.3390/curroncol29030130] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022] Open
Abstract
Smoking during cancer treatment is associated with reduced treatment response and cancer recurrence in patients with tobacco-related cancers. The purpose of this study was to examine smoking characteristics in head and neck cancer patients (n = 503) with a history of smoking and examine the impact of an intensive clinical tobacco intervention to patients who were currently smoking. All participants completed an interviewer-administered questionnaire at study enrollment which examined smoking behaviours, motivations to quit, and strategies used to cessate smoking. Follow-up assessments were completed at 6- and 12-months which monitored whether patients had quit smoking, remained cessated, or continued to smoke since study recruitment. For those who were currently smoking (n = 186, 37.0%), an intensive clinical tobacco intervention that utilized the 3A's-Ask, Advise, Arrange-and the Opt-Out approach was offered to assist with smoking cessation at their new patient visit and followed-up weekly during their head and neck radiation therapy for 7 weeks. At 6 months, 23.7% (n = 41) of those who were smoking successfully quit; 51.2% quit 'cold turkey' (defined as using no smoking cessation assistance, aids or pharmacotherapy to quit), while 34.9% used pharmacotherapy (varenicline (Champix)) to quit. On average, it took those who were smoking 1-5 attempts to quit, but once they quit they remained cessated for the duration of the study. Although the head and neck cancer patients in this study reported high levels of nicotine dependence, many were able to successfully cessate.
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Affiliation(s)
- Stacey A. Santi
- Health Sciences North Research Institute (HSNRI), Sudbury, ON P3E 5J1, Canada; (S.A.S.); (M.S.C.C.); (M.L.M.); (K.M.-B.)
| | - Michael S. C. Conlon
- Health Sciences North Research Institute (HSNRI), Sudbury, ON P3E 5J1, Canada; (S.A.S.); (M.S.C.C.); (M.L.M.); (K.M.-B.)
- School of Rural and Northern Health, Laurentian University, Sudbury, ON P3E 2C6, Canada
- Northern Ontario School of Medicine (NOSM), Sudbury, ON P3E 2C6, Canada;
| | - Margaret L. Meigs
- Health Sciences North Research Institute (HSNRI), Sudbury, ON P3E 5J1, Canada; (S.A.S.); (M.S.C.C.); (M.L.M.); (K.M.-B.)
| | - Stacey M. Davidson
- Northern Ontario School of Medicine (NOSM), Sudbury, ON P3E 2C6, Canada;
- Northeast Cancer Centre (NECC), Health Sciences North, Sudbury, ON P3E 5J1, Canada
| | - Kyle Mispel-Beyer
- Health Sciences North Research Institute (HSNRI), Sudbury, ON P3E 5J1, Canada; (S.A.S.); (M.S.C.C.); (M.L.M.); (K.M.-B.)
| | - Deborah P. Saunders
- Health Sciences North Research Institute (HSNRI), Sudbury, ON P3E 5J1, Canada; (S.A.S.); (M.S.C.C.); (M.L.M.); (K.M.-B.)
- Northern Ontario School of Medicine (NOSM), Sudbury, ON P3E 2C6, Canada;
- Northeast Cancer Centre (NECC), Health Sciences North, Sudbury, ON P3E 5J1, Canada
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Cancer-related accelerated ageing and biobehavioural modifiers: a framework for research and clinical care. Nat Rev Clin Oncol 2022; 19:173-187. [PMID: 34873313 PMCID: PMC9974153 DOI: 10.1038/s41571-021-00580-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 12/15/2022]
Abstract
A growing body of evidence indicates that patients with cancer who receive cytotoxic treatments (such as chemotherapy or radiotherapy) have an increased risk of accelerated physical and cognitive ageing. Furthermore, accelerated biological ageing is a suspected driving force behind many of these observed effects. In this Review, we describe the mechanisms of biological ageing and how they apply to patients with cancer. We highlight the important role of specific behavioural factors, namely stress, sleep and lifestyle-related factors such as physical activity, weight management, diet and substance use, in the accelerated ageing of patients with cancer and cancer survivors. We also present a framework of how modifiable behaviours could operate to either increase the risk of accelerated ageing, provide protection, or promote resilience at both the biological level and in terms of patient-reported outcomes.
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Cardoso JS, Folha OADAC, Omura KM, Leite APSB, Corrêa VAC. Ocupar-se de fumar: sentidos e significados atribuídos por pessoas em tratamento do tabagismo. CADERNOS BRASILEIROS DE TERAPIA OCUPACIONAL 2022. [DOI: 10.1590/2526-8910.ctoao255333321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Resumo Objetivo Este estudo buscou compreender as ocupações de pessoas em tratamento para deixar de fumar. As motivações para tal pesquisa surgiram durante a prática como profissional residente em um Programa de Controle do Tabagismo. A fim de compreender as ocupações das pessoas participantes desse programa, utilizou-se uma perspectiva teórica sobre os sentidos e significados ocupacionais desenvolvida no contexto da Ciência Ocupacional. Método Trata-se de uma pesquisa qualitativa realizada em setembro e outubro de 2020 com quatro participantes que estavam em tratamento do tabagismo. Os dados foram analisados a partir da Análise de Conteúdo. Resultados Foi possível identificar e discutir sobre fumar como ocupação e os sentidos que levaram os participantes a fumar e deixar de fumar. Esses sentidos estão relacionados à cultura, contexto e fatores psicoemocionais, adoecimento e autopercepção de saúde. Além disso, os participantes identificaram o espaço de tratamento como um suporte para o momento de transição ocupacional. Conclusão Fumar é uma ocupação que precisa ser considerada no tratamento do tabagismo, pois a maneira como se lida com a transição ocupacional pode interferir na adesão ao tratamento.
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Cardoso JS, Folha OADAC, Omura KM, Leite APSB, Corrêa VAC. Smoking as an occupation: functions and meanings attributed by people undergoing smoking cessation treatment. CADERNOS BRASILEIROS DE TERAPIA OCUPACIONAL 2022. [DOI: 10.1590/2526-8910.ctoao255333322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Abstract Objective This study sought to understand the occupations of people undergoing smoking cessation treatment. The motivations for this research emerged during a resident professional practice in a Tobacco Control Program. A theoretical perspective on the functions and meanings of occupations in the context of Occupational Science was used to understand the occupations of the participants of this program. Method This is a qualitative study carried out with four people undergoing smoking cessation treatment from September to October 2020. Data were analyzed by Content Analysis. Results It was possible to identify and discuss smoking as an occupation and the meanings that have led the participants to smoke and stop smoking. These meanings are related to culture, psycho-emotional context and factors, illness, and self-perception of health. In addition, the participants identified the treatment space as a support for the moment of occupational transition. Conclusion Smoking is an occupation that needs to be considered during smoking cessation treatment, as how the occupational transition is addressed can interfere with treatment adherence.
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Pipe A. Overcoming 'Cessation Stasis': The Need to Address Inertia. J Natl Cancer Inst 2021; 114:338-339. [PMID: 34850035 DOI: 10.1093/jnci/djab209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/11/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Andrew Pipe
- Division of Cardiac Prevention & Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Ramani VK, V GD, Benny N, Naik R. Characteristics of tobacco consumption among cancer patients at a tertiary cancer hospital in South India-A cross-sectional study. Tob Use Insights 2021; 14:1179173X211050395. [PMID: 34720601 PMCID: PMC8554559 DOI: 10.1177/1179173x211050395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/13/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction Cancer patients commonly present with antecedent addiction to tobacco consumption. Our study describes the characteristics of this substance use. Following the diagnosis of cancer, continued consumption of tobacco results in reduced tolerance to treatment, failure of treatment, tumor progression, other primary tumors, secondary cancers, and poor quality of life. The aim of our study is to enumerate the clinico-social aspects of tobacco consumption among cancer patients. Methods This cross-sectional study includes 100 cancer patients admitted to Healthcare Global cancer hospital, Bangalore, India. The study subjects were assessed for tobacco consumption, as well as other substance use such as intake of alcohol. We assessed various dimensions of exposure to tobacco consumption such as duration, intensity, and cumulative dose as independent risk factors for cancer. Results Among the study subjects, 46.2% were found to smoke filter cigarettes. The mean duration of tobacco consumption among beedi users was found to be longer (25.9 years, SD: 14.4). When stratified for exclusive consumption, the mean durations were as follows: beedis (29 ± 14.4 years), cigarettes (23.8 ± 13.3 years), and chewing (15.9 ± 9.6 years). Along with tobacco, a large proportion (59.3%) of patients consumed alcohol as well. After attempts to quit, 89.01% patients had reversal of tobacco substance use. The data did not show significance for duration, intensity, and cumulative dose of tobacco consumption. Conclusion The diagnosis of cancer is a life-altering event, which results in higher motivation to quit the use of tobacco. Smoking cessation initiatives can reduce the risk of developing tobacco-related malignancies.
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Affiliation(s)
| | - Ganesha D V
- Department of Medical Oncology, St.John's Medical College and Hospital, Bangalore, India
| | - Neethu Benny
- Department of Medical Oncology, Healthcare Global Enterprise Ltd., Bangalore, India
| | - Radheshyam Naik
- Department of Medical Oncology, Healthcare Global Enterprise Ltd., Bangalore, India
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Perception of Tobacco Counseling and Cessation among Dental Practitioners. J Smok Cessat 2021; 2021:6692525. [PMID: 34306235 PMCID: PMC8279209 DOI: 10.1155/2021/6692525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/16/2021] [Accepted: 03/02/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate the knowledge and practice of tobacco cessation and counseling (TCC) among dental practitioners and their attitude and perceived barriers. Methods A cross-sectional study targeted licensed dental practitioners in Jeddah, Saudi Arabia. Participants answered a pretested and validated self-administered questionnaire consisted of demographic data; smoking status; knowledge of tobacco hazards, attitude, and practice; and perceived barriers of tobacco cessation counseling. Result Among the total sample of 529, response rate was 72.2% (mean age (34.20 ± 9.38 years), males (42.4%), and current smokers (23.8%)). Only 13.2% received formal training on TCC. Around (57.1%) reported smoking of dental team as an obstacle for TCC. Half of the participants (49.9%) reported patient's resistance as barrier to TCC. Others (45%-48%) reported insufficient time, knowledge, or training for TCC. Professional responsibility and willingness to provide cessation services constituted the highest median. Conclusion The majority showed willingness to participate in TCC. Lack of training, smoking status of providers, females, inadequate materials, and patients' resistance were the most common barriers. Education and training on TCC are recommended and should be allowed as a routine practice in dentistry.
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Affiliation(s)
- Young Gyu Cho
- Department of Family Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Smaily H, Khalaf M, Melkane AE, Helou D, Richa T, Khoury C, Azoury F, Farha G, Haddad A, Matar N. Smoking cessation intervention for patients with head and neck cancer: A prospective randomized controlled trial. Am J Otolaryngol 2021; 42:102832. [PMID: 33221636 DOI: 10.1016/j.amjoto.2020.102832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 11/07/2020] [Indexed: 10/23/2022]
Abstract
AIMS To evaluate the effectiveness of a brief smoking cessation intervention in head and neck cancer patients (HNCP). STUDY DESIGN A prospective randomized controlled trial that randomly assigns participants in two groups: a usual care group (UCG), and a standardized intervention group (SIG). MATERIAL AND METHODS Patients with a confirmed diagnosis of head and neck squamous cell carcinoma (HNSCC) and who are active smokers were prospectively approached by one of 4 trained Ear-nose-throat (ENT) residents. Participants were randomized into a UCG, and a SIG consisting of a brief perioperative smoking cessation intervention based on National Institute of Health (NIH) "5A's" model along with an informative motivational document and nicotine patch therapy (NPT) offered for 8 weeks in gradually decreasing doses. OBJECTIVE The evaluation of abstinence at 3, 6 and 12 months after enrollment. RESULTS 56 subjects were randomized into the UCG (N = 29, 52%), and the SIG (N = 27, 48%). The overall smoking cessation rates were not statistically different between the two groups; we observed at 3 months cessation rates of 57.1% vs. 57.7% (p = 0.96); at 6 months, 42.9% vs. 24% (p = 0.148); and at 12 months, 33.3% vs. 20.8% (p = 0.318), for the UCG and the SIG respectively. CONCLUSION This study failed to show the effectiveness of a combined brief smoking cessation approach led by and ENT resident in HNSCC patients. A multifaceted approach addressing different pharmacological treatments, factors contributing to smoking maintenance, mainly alcohol dependence and mood disturbances and dealing with relapse risks through close face-to-face or phone call follow-ups may have better outcomes and should be evaluated in upcoming trials.
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Implementation of tobacco cessation services at a comprehensive cancer center: a qualitative study of oncology providers’ perceptions and practices. Support Care Cancer 2020; 29:2465-2474. [DOI: 10.1007/s00520-020-05749-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/04/2020] [Indexed: 12/27/2022]
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May JR, Klass E, Davis K, Pearman T, Rittmeyer S, Kircher S, Hitsman B. Leveraging Patient Reported Outcomes Measurement via the Electronic Health Record to Connect Patients with Cancer to Smoking Cessation Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5034. [PMID: 32668758 PMCID: PMC7399884 DOI: 10.3390/ijerph17145034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/05/2020] [Accepted: 07/08/2020] [Indexed: 12/16/2022]
Abstract
Tobacco use negatively impacts cancer treatment outcomes, yet too few providers actively support their patients in quitting. Barriers to consistently addressing tobacco use and referring to treatment include time constraints and lack of knowledge surrounding treatment options. Patient Reported Outcomes (PRO) measurement is best practice in cancer care and has potential to help address these barriers to tobacco cessation treatment. This descriptive program evaluation study reports preliminary results following implementation of a novel automated PRO tobacco use screener and referral system via the electronic health record (EHR) patient portal (MyChart) that was developed and implemented as a part of a population-based tobacco treatment program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Between 25 June 2019 and 6 April 2020, 4589 unique patients completed the screener and 164 (3.6%) unique patients screened positive for recent (past month) cigarette smoking. All patients who screened positive were automatically referred to a smoking cessation treatment program integrated within the Lurie Cancer Center, and 71 (49.7%) patients engaged in treatment, as defined by completing at least one behavioral counseling session. Preliminary results indicate that the PRO/MyChart system may improve smoker identification and increase offering of treatment and, despite the "cold call" following a positive screen, may result in a treatment engagement rate that is higher than rates of treatment engagement previously documented in oncology settings. Longer term evaluation with formal statistical testing is needed before drawing conclusions regarding effectiveness, but PRO measurement via the EHR patient portal may serve a potentially important role in a multi-component approach to reaching and engaging cancer patients in comprehensive tobacco cessation treatment.
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Affiliation(s)
- Julia R. May
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA; (T.P.); (S.K.)
| | - Elizabeth Klass
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA; (T.P.); (S.K.)
| | - Kristina Davis
- Quality Innovation Center, Northwestern Medicine, Chicago, IL 60611, USA;
| | - Timothy Pearman
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA; (T.P.); (S.K.)
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Steven Rittmeyer
- Information Systems, Northwestern Medicine, Chicago, IL 60611, USA;
| | - Sheetal Kircher
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA; (T.P.); (S.K.)
| | - Brian Hitsman
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA; (T.P.); (S.K.)
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Heberg J, Simonsen MK, Thomsen T, Zoffmann V, Danielsen AK. Smoking cessation prolongs survival in female cancer survivors - the Danish nurse cohort. Eur J Oncol Nurs 2020; 47:101796. [PMID: 32682286 DOI: 10.1016/j.ejon.2020.101796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To explore smoking cessation between cancer survivors and cancer-free women, and the potential survival benefits from smoking cessation in cancer surviving women. METHOD We pooled 46,334 responses from the Danish Nurse Cohort. The cohort consists of female nurses, who were invited for surveys in 1993, 1999 and 2009. Participants were linked to nationwide registries on hospitalization, cause of death and migration through 2016. Odds for smoking cessation by cancer diagnosis were computed in propensity score matched logistic regression models, while survival by postdiagnosis smoking cessation was estimated in cox proportional hazards models. RESULTS Eligible for analysis were 7841 women (mean age = 56.7 years, SD ± 7.2), who were smokers at baseline and survived to the next follow-up survey. Of these, 545 women were diagnosed with cancer and matched by propensity score (1:2) with 1090 cancer-free women. Odds for smoking cessation were significantly higher in cancer-diagnosed women compared to their cancer-free peers (OR = 1.31, 95% CI: 1.06-1.61). Moreover, mortality risk was significantly lower among cancer survivors who stopped smoking (HR = 0.64, 95% CI: 0.46-0.91), compared to persistent smokers. CONCLUSIONS The results suggest considerable survival benefits from smoking cessation in cancer surviving female nurses, and that the time surrounding cancer diagnosis may serve as a teachable moment for smoking cessation. However, due to substantial methodological limitations embedded in the study, careful interpretation of the presented results is warranted. Future studies are needed to demonstrate the effects of diagnosis on smoking cessation as well as the effects of smoking cessation on survival in female cancer populations.
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Affiliation(s)
- Jette Heberg
- Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Tagensvej 22, 2200, Copenhagen N, Denmark; Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark.
| | - Mette Kildevæld Simonsen
- The Parker Institute, Bispebjerg and Frederiksbergs Hospital, Region H, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark; Aarhus University, Health, Department of Public Health, Vennelyst, Boulevard 4, 8000, Aarhus C, Denmark
| | - Thordis Thomsen
- Herlev Acute, Critical and Emergency Care Science Unit, Department of Anaesthesiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark; University of Copenhagen, Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Vibeke Zoffmann
- Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Tagensvej 22, 2200, Copenhagen N, Denmark; University of Copenhagen, IFSV, Section of Health Services Research, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Anne Kjaergaard Danielsen
- Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark; University of Copenhagen, Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
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Design and Pilot Implementation of an Electronic Health Record-Based System to Automatically Refer Cancer Patients to Tobacco Use Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114054. [PMID: 32517176 PMCID: PMC7312526 DOI: 10.3390/ijerph17114054] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 12/13/2022]
Abstract
Continued tobacco use after cancer diagnosis is detrimental to treatment and survivorship. The current reach of evidence-based tobacco treatments in cancer patients is low. As a part of the National Cancer Institute Cancer Center Cessation Initiative, the Mayo Clinic Cancer Center designed an electronic health record (EHR, Epic©)-based process to automatically refer ambulatory oncology patients to tobacco use treatment, regardless of intent to cease tobacco use(“opt out”). The referral and patient scheduling, accomplished through a best practice advisory (BPA) directed to staff who room patients, does not require a co-signature from clinicians. This process was piloted for a six-week period starting in July of 2019 at the Division of Medical Oncology, Mayo Clinic, Rochester, MN. All oncology patients who were tobacco users were referred for tobacco treatment by the rooming staff (n = 210). Of these, 150 (71%) had a tobacco treatment appointment scheduled, and 25 (17%) completed their appointment. We conclude that an EHR-based “opt-out” approach to refer patients to tobacco dependence treatment that does not require active involvement by clinicians is feasible within the oncology clinical practice. Further work is needed to increase the proportion of scheduled patients who attend their appointments.
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Hawari FI, Obeidat NA, Rimawi D, Jamal K. Smoking cessation care can translate to lower hazard of death in the short-run in cancer patients - a retrospective cohort study to demonstrate the value of smoking cessation services within the treatment phase of cancer. BMC Cancer 2019; 19:580. [PMID: 31256763 PMCID: PMC6600880 DOI: 10.1186/s12885-019-5778-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 05/30/2019] [Indexed: 01/04/2023] Open
Abstract
Background Smoking cessation is a key step towards improving cancer care and outcomes. However, smoking cessation interventions are underprovided in oncology settings. Within Jordan’s only comprehensive oncology center, we sought to evaluate receipt of care at a smoking cessation clinic and the effect of assisted abstinence through the smoking cessation clinic on short-term (two-year) survival after a cancer diagnosis. Methods We employed a retrospective cohort study design. Cancer registry and smoking cessation clinic data for adult Jordanian cancer patients diagnosed between 2009 and 2016, who also were cigarette smokers, and who received full treatment at King Hussein Cancer Center, were analyzed. Specifically, descriptive statistics of patients who visited the smoking cessation clinic were generated, and short-term (two-year) hazard of death of patients based on whether or not smoking cessation clinic-assisted abstinence occurred, were evaluated. Results There were 3403 patients who met our inclusion criteria. Approximately 21% of cancer patients were seen at the smoking cessation clinic, and significant demographic and clinical disparities in who was being seen [at the smoking cessation clinic] existed. In 2387 patients with available survival data, smokers who never went to the smoking cessation clinic (or were seen only once, or seen a year or more from diagnosis) had a hazard of death 2.8 times higher than smokers who had visited the smoking cessation clinic and who also confirmed they had not smoked on atleast two of their 3-, 6- or 12-month follow-up visits (95% confidence interval [CI] = 1.7–4.6). Non-abstainers at the smoking cessation clinic exhibited a similar disadvantage (HR 2.7, 95% CI 1.4–5.0). Conclusions Although evidence-based smoking cessation interventions increase the likelihood of abstinence and can lower the short-term hazard of death during cancer treatment, there is a deprioritization of smoking cessation interventions during cancer care, as indicated by low proportions of patients seen at the smoking cessation clinic. Our findings emphasize the importance of promoting interventions to avail smoking cessation interventions in oncology settings within the cancer treatment phase.
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Affiliation(s)
- F I Hawari
- Section of Pulmonary and Critical Care, Department of Medicine, King Hussein Cancer Center, P.O. Box 1269, Queen Rania Al Abdullah Street, Amman, Al-Jubeiha, 11941, Jordan. .,Cancer Control Office, King Hussein Cancer Center
- , Amman, Jordan.
| | - N A Obeidat
- Cancer Control Office, King Hussein Cancer Center
- , Amman, Jordan
| | - D Rimawi
- Office of Scientific Affairs - Center of Research Shared Resources, King Hussein Cancer Center, Amman, Jordan
| | - K Jamal
- Office of Scientific Affairs - Cancer Registry, King Hussein Cancer Center, Amman, Jordan
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