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Perez GK, Rabin JT, Tandon M, Strauss NM, Irwin K, Philpotts L, Ostroff J, Park ER. Do Tobacco Treatment Trials Address Disparities in Smoking Outcomes Among Black and Hispanic Cancer Patients? A Systematic Review of Smoking Cessation Interventions for Black and Hispanic Patients Diagnosed with Cancer. J Racial Ethn Health Disparities 2024; 11:2390-2406. [PMID: 37468742 PMCID: PMC11236890 DOI: 10.1007/s40615-023-01705-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 05/30/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To characterize the representation of Black and Hispanic cancer patients in tobacco treatment trials, and to offer recommendations for future research. METHODS We conducted two systematic searches of the literature (2018, 2021) using 5 databases (MEDLINE via EBSCO, Pubmed, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (EMBASE)) to examine the prevalence of tobacco trials that included Black or Hispanic cancer patients. Two coders independently screened all articles at title, abstract, and full-text to identify eligible trials. Information about the proportion of Black and Hispanic patients included, trial design features, and whether the authors analyzed outcomes for Black and Hispanic patients were documented. RESULTS Of 4682 identified studies, only 10 published trials included and reported on the rates of Black or Hispanic cancer patients enrolled in their tobacco trial. The proportion of enrolled Black cancer patients ranged from 2 to 55.6%. Only our studies documented enrollment rates for Hispanics, and rates were less than 6%. None of the studies offered strategies to promote or the accrual of Black or Hispanic patients. DISCUSSION There remains a large gap in the literature regarding the reach and efficacy of tobacco treatment for Black and Hispanic cancer patients. Black and Hispanic cancer patients remain largely under-represented in tobacco cessation trials, limiting the applicability of existing, evidence-based treatments. To optimize intervention generalizability, future studies should emphasize the targeted recruitment and engagement of these patients in tobacco trials.
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Affiliation(s)
- Giselle K Perez
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA.
- Health Promotion and Resilience Intervention Research Program, 100 Cambridge Street, 16th floor, Boston, MA, 02114, USA.
| | - Julia T Rabin
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | | | | | - Kelly Irwin
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
- Health Promotion and Resilience Intervention Research Program, 100 Cambridge Street, 16th floor, Boston, MA, 02114, USA
| | - Lisa Philpotts
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - Jamie Ostroff
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elyse R Park
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
- Health Promotion and Resilience Intervention Research Program, 100 Cambridge Street, 16th floor, Boston, MA, 02114, USA
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Chen J, Wan J, Wu Y, Gan L, Li H, Zhou Y, Liu S, Luo L, Zhou H, Yin X, Chang J. The Association Between Personality Traits and Health-Related Quality of Life and the Mediating Role of Smoking: Nationwide Cross-Sectional Study. JMIR Public Health Surveill 2024; 10:e51416. [PMID: 38989838 PMCID: PMC11240240 DOI: 10.2196/51416] [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: 08/05/2023] [Revised: 04/02/2024] [Accepted: 05/16/2024] [Indexed: 07/12/2024] Open
Abstract
Background There are positive and negative correlations in different directions between smoking, personality traits, and health-related quality of life (HRQOL), where smoking may mask the pathway between personality traits and HRQOL. Understanding the masking pathway of smoking between personality traits and HRQOL can elucidate the mechanisms of smoking's psychosocial effects and provide new ideas for developing tobacco control strategies. Objective The purpose of this study was to investigate the correlation between Big Five personality traits and HRQOL and whether smoking mediates the relationship between them. Methods This was a cross-sectional study using data from 21,916 respondents from the 2022 Psychology and Behavior Investigation of Chinese Residents survey. Linear regression models were used to analyze the correlations between smoking, Big Five personality traits, and HRQOL while controlling for potential confounders. The mediating role of smoking on the association between Big Five Personality traits and HRQOL was analyzed using the Sobel-Goodman mediation test. Results Extraversion (β=.001; P=.04), agreeableness (β=.003; P<.001), and neuroticism (β=.003; P<.001) were positively correlated with HRQOL, whereas openness was negatively correlated with HRQOL (β=-.001; P=.003). Smoking was associated with a decrease in HRQOL and mediated the positive effect of HRQOL on extraversion (z=-2.482; P=.004), agreeableness (z=-2.264; P=.02), and neuroticism (z=-3.230; P=.001). Subgroup analyses further showed that smoking mediated the effect of neuroticism on HRQOL in the population with chronic illnesses (z=-2.724; P=.006), and in the population without chronic illnesses, smoking contributed to the effect of HRQOL on extraversion (z=-2.299; P=.02), agreeableness (z=-2.382; P=.02), and neuroticism (z=-2.213; P=.03). Conclusions This study provided evidence that there is a correlation between personality traits and HRQOL. It also found that smoking plays a role in mediating the connection between personality traits and HRQOL. The development of future tobacco control strategies should consider the unique traits of each individual's personality, highlighting the significance of extraversion, agreeableness, and neuroticism.
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Affiliation(s)
- Jiangyun Chen
- Center for WHO Studies and Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China
| | - Jiahuan Wan
- Center for WHO Studies and Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China
| | | | - Li Gan
- Center for WHO Studies and Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China
| | - Haomiao Li
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
| | - Yan Zhou
- Operation Management Department, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
| | - Siyuan Liu
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Lan Luo
- Guangzhou Huangpu District Hongshan Street Community Health Service Center, Guangzhou, China
| | - Haozheng Zhou
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Xuanhao Yin
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Jinghui Chang
- Center for WHO Studies and Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China
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Verma M, Singhal S, Kukreja D. Is It Physician or Individual or Both: Whose Preference Matters Finally? Ann Afr Med 2024; 23:525-527. [PMID: 39034587 DOI: 10.4103/aam.aam_115_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/16/2023] [Indexed: 07/23/2024] Open
Affiliation(s)
- Mrinalini Verma
- Department of Radiation Oncology, KGMU, Lucknow, Uttar Pradesh, India
| | - Sanjay Singhal
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rajkot, Gujarat, India
| | - Divya Kukreja
- Department of Radiotherapy, RMLIMS, Lucknow, Uttar Pradesh, India
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Shin J, Hammer M, Cooley ME, Cooper BA, Paul SM, Cartwright F, Kober KM, Conley YP, Levine JD, Miaskowski C. Common and distinct risk factors that influence more severe and distressing shortness of breath profiles in oncology outpatients. Cancer Med 2024; 13:e7013. [PMID: 38400684 PMCID: PMC10891479 DOI: 10.1002/cam4.7013] [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: 11/07/2023] [Revised: 01/05/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Shortness of breath occurs in 10%-70% of oncology patients. Very little is known about interindividual variability in its severity and distress and associated risk factors. Using latent profile analyses (LPAs), purpose was to identify subgroups of patients with distinct severity and distress profiles for shortness of breath as single symptom dimensions. In addition, a joint LPA was done using patients' severity AND distress ratings. For each of the three LPAs, differences among the shortness of breath classes in demographic, clinical, symptom, stress, and resilience characteristics were evaluated. METHODS Patients completed ratings of severity and distress from shortness of breath a total of six times over two cycles of chemotherapy. All of the other measures were completed at enrollment (i.e., prior to the second or third cycle of chemotherapy). Separate LPAs were done using ratings of severity and distress, as well as a joint analysis using severity AND distress ratings. Differences among the latent classes were evaluated using parametric and nonparametric tests. RESULTS For severity, two classes were identified (Slight to Moderate [91.6%] and Moderate to Severe [8.4%]). For distress, two classes were identified (A Little Bit to Somewhat [83.9%] and Somewhat to Quite a Bit [16.1%]). For the joint LPA, two classes were identified (Lower Severity and Distress [79.9%] and Higher Severity and Distress [20.1%]). While distinct risk factors were associated with each of the LPAs, across the three LPAs, the common risk factors associated with membership in the worse class included: a past or current history of smoking, poorer functional status, and higher comorbidity burden. In addition, these patients had a higher symptom burden and higher levels of cancer-specific stress. CONCLUSIONS Clinicians can use the information provided in this study to identify high-risk patients and develop individualized interventions.
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Affiliation(s)
- Joosun Shin
- Dana‐Farber Cancer InstituteBostonMassachusettsUSA
| | | | | | - Bruce A. Cooper
- School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Steven M. Paul
- School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Kord M. Kober
- School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Yvette P. Conley
- School of NursingUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Jon D. Levine
- School of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Christine Miaskowski
- School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- School of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
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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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Halms T, Strasser M, Hasan A, Rüther T, Trepel M, Raab S, Gertzen M. Smoking and quality of life in lung cancer patients: systematic review. BMJ Support Palliat Care 2024; 13:e686-e694. [PMID: 37607808 DOI: 10.1136/spcare-2023-004256] [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: 03/03/2023] [Accepted: 08/09/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES Lung cancer (LC) accounts for the largest number of cancer deaths worldwide, with smoking being the leading cause for its development. While quality of life (QoL) is a crucial factor in the treatment of patients with LC, the impact of smoking status on QoL remains unclear. This systematic review aims to provide a comprehensive overview of available evidence on the relationship between smoking status and QoL among patients with LC. METHODS A systematic search of Embase, Medline and Web of Science was conducted. Studies reporting the impact of smoking status on QoL among patients with LC were eligible for inclusion. Two reviewers independently assessed the eligibility of studies, extracted data and evaluated the risk of bias using the Critical Appraisal Skills Programme appraisal tool for cohort studies. A descriptive synthesis was performed due to the heterogeneity of the studies. RESULTS A total of 23 studies met the inclusion criteria (17 studies providing cross-sectional and 6 longitudinal data). The studies included a total of 10 251 participants. The results suggested a tendency towards lower QoL among smokers compared with non-smokers. The effect of smoking cessation on QoL was insufficiently investigated in the included studies and therefore remains inconclusive. CONCLUSIONS The findings of this review suggest that current smokers may experience worse QoL than former and never smokers. The results of this systematic review should, however, be viewed in the context of the difficulty of data collection in this patient group given the low survival rates and low performance status, among other factors and in light of the large variety of different QoL measures used. Future research requires uniform QoL measures, a holistic representation of all patients with LC as well as a comprehensive consideration of all potential determinants of QoL. The potential benefits of smoking cessation on QoL among patients with LC require investigation.
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Affiliation(s)
- Theresa Halms
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Martina Strasser
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Tobias Rüther
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig‑Maximilians University Munich, Munich, Germany
| | - Martin Trepel
- Department of Hematology and Oncology, Medical Faculty, University of Augsburg, University Hospital Augsburg, Augsburg, Germany
- Comprehensive Cancer Center Augsburg (CCCA), Augsburg, Germany
| | - Stephan Raab
- Department of Thoracic Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Marcus Gertzen
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Augsburg, Augsburg, Germany
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Adamczak BB, Kuźnik Z, Makles S, Wasilewski A, Kosendiak AA. Physical Activity, Alcohol, and Cigarette Use in Urological Cancer Patients over Time since Diagnosis. Healthcare (Basel) 2023; 12:59. [PMID: 38200965 PMCID: PMC10779175 DOI: 10.3390/healthcare12010059] [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: 11/05/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024] Open
Abstract
Urological cancers represent a substantial global public health concern, exerting far-reaching effects on both individuals and their families. There is an urgent need to comprehensively understand the transformations in patients' lifestyles and behaviors, given their critical role in the treatment process and overall well-being. This study, involving 128 urological cancer patients, aims to investigate changes in physical activity levels, problematic drinking behaviors assessed through the Alcohol Use Disorders Identification Test (AUDIT), and smoking habits assessed using the Fagerström Test for Nicotine Dependence (FTND) over four distinct time intervals over the subsequent three years from the time of diagnosis and among individuals diagnosed more than three years ago. The results reveal a significant decrease in physical activity levels between study intervals (p < 0.0001), declining from 69% to 45% between the first and second post-diagnosis assessments. Furthermore, the highest levels of problematic substance use, indicated by mean scores, were noted in the first year following diagnosis (AUDIT: 4.20, p = 0.01; FTND: 4.83, p = 0.08). Given the significant impact of physical activity on the prospects of recovery, it is imperative to delve more deeply into the factors contributing to this decline and devise targeted interventions for its improvement. In the context of substance use, it is essential to ascertain whether the initially high levels are a result of coping with the cancer diagnosis or represent a turning point at which patients modify their behaviors and cease their addiction. A more thorough understanding of this phenomenon would enhance the effectiveness of precisely focused interventions.
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Affiliation(s)
- Bartosz Bogusz Adamczak
- Student Scientific Association, Department of Physical Education and Sport, Wroclaw Medical University, 51-601 Wroclaw, Poland
| | - Zofia Kuźnik
- Student Scientific Association, Department of Physical Education and Sport, Wroclaw Medical University, 51-601 Wroclaw, Poland
| | - Szymon Makles
- Student Scientific Association, Department of Physical Education and Sport, Wroclaw Medical University, 51-601 Wroclaw, Poland
| | - Andrzej Wasilewski
- Student Scientific Association, Department of Physical Education and Sport, Wroclaw Medical University, 51-601 Wroclaw, Poland
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Nolazco JI, Tang Y, Alkhatib KY, King AJ, Mossanen M, Chang SL. Smoking status among cancer patients by specialty: A U.S. nationwide representative analysis. Cancer Med 2023; 12:21389-21399. [PMID: 37986671 PMCID: PMC10726820 DOI: 10.1002/cam4.6684] [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: 01/03/2023] [Revised: 03/07/2023] [Accepted: 10/23/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Persistence in tobacco use among cancer survivors has been associated with a multitude of clinicodemographic factors. However, there is a paucity of understanding regarding the role the healthcare professional's specialty plays in tobacco cessation in tobacco-related cancer survivors. METHODS We conducted a cross-sectional analysis of data from cancer survivors with a smoking history using the Behavioral Risk Factor Surveillance System (BRFSS) database to examine differences in the proportion of patients continuing tobacco use among patients with a diagnosis of cancer segregated by cancer site specialty over the 2016-2020 period. We accounted for complex survey design and used sampling weights to obtain a nationwide representative sample. We employed modified Poisson regression adjusting for age, gender, education, income, race, marital status, and medical specialty. RESULTS We analyzed 19,855 cancer survivors with a current or past history of tobacco use, of whom 5222 (26,3%) self-reported to be current smokers. Patients with urological and gynecological tobacco-related malignancies had a higher relative risk (RR) of being current smokers with a RR of 1.30 (95% confidence interval, 1.12-1.51) and 1.25 (95% confidence interval, 1.12-1.39) respectively. Malignant Hematology had the lowest RR of smoking status among all other specialties RR 0.85 (95% confidence interval, 0.59-1.21). CONCLUSIONS Continuing smoking rates among tobacco-related cancer survivors were different between specialties. One in four cancer survivors were current smokers; this emphasizes health professionals' paramount role in tobacco cessation counseling.
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Affiliation(s)
- José Ignacio Nolazco
- Division of Urological SurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Servicio de Urología, Hospital Universitario Austral, Universidad AustralPilarArgentina
| | - Yuzhe Tang
- Division of Urological SurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Urology Department, Beijing Tsinghua Changgung Hospital School of Clinical MedicineTsinghua UniversityBeijingChina
| | - Khalid Y. Alkhatib
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Division of UrologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Andrew J. King
- Department of Health Care PolicyHarvard Medical SchoolBostonMassachusettsUSA
| | - Matthew Mossanen
- Division of Urological SurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Department of Radiation OncologyBrigham and Women's HospitalBostonMassachusettsUSA
| | - Steven Lee Chang
- Division of Urological SurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Lank Center for Genitourinary Oncology, Dana‐Farber Cancer InstituteBostonMassachusettsUSA
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Price SN, Palmer AM, Fucito LM, Graboyes EM, Baker NL, Rojewski AM, Toll BA. Tobacco use and cancer-related symptom burden: Analysis of the US Population Assessment of Tobacco and Health Study. Cancer 2023; 129:2385-2394. [PMID: 37211959 PMCID: PMC10593116 DOI: 10.1002/cncr.34746] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/03/2023] [Accepted: 02/22/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Understanding the relationship between tobacco use and symptom burden may inform tobacco treatment interventions tailored to the needs of individuals with cancer. METHODS The study included 1409 adult cancer survivors from Wave 5 of the US Food and Drug Administration Population Assessment of Tobacco and Health (PATH) Study. A multivariate analysis of variance controlling for age, sex, and race/ethnicity assessed the association of cigarette smoking and vaping on cancer-related symptom burden (fatigue, pain, emotional problems) and quality of life (QoL). Generalized linear mixed models controlling for the same factors were used to assess associations among symptom burden, QoL, and quit-smoking intentions, quit-smoking likelihood, and past 12-month smoking quit attempts. RESULTS Weighted rates of current cigarette smoking and vaping were 14.21% and 2.88%, respectively. Current smoking was associated with greater fatigue (p < .0001; partial η 2 = .02), pain (p < .0001; partial η 2 = .08), emotional problems (p < .0001; partial η 2 = .02), and worse QoL (p < .0001; partial η 2 = .08). Current vaping was associated with greater fatigue (p = .001; partial η 2 = .008), pain (p = .009; partial η 2 = .005), and emotional problems (p = .04; partial η 2 = .003), but not worse QoL (p = .17). Higher cancer symptom burden was not associated with reduced interest in quitting, likelihood of quitting, or odds of past year quit attempts (p > .05 for each). CONCLUSIONS Among adults with cancer, current smoking and vaping were associated with greater symptom burden. Survivors' interest in and intentions to quit smoking were not related to symptom burden. Future research should examine the role of tobacco cessation in improving symptom burden and QoL.
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Affiliation(s)
- Sarah N. Price
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Amanda M. Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lisa M. Fucito
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
| | - Evan M. Graboyes
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nathaniel L. Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alana M. Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Benjamin A. Toll
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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Tikka SK, Shukla A, Arora RD, Singh S, Mahant S, Verma S, Singh LK. Brief intervention to enhance cessation of smokeless tobacco use in newly diagnosed patients with head and neck cancers: A randomized controlled trial in patient-relative dyads. Indian J Psychiatry 2023; 65:742-748. [PMID: 37645365 PMCID: PMC10461584 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_578_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 04/24/2023] [Accepted: 05/31/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction Tobacco use is a major causative factor for head and neck cancers (HNC). Continued use of tobacco even after cancer diagnosis is common and is associated with all-cause and cancer-specific mortality, cancer recurrence and poor treatment response. Evidence suggests that behavioral interventions, help achieve greater smoking cessation rates in HNC patients. However, intervention studies focussed on HNC patients using smokeless tobacco, which is more common than smoking in India, are sparse. Materials and Methods We conducted a parallel arm randomized controlled trial (RCT) on dyads of patients with recently diagnosed HNC and a close relative. The experimental arm received a brief tobacco cessation intervention (BTCI) and the control arm received treatment as usual (TAU); 27 and 25 dyads in each arm completed the trial. Results Overall for the dyads using SLT, the relative risk of continuing to use SLT was 3.23 times higher (odds ratio = 7.01) if BTCI was not undertaken at one-month follow-up and 4.43 times higher (odds ratio = 8.65) at 3-months follow-up. For patients only, the relative risk of continuing to use SLT at one-month and 3-months follow-ups was 4.99 and 12.04 times higher, respectively, if BTCI was not undertaken. For relatives only, the corresponding relative risk values were 2.14 and 2.2. Conclusion We conclude that BTCI delivered to patient-relative dyads, compared to TAU, is effective in enhancing the discontinuation rates of the use of SLT in newly diagnosed patients with HNC. This form of intervention is significantly effective for discontinuing SLT use in the relatives too.
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Affiliation(s)
- Sai Krishna Tikka
- Department of Psychiatry, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Avinash Shukla
- Department of Psychiatry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Ripu D. Arora
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Sharda Singh
- Department of Psychiatry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Supriya Mahant
- Department of Psychiatry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Sachin Verma
- Department of Psychiatry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Lokesh K. Singh
- Department of Psychiatry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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11
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Issabakhsh M, Sánchez-Romero LM, Le TTT, Liber AC, Tan J, Li Y, Meza R, Mendez D, Levy DT. Machine learning application for predicting smoking cessation among US adults: An analysis of waves 1-3 of the PATH study. PLoS One 2023; 18:e0286883. [PMID: 37289765 PMCID: PMC10249849 DOI: 10.1371/journal.pone.0286883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/25/2023] [Indexed: 06/10/2023] Open
Abstract
Identifying determinants of smoking cessation is critical for developing optimal cessation treatments and interventions. Machine learning (ML) is becoming more prevalent for smoking cessation success prediction in treatment programs. However, only individuals with an intention to quit smoking cigarettes participate in such programs, which limits the generalizability of the results. This study applies data from the Population Assessment of Tobacco and Health (PATH), a United States longitudinal nationally representative survey, to select primary determinants of smoking cessation and to train ML classification models for predicting smoking cessation among the general population. An analytical sample of 9,281 adult current established smokers from the PATH survey wave 1 was used to develop classification models to predict smoking cessation by wave 2. Random forest and gradient boosting machines were applied for variable selection, and the SHapley Additive explanation method was used to show the effect direction of the top-ranked variables. The final model predicted wave 2 smoking cessation for current established smokers in wave 1 with an accuracy of 72% in the test dataset. The validation results showed that a similar model could predict wave 3 smoking cessation of wave 2 smokers with an accuracy of 70%. Our analysis indicated that more past 30 days e-cigarette use at the time of quitting, fewer past 30 days cigarette use before quitting, ages older than 18 at smoking initiation, fewer years of smoking, poly tobacco past 30-days use before quitting, and higher BMI resulted in higher chances of cigarette cessation for adult smokers in the US.
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Affiliation(s)
- Mona Issabakhsh
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, United States of America
| | - Luz Maria Sánchez-Romero
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, United States of America
| | - Thuy T. T. Le
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
| | - Alex C. Liber
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, United States of America
| | - Jiale Tan
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
| | - Yameng Li
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, United States of America
| | - Rafael Meza
- Integrative Oncology, BC Cancer Research Institute, Vancouver, BC, Canada
| | - David Mendez
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
| | - David T. Levy
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, United States of America
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Bade BC, Faiz SA, Ha DM, Tan M, Barton-Burke M, Cheville AL, Escalante CP, Gozal D, Granger CL, Presley CJ, Smith SM, Chamberlaine DM, Long JM, Malone DJ, Pirl WF, Robinson HL, Yasufuku K, Rivera MP. Cancer-related Fatigue in Lung Cancer: A Research Agenda: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2023; 207:e6-e28. [PMID: 36856560 PMCID: PMC10870898 DOI: 10.1164/rccm.202210-1963st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Background: Fatigue is the most common symptom among cancer survivors. Cancer-related fatigue (CRF) may occur at any point in the cancer care continuum. Multiple factors contribute to CRF development and severity, including cancer type, treatments, presence of other symptoms, comorbidities, and medication side effects. Clinically, increasing physical activity, enhancing sleep quality, and recognizing sleep disorders are integral to managing CRF. Unfortunately, CRF is infrequently recognized, evaluated, or treated in lung cancer survivors despite more frequent and severe symptoms than in other cancers. Therefore, increased awareness and understanding of CRF are needed to improve health-related quality of life in lung cancer survivors. Objectives: 1) To identify and prioritize knowledge and research gaps and 2) to develop and prioritize research questions to evaluate mechanistic, diagnostic, and therapeutic approaches to CRF among lung cancer survivors. Methods: We convened a multidisciplinary panel to review the available literature on CRF, focusing on the impacts of physical activity, rehabilitation, and sleep disturbances in lung cancer. We used a three-round modified Delphi process to prioritize research questions. Results: This statement identifies knowledge gaps in the 1) detection and diagnostic evaluation of CRF in lung cancer survivors; 2) timing, goals, and implementation of physical activity and rehabilitation; and 3) evaluation and treatment of sleep disturbances and disorders to reduce CRF. Finally, we present the panel's initial 32 research questions and seven final prioritized questions. Conclusions: This statement offers a prioritized research agenda to 1) advance clinical and research efforts and 2) increase awareness of CRF in lung cancer survivors.
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13
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Chellappan S. Smoking Cessation after Cancer Diagnosis and Enhanced Therapy Response: Mechanisms and Significance. Curr Oncol 2022; 29:9956-9969. [PMID: 36547196 PMCID: PMC9776692 DOI: 10.3390/curroncol29120782] [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: 10/21/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
The adverse effects of smoking on human health have been recognized for several decades, especially in the context of cancer. The ability of tobacco smoke components, including tobacco-specific carcinogens and additive compounds such as nicotine, to initiate or promote tumor growth have been described in hundreds of studies. These investigations have revealed the tumor-promoting activities of nicotine and other tobacco smoke components and have also recognized the ability of these agents to suppress the efficacy of cancer therapy; it is now clear that smoking can reduce the efficacy of most of the widely used therapeutic modalities, including immunotherapy, radiation therapy, and chemotherapy. Several studies examined if continued smoking after cancer diagnosis affected therapy response; it was found that while never smokers or non-smokers had the best response to therapy, those who quit smoking at the time of diagnosis had higher overall survival and reduced side-effects than those who continued to smoke. These studies also revealed the multiple mechanisms via which smoking enhances the growth and survival of tumors while suppressing therapy-induced cell death. In conclusion, smoking cessation during the course of cancer therapy markedly increases the chances of survival and the quality of life.
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Affiliation(s)
- Srikumar Chellappan
- Department of Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
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14
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The Role of Electronic Patient-Reported Outcome Measures in Assessing Smoking Status and Cessation for Patients with Lung Cancer. Oncol Ther 2022; 10:481-491. [PMID: 36223028 DOI: 10.1007/s40487-022-00210-7] [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: 08/23/2022] [Accepted: 09/23/2022] [Indexed: 10/17/2022] Open
Abstract
INTRODUCTION Smoking cessation following lung cancer diagnosis is recommended to improve patient outcomes. Electronic Patient Reported Outcome Measures (ePROMs) may be useful for identifying and facilitating cessation support in patients that continue to smoke after a cancer diagnosis. The primary aim was to investigate the level of agreement between clinician-reported and self-reported patient smoking status during the first visit to a cancer centre (I). Secondary aims included investigating differences between cancer-specific characteristics between never smokers and current/ex-smokers (IIA), and the self-reported frequency of smoking cessation after diagnosis of lung cancer (IIB). METHODS Retrospective single-centre study carried out at a tertiary cancer centre in the UK. Lung cancer patients that completed at least one ePROM questionnaire within 6 weeks of their first visit to the cancer centre (baseline), between February 2019 and February 2020, were included in the study. All ePROM questionnaires included a question regarding smoking status to allow comparison with the clinician records. Patients were offered these electronic questionnaires at each subsequent visit to the hospital. RESULTS Of 195 patients included, 24 (12.3%) demonstrated discordance between clinician-reported and self-reported smoking status at the baseline assessment. Clinician-reported 'current smokers' were more likely to be discordant with self-reported smoking status, compared with clinician-reported 'ex-smokers' and 'never smokers' (P = 0.017). Never smokers were more likely to have adenocarcinoma (P < 0.005), present with stage IV cancer (P = 0.023) and receive treatment with palliative intention (P = 0.042), compared with current and ex-smokers. Of those that were reported by clinicians as being current smokers, 9/38 (23.7%) were self-reported ex-smokers. A sub-group of 137 patients completed at least one additional ePROM questionnaire after the baseline and were included in the smoking cessation analysis. Thirty-eight patients were clinician-reported as 'current smokers' at baseline. Of these, 9 subsequently stopped smoking, 17 continued and 3 had short periods of cessation, identified through self-reporting. CONCLUSION In most cases, there is concordance between clinician- and self-reported smoking status. A small area of discordance was identified where clinicians reported some patients as 'current smokers', whilst patients self-reported having stopped. The causes for this were not explored and require further investigation. This study supports the use of ePROMs as a helpful tool to assess smoking status, and it can be used to identify patients for smoking cessation referral.
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15
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Hoch JS, Barr HK, Guggenbickler AM, Dewa CS. Lessons from Cost-Effectiveness Analysis of Smoking Cessation Programs for Cancer Patients. Curr Oncol 2022; 29:6982-6991. [PMID: 36290826 PMCID: PMC9600008 DOI: 10.3390/curroncol29100549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Smoking among patients diagnosed with cancer poses important health and financial challenges including reduced effectiveness of expensive cancer therapies. This study explores the value of smoking cessation programs (SCPs) for patients already diagnosed with cancer. It also identifies conditions under which SPCs may be wise investments. METHODS Using a simplified decision analytic model combined with insights from a literature review, we explored the cost-effectiveness of SCPs. RESULTS The findings provide insights about the potential impact of cessation probabilities among cancer patients in SCPs and the potential impact of SCPs on cancer patients' lives. CONCLUSION The evidence suggests that there is good reason to believe that SCPs are an economically attractive way to improve outcomes for cancer patients when SCPs are offered in conjunction with standard cancer care.
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Affiliation(s)
- Jeffrey S. Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, CA 95616, USA
- Center for Healthcare Policy and Research, University of California, Sacramento, CA 95820, USA
- Correspondence:
| | - Heather K. Barr
- Graduate Group in Public Health Sciences, Department of Public Health Sciences, University of California, Davis, CA 95616, USA
| | - Andrea M. Guggenbickler
- Graduate Group in Public Health Sciences, Department of Public Health Sciences, University of California, Davis, CA 95616, USA
| | - Carolyn S. Dewa
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA 95616, USA
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16
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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] [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
- grid.38142.3c000000041936754XDepartment of Psychiatry, Massachusetts General Hospital / Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA 02114 USA ,grid.32224.350000 0004 0386 9924Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA USA ,grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Autumn W. Rasmussen
- grid.38142.3c000000041936754XDepartment of Psychiatry, Massachusetts General Hospital / Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA 02114 USA ,grid.32224.350000 0004 0386 9924Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA USA ,grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA
| | - Lynne I. Wagner
- grid.241167.70000 0001 2185 3318Wake Forest University School of Medicine, Winston-Salem, NC USA
| | - JoRean D. Sicks
- grid.40263.330000 0004 1936 9094ECOG-ACRIN Biostatistics Center, Brown University, Providence, RI USA
| | - Ilana F. Gareen
- grid.40263.330000 0004 1936 9094Department of Epidemiology and the Center for Statistical Sciences, Brown University School of Public Health, Providence, RI USA
| | - Ruth C. Carlos
- grid.214458.e0000000086837370Michigan Medicine, University of Michigan, Ann Arbor, MI USA
| | - Benjamin A. Herman
- grid.40263.330000 0004 1936 9094ECOG-ACRIN Biostatistics Center, Brown University, Providence, RI USA
| | - Angela Wangari Walter
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA ,grid.225262.30000 0000 9620 1122Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA USA
| | - Susan Regan
- grid.32224.350000 0004 0386 9924Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Douglas E. Levy
- grid.32224.350000 0004 0386 9924Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Irene Mahon
- grid.417949.60000 0004 0638 1385 ECOG-ACRIN Cancer Research Group, American College of Radiology, Philadelphia, PA USA
| | - Alona Muzikansky
- grid.32224.350000 0004 0386 9924Biostatistics Center, Massachusetts General Hospital, Boston, MA USA
| | - Jordan M. Neil
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA ,grid.266902.90000 0001 2179 3618Department of Family and Preventative Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Michelle Lui
- grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Deepika Dilip
- grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Laura Malloy
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA
| | - Irina Gonzalez
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA
| | - Lucy Finkelstein-Fox
- grid.38142.3c000000041936754XDepartment of Psychiatry, Massachusetts General Hospital / Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA 02114 USA ,grid.32224.350000 0004 0386 9924Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA USA ,grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Caitlin McCann
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA
| | - Elissa Perez
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA
| | - Jamie S. Ostroff
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA ,grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Elyse R. Park
- grid.38142.3c000000041936754XDepartment of Psychiatry, Massachusetts General Hospital / Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA 02114 USA ,grid.32224.350000 0004 0386 9924Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA USA ,grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
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Avancini A, Belluomini L, Borsati A, Riva ST, Trestini I, Tregnago D, Dodi A, Lanza M, Pompili C, Mazzarotto R, Micheletto C, Motton M, Scarpa A, Schena F, Milella M, Pilotto S. Integrating supportive care into the multidisciplinary management of lung cancer: we can't wait any longer. Expert Rev Anticancer Ther 2022; 22:725-735. [PMID: 35608060 DOI: 10.1080/14737140.2022.2082410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Due to important achievements in terms of diagnostic and therapeutic tools and the complexity of the disease itself, lung cancer management needs a multidisciplinary approach. To date, the classical multidisciplinary team involves different healthcare providers mainly dedicated to lung cancer diagnosis and treatments. Nevertheless, the underlying disease and related treatments significantly impact on patient function and psychological well-being. In this sense, supportive care may offer the best approach to relieve and manage patient symptoms and treatment-related adverse events. AREAS COVERED Evidence report that exercise, nutrition, smoking cessation and psychological well-being bring many benefits in patients with lung cancer, from both a physical and socio-psychological points of view, and potentially improving their survival. Nevertheless, supportive care is rarely offered to patients, and even less frequently these needs are discussed within the multidisciplinary meeting. EXPERT OPINION Integrating supportive care as part of the standard multidisciplinary approach for lung cancer involves a series of challenges, the first one represented by the daily necessity of specialists, such as kinesiologists, dietitians, psycho-oncologists, able to deliver a personalized approach. In the era of precision medicine this is an essential step forward to guarantee comprehensive and patient-centered care for all patients with lung cancer.
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Affiliation(s)
- Alice Avancini
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Lorenzo Belluomini
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Anita Borsati
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Silvia Teresa Riva
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Ilaria Trestini
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Daniela Tregnago
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Alessandra Dodi
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Massimo Lanza
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Cecilia Pompili
- Thoracic Surgery Department, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Renzo Mazzarotto
- Section of Radiotherapy, Department of Surgery and Oncology, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Claudio Micheletto
- Pulmonary Unit, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Massimiliano Motton
- Radiology Department, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Aldo Scarpa
- Section of Pathology, Department of Diagnostic and Public Health, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Federico Schena
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Milella
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
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Oswald LB, Brownstein NC, Whiting J, Hoogland AI, Saravia S, Kirtane K, Chung CH, Vinci C, Gonzalez BD, Johnstone PAS, Jim HSL. OUP accepted manuscript. Oncologist 2022; 27:e176-e184. [PMID: 35641215 PMCID: PMC8895733 DOI: 10.1093/oncolo/oyab029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/29/2021] [Indexed: 11/15/2022] Open
Abstract
Background Cigarette smoking is related to greater cancer incidence, worse cancer-related clinical outcomes, and worse patient quality of life. Few studies have evaluated the role of smoking in patients’ experiences of cancer-related symptom burden. This study examined relationships between smoking and total symptom burden as well as the incidence of severe symptoms among adult cancer patients. Patients and Methods Patients at Moffitt Cancer Center completed self-report surveys as part of routine cancer care. Symptom burden was evaluated as the sum of individual symptom ratings (total symptom burden) and the number of symptoms rated severe (incidence of severe symptoms). Zero-inflated negative binomial modeling was used to evaluate the relationships between smoking status (ever vs never smoker) and symptom burden outcomes controlling for relevant sociodemographic and clinical covariates and accounting for the proportion of participants reporting no symptom burden. Results This study included 12 571 cancer patients. More than half reported a history of cigarette smoking (n = 6771, 55%). Relative to never smokers, participants with a smoking history had 15% worse expected total symptom burden (ratio = 1.15, 95% confidence interval [CI] 1.11-1.20, P < .001) and 13% more expected severe symptoms (ratio = 1.13, 95% CI 1.05-1.21, P = .001) above and beyond the effects of relevant sociodemographic and clinical characteristics. Conclusion Results provide support that smoking is associated with worse cancer symptom burden. More research is needed to evaluate how smoking history (ie, current vs former smoker) and smoking cessation influence cancer symptom burden.
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Affiliation(s)
- Laura B Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Corresponding author: Laura B. Oswald, PhD, Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, MFC-EDU, Tampa, FL 33612, USA. Tel: 813-745-1338;
| | - Naomi C Brownstein
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Sabrina Saravia
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Kedar Kirtane
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Christine H Chung
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Christine Vinci
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
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Streck JM, Luberto CM, Muzikansky A, Skurla S, Ponzani CJ, Perez GK, Hall DL, Gonzalez A, Mahaffey B, Rigotti NA, Ostroff JS, Park ER. Examining the effects of stress and psychological distress on smoking abstinence in cancer patients. Prev Med Rep 2021; 23:101402. [PMID: 34094817 PMCID: PMC8163988 DOI: 10.1016/j.pmedr.2021.101402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Cancer patients who smoke report more stress and psychological distress than patients who do not smoke. It is unclear how these emotional symptoms may modify smoking behavior in cancer patients. We examined the influence of a smoking cessation intervention for cancer patients on stress and distress, and the effects of these symptoms on smoking abstinence. METHODS Mixed-methods secondary analysis of data from the Smokefree Support Study, a two-site randomized controlled trial examining the efficacy of Intensive (IT; n = 153) vs. Standard Treatment (ST; n = 150) for smoking cessation in newly diagnosed cancer patients. Stress coping, perceived stress, distress, and anxiety were self-reported at baseline, 3, and 6 months. Abstinence was biochemically-confirmed at 6 months. A subset of patients (n = 72) completed qualitative exit-interviews. RESULTS Patients were on average, 58 years old, 56% female, and smoked a median of 10 cigarettes/day. There were no significant treatment group × time interactions or main effects of treatment group on stress or distress measures (p's > 0.05), however there were significant main effects of time suggesting symptom improvements on each measure in both study groups (p's < 0.05). In adjusted logistic regression models, lower levels anxiety at 3 months predicted confirmed smoking abstinence at 6 months (p = .03). Qualitatively, at 6 months, patients reported their stress and smoking were connected and that the cessation counseling was helpful. CONCLUSIONS Cancer patients enrolled in a smoking cessation trial report decreases in stress, distress and anxiety over time, and anxiety symptoms may impact smoking cessation success at follow-up resulting in an important intervention target.
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Affiliation(s)
- Joanna M. Streck
- Massachusetts General Hospital, Memorial Sloan Kettering Cancer Center, United States
- Harvard Medical School, Memorial Sloan Kettering Cancer Center, United States
- Department of Psychiatry, Memorial Sloan Kettering Cancer Center, United States
- Mongan Institute Health Policy Research Center & Tobacco Research and Treatment Center, Memorial Sloan Kettering Cancer Center, United States
| | - Christina M. Luberto
- Massachusetts General Hospital, Memorial Sloan Kettering Cancer Center, United States
- Harvard Medical School, Memorial Sloan Kettering Cancer Center, United States
- Department of Psychiatry, Memorial Sloan Kettering Cancer Center, United States
- Mongan Institute Health Policy Research Center & Tobacco Research and Treatment Center, Memorial Sloan Kettering Cancer Center, United States
| | - Alona Muzikansky
- Massachusetts General Hospital, Memorial Sloan Kettering Cancer Center, United States
- Center for Biostatistics, Memorial Sloan Kettering Cancer Center, United States
| | - Sarah Skurla
- VA Center for Clinical Management Research, Memorial Sloan Kettering Cancer Center, United States
| | - Colin J. Ponzani
- Massachusetts General Hospital, Memorial Sloan Kettering Cancer Center, United States
- Mongan Institute Health Policy Research Center & Tobacco Research and Treatment Center, Memorial Sloan Kettering Cancer Center, United States
| | - Giselle K. Perez
- Massachusetts General Hospital, Memorial Sloan Kettering Cancer Center, United States
- Harvard Medical School, Memorial Sloan Kettering Cancer Center, United States
- Mongan Institute Health Policy Research Center & Tobacco Research and Treatment Center, Memorial Sloan Kettering Cancer Center, United States
| | - Daniel L. Hall
- Massachusetts General Hospital, Memorial Sloan Kettering Cancer Center, United States
- Harvard Medical School, Memorial Sloan Kettering Cancer Center, United States
- Department of Psychiatry, Memorial Sloan Kettering Cancer Center, United States
- Mongan Institute Health Policy Research Center & Tobacco Research and Treatment Center, Memorial Sloan Kettering Cancer Center, United States
| | - Adam Gonzalez
- Stony Brook University, School of Medicine, Memorial Sloan Kettering Cancer Center, United States
| | - Brittain Mahaffey
- Stony Brook University, School of Medicine, Memorial Sloan Kettering Cancer Center, United States
| | - Nancy A. Rigotti
- Massachusetts General Hospital, Memorial Sloan Kettering Cancer Center, United States
- Harvard Medical School, Memorial Sloan Kettering Cancer Center, United States
- Mongan Institute Health Policy Research Center & Tobacco Research and Treatment Center, Memorial Sloan Kettering Cancer Center, United States
- Department of Medicine, Memorial Sloan Kettering Cancer Center, United States
| | - Jamie S. Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, United States
| | - Elyse R. Park
- Massachusetts General Hospital, Memorial Sloan Kettering Cancer Center, United States
- Harvard Medical School, Memorial Sloan Kettering Cancer Center, United States
- Department of Psychiatry, Memorial Sloan Kettering Cancer Center, United States
- Mongan Institute Health Policy Research Center & Tobacco Research and Treatment Center, Memorial Sloan Kettering Cancer Center, United States
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20
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Christensen SF, Scherber RM, Mazza GL, Dueck AC, Brochmann N, Andersen CL, Hasselbalch HC, Mesa RA, Geyer HL. Tobacco use in the Myeloproliferative neoplasms: symptom burden, patient opinions, and care. BMC Cancer 2021; 21:691. [PMID: 34112113 PMCID: PMC8194237 DOI: 10.1186/s12885-021-08439-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with Philadelphia-negative Myeloproliferative Neoplasms (MPN) suffer from numerous symptoms and decreased quality of life. Smoking is associated with an increased symptom burden in several malignancies. The aim of this study was to analyze the association between smoking and MPN-related symptom burden and explore MPN patients' opinions on smoking. METHODS A total of 435 patients with MPN participated in a cross-sectional internet-based survey developed by the Mayo Clinic and the Myeloproliferative Neoplasm Quality of Life Group. Patients reported their demographics, disease characteristics, tobacco use, and opinions on tobacco use. In addition, MPN-related symptoms were reported via the validated 10-item version of the Myeloproliferative Neoplasms Symptom Assessment Form. RESULTS Current/former smokers reported worse fatigue (mean severity 5.6 vs. 5.0, p = 0.02) and inactivity (mean severity 4.0 vs. 3.4, p = 0.03) than never smokers. Moreover, current/former smokers more frequently experienced early satiety (68.5% vs. 58.3%, p = 0.03), inactivity (79.9% vs. 71.1%, p = 0.04), and concentration difficulties (82.1% vs. 73.1%, p = 0.04). Although not significant, a higher total symptom burden was observed for current/former smokers (mean 30.4 vs. 27.0, p = 0.07). Accordingly, overall quality of life was significantly better among never smokers than current/former smokers (mean 3.5 vs. 3.9, p = 0.03). Only 43.2% of the current/former smokers reported having discussed tobacco use with their physician, and 17.5% did not believe smoking increased the risk of thrombosis. CONCLUSION The current study suggests that smoking may be associated with increased prevalence and severity of MPN symptoms and underscores the need to enhance patient education and address tobacco use in the care of MPN patients.
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Affiliation(s)
- Sarah F. Christensen
- Department of Hematology, Zealand University Hospital, Roskilde, Vestermarksvej 9, 4000 Roskilde, Denmark
| | - Robyn M. Scherber
- Department of Hematology and Oncology, UT Health San Antonio MD Anderson Cancer Center, 7979 Wurzbach Rd, San Antonio, TX 78229 USA
- Hematologic Malignancies, Incyte Corporation, Wilmington, Delaware, USA
| | - Gina L. Mazza
- Department of Health Sciences Research, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259 USA
| | - Amylou C. Dueck
- Department of Health Sciences Research, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259 USA
| | - Nana Brochmann
- Department of Hematology, Zealand University Hospital, Roskilde, Vestermarksvej 9, 4000 Roskilde, Denmark
| | - Christen L. Andersen
- Department of Hematology, University Hospital of Copenhagen at Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Hans C. Hasselbalch
- Department of Hematology, Zealand University Hospital, Roskilde, Vestermarksvej 9, 4000 Roskilde, Denmark
| | - Ruben A. Mesa
- Department of Hematology and Oncology, UT Health San Antonio MD Anderson Cancer Center, 7979 Wurzbach Rd, San Antonio, TX 78229 USA
| | - Holly L. Geyer
- Department of Hematology and Medical Oncology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259 USA
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Taylor GM, Lindson N, Farley A, Leinberger-Jabari A, Sawyer K, Te Water Naudé R, Theodoulou A, King N, Burke C, Aveyard P. Smoking cessation for improving mental health. Cochrane Database Syst Rev 2021; 3:CD013522. [PMID: 33687070 PMCID: PMC8121093 DOI: 10.1002/14651858.cd013522.pub2] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is a common perception that smoking generally helps people to manage stress, and may be a form of 'self-medication' in people with mental health conditions. However, there are biologically plausible reasons why smoking may worsen mental health through neuroadaptations arising from chronic smoking, leading to frequent nicotine withdrawal symptoms (e.g. anxiety, depression, irritability), in which case smoking cessation may help to improve rather than worsen mental health. OBJECTIVES To examine the association between tobacco smoking cessation and change in mental health. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, and the trial registries clinicaltrials.gov and the International Clinical Trials Registry Platform, from 14 April 2012 to 07 January 2020. These were updated searches of a previously-conducted non-Cochrane review where searches were conducted from database inception to 13 April 2012. SELECTION CRITERIA: We included controlled before-after studies, including randomised controlled trials (RCTs) analysed by smoking status at follow-up, and longitudinal cohort studies. In order to be eligible for inclusion studies had to recruit adults who smoked tobacco, and assess whether they quit or continued smoking during the study. They also had to measure a mental health outcome at baseline and at least six weeks later. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods for screening and data extraction. Our primary outcomes were change in depression symptoms, anxiety symptoms or mixed anxiety and depression symptoms between baseline and follow-up. Secondary outcomes included change in symptoms of stress, psychological quality of life, positive affect, and social impact or social quality of life, as well as new incidence of depression, anxiety, or mixed anxiety and depression disorders. We assessed the risk of bias for the primary outcomes using a modified ROBINS-I tool. For change in mental health outcomes, we calculated the pooled standardised mean difference (SMD) and 95% confidence interval (95% CI) for the difference in change in mental health from baseline to follow-up between those who had quit smoking and those who had continued to smoke. For the incidence of psychological disorders, we calculated odds ratios (ORs) and 95% CIs. For all meta-analyses we used a generic inverse variance random-effects model and quantified statistical heterogeneity using I2. We conducted subgroup analyses to investigate any differences in associations between sub-populations, i.e. unselected people with mental illness, people with physical chronic diseases. We assessed the certainty of evidence for our primary outcomes (depression, anxiety, and mixed depression and anxiety) and our secondary social impact outcome using the eight GRADE considerations relevant to non-randomised studies (risk of bias, inconsistency, imprecision, indirectness, publication bias, magnitude of the effect, the influence of all plausible residual confounding, the presence of a dose-response gradient). MAIN RESULTS We included 102 studies representing over 169,500 participants. Sixty-two of these were identified in the updated search for this review and 40 were included in the original version of the review. Sixty-three studies provided data on change in mental health, 10 were included in meta-analyses of incidence of mental health disorders, and 31 were synthesised narratively. For all primary outcomes, smoking cessation was associated with an improvement in mental health symptoms compared with continuing to smoke: anxiety symptoms (SMD -0.28, 95% CI -0.43 to -0.13; 15 studies, 3141 participants; I2 = 69%; low-certainty evidence); depression symptoms: (SMD -0.30, 95% CI -0.39 to -0.21; 34 studies, 7156 participants; I2 = 69%' very low-certainty evidence); mixed anxiety and depression symptoms (SMD -0.31, 95% CI -0.40 to -0.22; 8 studies, 2829 participants; I2 = 0%; moderate certainty evidence). These findings were robust to preplanned sensitivity analyses, and subgroup analysis generally did not produce evidence of differences in the effect size among subpopulations or based on methodological characteristics. All studies were deemed to be at serious risk of bias due to possible time-varying confounding, and three studies measuring depression symptoms were judged to be at critical risk of bias overall. There was also some evidence of funnel plot asymmetry. For these reasons, we rated our certainty in the estimates for anxiety as low, for depression as very low, and for mixed anxiety and depression as moderate. For the secondary outcomes, smoking cessation was associated with an improvement in symptoms of stress (SMD -0.19, 95% CI -0.34 to -0.04; 4 studies, 1792 participants; I2 = 50%), positive affect (SMD 0.22, 95% CI 0.11 to 0.33; 13 studies, 4880 participants; I2 = 75%), and psychological quality of life (SMD 0.11, 95% CI 0.06 to 0.16; 19 studies, 18,034 participants; I2 = 42%). There was also evidence that smoking cessation was not associated with a reduction in social quality of life, with the confidence interval incorporating the possibility of a small improvement (SMD 0.03, 95% CI 0.00 to 0.06; 9 studies, 14,673 participants; I2 = 0%). The incidence of new mixed anxiety and depression was lower in people who stopped smoking compared with those who continued (OR 0.76, 95% CI 0.66 to 0.86; 3 studies, 8685 participants; I2 = 57%), as was the incidence of anxiety disorder (OR 0.61, 95% CI 0.34 to 1.12; 2 studies, 2293 participants; I2 = 46%). We deemed it inappropriate to present a pooled estimate for the incidence of new cases of clinical depression, as there was high statistical heterogeneity (I2 = 87%). AUTHORS' CONCLUSIONS Taken together, these data provide evidence that mental health does not worsen as a result of quitting smoking, and very low- to moderate-certainty evidence that smoking cessation is associated with small to moderate improvements in mental health. These improvements are seen in both unselected samples and in subpopulations, including people diagnosed with mental health conditions. Additional studies that use more advanced methods to overcome time-varying confounding would strengthen the evidence in this area.
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Affiliation(s)
- Gemma Mj Taylor
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amanda Farley
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | | | - Katherine Sawyer
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | | | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Naomi King
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Chloe Burke
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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The characteristics of patients who quit smoking in the year following a cancer diagnosis. J Cancer Surviv 2021; 16:111-118. [PMID: 33641030 PMCID: PMC10117081 DOI: 10.1007/s11764-021-01009-7] [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: 11/04/2020] [Accepted: 02/17/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Continued tobacco smoking following a cancer diagnosis is associated with adverse outcomes. Our study aims to identify the demographic and clinical characteristics of survivors who quit smoking within a year of diagnosis. METHODS We conducted a secondary analysis of the Measuring Your Health (MY-Health) study, a community-based survey cohort of 5506 cancer patients registered across four Surveillance, Epidemiology, and End Results (SEER) cancer registries. Using surveys completed 6-13 months after diagnosis, we identified 868 participants who reported smoking around the time of cancer diagnosis and compared their current smoking status. We employed logistic regression models to predict current smoking status, adjusting for clinical and demographic variables. RESULTS The overall smoking cessation rate was 35% (n = 306). Survivors with non-small cell lung cancer were three times more likely to quit smoking compared to patients with non-smoking-related cancers (aOR = 3.23, 95% CI = 2.20-4.74). Participants with advanced stage cancer reported higher odds of quitting compared to those with localized cancer (aOR = 1.42, 95% CI = 1.02-1.96). Other characteristics that predicted quitting included being married, higher education level, and female sex (aOR = 2.01, 95% CI = 1.46-2.77; aOR = 1.74, 95% CI = 1.27-2.39; aOR = 1.54, 95% CI = 1.11-2.13, respectively). CONCLUSIONS This is one of the first studies to examine smoking cessation trends in a community-based, US cancer cohort during the year after diagnosis. Survivors with lung cancer and advanced cancer were significantly more likely to quit smoking. IMPLICATIONS FOR CANCER SURVIVORS Practitioners may use this knowledge to target interventions and address substantial disparities in cessation rates among survivors with early stage and non-lung cancers.
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Steuer CE, Jegede OA, Dahlberg SE, Wakelee HA, Keller SM, Tester WJ, Gandara DR, Graziano SL, Adjei AA, Butts CA, Ramalingam SS, Schiller JH. Smoking Behavior in Patients With Early-Stage NSCLC: A Report From ECOG-ACRIN 1505 Trial. J Thorac Oncol 2021; 16:960-967. [PMID: 33539971 DOI: 10.1016/j.jtho.2020.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Smoking cessation has been reported to benefit patients even after a diagnosis of lung cancer. We studied the smoking behavior of patients who participated in a phase 3 trial of adjuvant therapy following resection of stages IB-IIIA NSCLC. METHODS The ECOG-ACRIN 1505 was conducted to determine whether the addition of bevacizumab to adjuvant chemotherapy would improve overall survival (OS) for patients with early-stage NSCLC. Studying the association between smoking status and OS was a secondary end point. Patients completed a questionnaire on their smoking habits at baseline, 3, 6, 9, and 12 months. RESULTS A total of 1501 patients were enrolled, and 99.8%, 95%, 94%, 93%, and 93% responded to the questionnaire at baseline, 3, 6, 9, and 12 months, respectively. A total of 90% reported a current or previous history of cigarette smoking. In addition, 60% of nonsmokers at enrollment reported smoking after diagnosis (before randomization); however, 1% of them reported smoking at 12 months. Furthermore, 94% of the respondents smoked none/fewer cigarettes daily at 12 months. The incidence of grades 3-5 toxicity on treatment was 68%, 76%, and 72% in never, former, and current smokers, respectively (p = 0.05). The disease-free survival for never-smokers relative to current and former smokers was (hazard ratio [HR] 0.93, p = 0.64 and HR 1.05, p = 0.72), and OS was (adjusted HR for death 0.54, p = 0.005 and adjusted HR for death 0.68, p = 0.03), respectively. CONCLUSIONS This is the first comprehensive, prospective report of smoking habits in patients with NSCLC patients from a phase III early-stage trial. There was a high rate of smoking reduction and cessation following study entry. The disease-free survival did not differ significantly between smokers and never smokers, though there were less grade 3-5 toxicities and more favorable OS in never-smokers.
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Affiliation(s)
- Conor E Steuer
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia.
| | - Opeyemi A Jegede
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | | | - Heather A Wakelee
- Stanford University School of Medicine and Stanford Cancer Institute, Stanford, California
| | | | - William J Tester
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - David R Gandara
- University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Stephen L Graziano
- State University of New York Upstate Medical University, Syracuse, New York
| | | | | | - Suresh S Ramalingam
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
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24
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May JR, Jao NC, McCarter K, Klass E, Pearman T, Leone F, Schnoll RA, Hitsman B. Change in Health-Related Quality of Life Among Individuals With Cancer Undergoing Smoking Cessation Treatment Involving Varenicline. Oncol Nurs Forum 2021; 48:112-120. [PMID: 33337436 DOI: 10.1188/21.onf.112-120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine whether health-related quality of life (HRQOL) among individuals with cancer is undermined by smoking cessation treatment involving varenicline. SAMPLE & SETTING Participants (N = 103) were daily smokers with cancer (up to five years postdiagnosis) who completed a placebo-controlled trial of standard versus extended duration varenicline. METHODS & VARIABLES For this secondary study, participants were selected based on having completed the SF-12® at weeks 0, 1, 12, and 24. Using separate repeated measures multivariate analysis of variance, change in SF-12 scores was evaluated by time and by cancer treatment, varenicline duration, and quit status at week 24. RESULTS There was no change in any of the three HRQOL scores by time or by cancer treatment status, varenicline duration, or quit status. Average emotional HRQOL score across time was significantly higher for quitters versus smokers. IMPLICATIONS FOR NURSING Varenicline, including long-term treatment, does not appear to adversely affect HRQOL, which is highly relevant to oncology nurses who are well positioned to assist with the pharmacologic treatment of tobacco dependence.
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Affiliation(s)
| | | | | | | | | | - Frank Leone
- University of Pennsylvania Presbyterian Medical Center
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25
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Association of Cigarette Use and Substance Use Disorders among US Adults with and without a Recent Diagnosis of Cancer. ACTA ACUST UNITED AC 2020; 28:86-93. [PMID: 33704178 PMCID: PMC7816172 DOI: 10.3390/curroncol28010011] [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: 10/31/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 11/25/2022]
Abstract
Background: Few studies have examined substance use disorders (SUDs) in cancer patients and it is unclear whether SUDs differentially impact cigarette smoking in patients with vs. without cancer. This study used epidemiological data to estimate current cigarette smoking prevalence and quit ratios among US adults with and without SUDs by cancer status. Methods: Data were drawn from the 2015–2018 National Survey on Drug Use and Health (n = 170,111). Weighted current smoking prevalence and quit ratios were estimated across survey years by SUDs (with vs. without) and by cancer status (with vs. without). Results: Among those with cancer, current smoking prevalence was higher for those with vs. without SUDs (47% vs. 13%, p < 0.001) and quit ratios lower for those with vs. without SUDs (45% vs. 71%, p = 0.002). A similar pattern was observed in adults without cancer, with higher smoking prevalence (56% vs. 21%, p < 0.001) and lower quit ratios (23% vs. 51%, p < 0.001) observed for those with vs. without SUDs, respectively. In adjusted logistic regressions, the SUD × cancer status interaction was not significant for smoking prevalence or quit ratios (AOR = 1.2; 95% CI: 0.7, 2.1, p = 0.56; AOR = 1.0; 95% CI: 0.5, 2.0, p = 0.91, respectively), though smoking prevalence was lower and quit ratios higher for adults with vs. without cancer (ps < 0.05). Conclusions: Among US adults with and without cancer, individuals with SUDs evidenced higher cigarette smoking and lower quit ratios than those without SUDs. Addressing SUDs and their impact on smoking cessation is critical in cancer patients with implications for improving health and treatment outcomes.
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26
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Enyioha C, Warren GW, Morgan GD, Goldstein AO. Tobacco Use and Treatment among Cancer Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239109. [PMID: 33291274 PMCID: PMC7730918 DOI: 10.3390/ijerph17239109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 05/08/2023]
Abstract
Tobacco use is causally associated with the risk of developing multiple health conditions, including over a dozen types of cancer, and is responsible for 30% of cancer deaths in the U [...].
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Affiliation(s)
- Chineme Enyioha
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (C.E.); (G.D.M.)
| | - Graham W. Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Glen D. Morgan
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (C.E.); (G.D.M.)
| | - Adam O. Goldstein
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (C.E.); (G.D.M.)
- Correspondence:
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27
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Radakrishnan A, Coughlin JM, Odell DD, Johnson JK. "Are We Gonna Talk About It or Not?" Thoracic Oncology Provider Perspectives on Smoking Cessation. J Surg Res 2020; 258:422-429. [PMID: 33059909 DOI: 10.1016/j.jss.2020.08.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Tobacco use is the greatest preventable cause of death and disease in the United States. Despite recommendations from the Centers for Disease Control and Prevention, United States Preventive Task Force, and major professional societies that all health-care providers provide smoking-cessation counseling, smoking-cessation interventions are not consistently delivered in clinical practice. We sought to identify important barriers and facilitators to the utilization of smoking-cessation interventions in a thoracic oncology program. MATERIALS AND METHODS We conducted 14 semistructured interviews with providers including thoracic surgeons (n = 3), interventional pulmonologists (n = 1), medical oncologists (n = 3), radiation oncologists (n = 2), and nurses (n = 5). Interviewees were asked about prior and current smoking-cessation efforts, their perspectives on barriers to successful smoking cessation, and opportunities for improvement. Responses were analyzed inductively to identify common themes. RESULTS All interviewees report discussing smoking cessation with their patients and realize the importance of a smoking-cessation counseling; however, smoking-cessation interventions are inconsistent and often lacking. Providers emphasized five domains that impact their delivery of smoking-cessation interventions: patient willingness and motivation to quit, clinical engagement and follow-up, documentation of smoking history, provider education in smoking cessation, and the availability of additional smoking-cessation resources. CONCLUSIONS Providers recognize the need for more efficient and consistent smoking-cessation interventions. Therefore, the development of interventions that address this need would not only be easily taught to providers and delivered to patients but also be welcomed into clinics.
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Affiliation(s)
| | - Julia M Coughlin
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David D Odell
- Northwestern University Feinberg School of Medicine, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Julie K Johnson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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28
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Feng Z, Cramm JM, Nieboer AP. Social participation is an important health behaviour for health and quality of life among chronically ill older Chinese people. BMC Geriatr 2020; 20:299. [PMID: 32831028 PMCID: PMC7444063 DOI: 10.1186/s12877-020-01713-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 08/16/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Health behaviours (physical activity, maintenance of a healthy diet and not smoking) are known to be beneficial to the health and well-being of chronically ill people. With China's ageing population and increased prevalence of people with chronic diseases, the improvement of unhealthy behaviours in this population has become crucial. Although recent studies have highlighted the importance of social participation for health and quality of life (QoL) among older people, no study to date has included social participation along with more traditional health behaviours. Therefore, this study aimed to identify associations of multiple health behaviours (social participation, physical activity, maintenance of a healthy diet and not smoking) with health and QoL outcomes (including cognitive and physical function) among chronically ill older adults in China. METHODS For this nationally representative cross-sectional study, wave 1 data from the World Health Organization's Study on global AGEing and adult health (China) were examined. In total, 6629 community-dwelling older adults (mean age, 64.9 years) with at least one chronic disease were included. Multivariate linear regression analyses were used to evaluate associations of health behaviours with health and QoL outcomes while controlling for background characteristics. RESULTS Greater social participation was associated with better QoL [β = 0.127, standard error (SE) = 0.002, p < 0.001], cognitive function (β = 0.154, SE = 0.033, p < 0.001) and physical function (β = - 0.102, SE = 0.008, p < 0.001). Physical activity was associated with better QoL (β = 0.091, SE = 0.015, p < 0.001) and physical function (β = - 0.155, SE = 0.062, p < 0.001). Sufficient fruit and vegetable consumption was associated with better QoL (β = 0.087, SE = 0.015, p < 0.001). CONCLUSIONS Our findings suggest that social participation is an important health behaviour for quality of life and cognitive function among chronically ill older people in China. Health promotion programmes should expand their focus to include social participation as a health behaviour, in addition to physical activity, maintenance of a healthy diet and not smoking.
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Affiliation(s)
- Zeyun Feng
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, DR. Rotterdam, Rotterdam, 3000 the Netherlands
- Department of Health Technology Assessment, Shanghai Health Development Research Center (Shanghai Medical Information Center), Jianguo Road 602, Shanghai, 200031 China
| | - Jane Murray Cramm
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, DR. Rotterdam, Rotterdam, 3000 the Netherlands
| | - Anna Petra Nieboer
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, DR. Rotterdam, Rotterdam, 3000 the Netherlands
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Perlík F. Impact of smoking on metabolic changes and effectiveness of drugs used for lung cancer. Cent Eur J Public Health 2020; 28:53-58. [PMID: 32228818 DOI: 10.21101/cejph.a5620] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 11/17/2019] [Indexed: 11/15/2022]
Affiliation(s)
- František Perlík
- Department of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- Institute for Postgraduate Medical Education, Prague, Czech Republic
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Gali K, Pike B, Kendra MS, Tran C, Fielding-Singh P, Jimenez K, Mirkin R, Prochaska JJ. Integration of Tobacco Treatment Services into Cancer Care at Stanford. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062101. [PMID: 32235713 PMCID: PMC7143650 DOI: 10.3390/ijerph17062101] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 01/08/2023]
Abstract
As part of a National Cancer Institute Moonshot P30 Supplement, the Stanford Cancer Center piloted and integrated tobacco treatment into cancer care. This quality improvement (QI) project reports on the process from initial pilot to adoption within 14 clinics. The Head and Neck Oncology Clinic was engaged first in January 2019 as a pilot site given staff receptivity, elevated smoking prevalence, and a high tobacco screening rate (95%) yet low levels of tobacco cessation treatment referrals (<10%) and patient engagement (<1% of smokers treated). To improve referrals and engagement, system changes included an automated "opt-out" referral process and provision of tobacco cessation treatment as a covered benefit with flexible delivery options that included phone and telemedicine. Screening rates increased to 99%, referrals to 100%, 74% of patients were reached by counselors, and 33% of those reached engaged in treatment. Patient-reported abstinence from all tobacco products at 6-month follow-up is 20%. In July 2019, two additional oncology clinics were added. In December 2019, less than one year from initiating the QI pilot, with demonstrated feasibility, acceptability, and efficacy, the tobacco treatment services were integrated into 14 clinics at Stanford Cancer Center.
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Affiliation(s)
- Kathleen Gali
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, CA 94305, USA; (K.G.); (B.P.); (P.F.-S.)
| | - Brittany Pike
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, CA 94305, USA; (K.G.); (B.P.); (P.F.-S.)
- Stanford Health Care, Stanford, CA 94305, USA; (C.T.); (R.M.)
| | - Matthew S. Kendra
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA 94305, USA;
| | - Cindy Tran
- Stanford Health Care, Stanford, CA 94305, USA; (C.T.); (R.M.)
| | - Priya Fielding-Singh
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, CA 94305, USA; (K.G.); (B.P.); (P.F.-S.)
| | - Kayla Jimenez
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, CA 94304, USA;
| | - Rachelle Mirkin
- Stanford Health Care, Stanford, CA 94305, USA; (C.T.); (R.M.)
| | - Judith J. Prochaska
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, CA 94305, USA; (K.G.); (B.P.); (P.F.-S.)
- Correspondence: ; Tel.: +1-650-724-3608
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Relationships Between Smoking Status and Psychological Distress, Optimism, and Health Environment Perceptions at Time of Diagnosis of Actual or Suspected Lung Cancer. Cancer Nurs 2020. [PMID: 29538022 DOI: 10.1097/ncc.0000000000000579] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND While much research and practice resources have addressed smoking cessation among cancer patients, less emphasis has been placed on personal psychological and environment factors associated with smoking at the time of diagnosis. OBJECTIVE The aim of this study was to examine differences in psychological distress, optimism, and perceptions of the health environment/illness experience based on smoking status in patients with current, former, and no smoking history with newly diagnosed suspected or actual lung cancer. METHODS Data were derived from a descriptive study of 52 patients (34 men and 18 women aged 37-83 years) undergoing diagnostic evaluation for actual or suspected lung cancer. Descriptive statistics were used to characterize data. Analysis of variance, χ, and Spearman correlation tests were used to determine relationships among main study variables (smoking status, anxiety, worry, perceived cognitive functioning, optimistic outlook, health environment/illness experience perceptions). RESULTS Current smoking status was associated with higher psychological distress (anxiety and worry) among patients facing a new suspected or actual cancer diagnosis. CONCLUSIONS The study was able to provide important information relative to smoking status and psychological distress at the time of diagnosis of suspected or actual lung cancer. Findings demonstrate needs for assessment and targeted interventions to reduce psychological distress and to promote long-term adaptation in patients smoking at time of diagnosis. IMPLICATIONS FOR PRACTICE Nurses are positioned to provide support and resources for cancer patients. It is critical that smoking cessation interventions also address nicotine craving, emotion regulation, and adaptive coping skills.
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Bricker JB, Watson NL, Heffner JL, Sullivan B, Mull K, Kwon D, Westmaas JL, Ostroff J. A Smartphone App Designed to Help Cancer Patients Stop Smoking: Results From a Pilot Randomized Trial on Feasibility, Acceptability, and Effectiveness. JMIR Form Res 2020; 4:e16652. [PMID: 31951215 PMCID: PMC6996729 DOI: 10.2196/16652] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/14/2019] [Accepted: 12/09/2019] [Indexed: 01/17/2023] Open
Abstract
Background Persistent smoking after a cancer diagnosis predicts worse treatment outcomes and mortality, but access to effective smoking cessation interventions is limited. Smartphone apps can address this problem by providing a highly accessible, low-cost smoking cessation intervention designed for patients with a recent cancer diagnosis. Objective This study aimed to summarize our development process and report the trial design, feasibility, participant acceptability, preliminary effectiveness, and impact on processes of change (eg, cancer stigma) of the first-known smoking cessation smartphone app targeted for cancer patients. Methods We used an agile, user-centered design framework to develop a fully automated smartphone app called Quit2Heal that provided skills training and stories from cancer survivors focusing on coping with internalized shame, cancer stigma, depression, and anxiety as core triggers of smoking. Quit2Heal was compared with the National Cancer Institute’s QuitGuide, a widely used stop smoking app for the general population, in a pilot double-blinded randomized trial with a 2-month follow-up period. Participants were 59 adult smokers diagnosed with cancer within the past 12 months and recruited through 2 cancer center care networks and social media over a 12-month period. The most common types of cancer diagnosed were lung (21/59, 36%) and breast (10/59, 17%) cancers. The 2-month follow-up survey retention rate was 92% (54/59) and did not differ by study arm (P=.15). Results Compared with QuitGuide participants, Quit2Heal participants were more satisfied with their assigned app (90% [19/21] for Quit2Heal vs 65% [17/26] for QuitGuide; P=.047) and were more likely to report that the app assigned to them was made for someone like them (86% [18/21] for Quit2Heal vs 62% [16/26] for QuitGuide; P=.04). Quit2Heal participants opened their app a greater number of times during the 2-month trial period, although this difference was not statistically significant (mean 10.0, SD 14.40 for Quit2Heal vs mean 6.1, SD 5.3 for QuitGuide; P=.33). Self-reported 30-day point prevalence quit rates at the 2-month follow-up were 20% (5/25) for Quit2Heal versus 7% (2/29) for QuitGuide (odds ratio 5.16, 95% CI 0.71-37.29; P=.10). Quit2Heal participants also showed greater improvement in internalized shame, cancer stigma, depression, and anxiety, although these were not statistically significant (all P>.05). Conclusions In a pilot randomized trial with a high short-term retention rate, Quit2Heal showed promising acceptability and effectiveness for helping cancer patients stop smoking. Testing in a full-scale randomized controlled trial with a longer follow-up period and a larger sample size is required to test the effectiveness, mediators, and moderators of this promising digital cessation intervention. Trial Registration ClinicalTrials.gov NCT03600038; https://clinicaltrials.gov/ct2/show/NCT03600038
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Affiliation(s)
- Jonathan B Bricker
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Noreen L Watson
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA, United States
| | - Jaimee L Heffner
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA, United States
| | - Brianna Sullivan
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA, United States
| | - Kristin Mull
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA, United States
| | - Diana Kwon
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - Jamie Ostroff
- Memorial Sloan Kettering, New York City, NY, United States
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Singh LK, Arora RD, Tikka SK, Shukla A, Singh S, Mahant S, Verma S. Brief Intervention for Tobacco when Diagnosed with Oral Cancer (BITDOC): Study protocol of a randomized clinical trial studying efficacy of brief tobacco cessation intervention, Chhattisgarh, India. Tob Prev Cessat 2020; 6:4. [PMID: 32548341 PMCID: PMC7291894 DOI: 10.18332/tpc/115028] [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: 09/29/2019] [Revised: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Tobacco use is a major causative factor for cancer. Cessation programs along with diagnosis of cancer as a motivating factor may improve quitting rates in patients. This is a protocol of a study that aims to assess the efficacy of brief tobacco cessation intervention (compared to treatment as usual, TAU) on pattern and attitudes towards tobacco chewing in newly diagnosed head and neck cancer patients and their relatives. METHODS The proposed study will be conducted in two phases. Phase 1 will include 105 dyads of patients and relatives and shall assess patterns (amount, frequency, duration of use and dependence etc.) and knowledge and attitudes (quitting, continued use, health-behavioural modifications, long-term effects on treatment etc.) towards tobacco chewing in newly diagnosed head and neck cancer patients using smokeless tobacco and their relatives. Sample will be recruited from outpatients attending the ear, nose, throat and head and neck surgery department of a tertiary health care institute. Phase 2 will be a randomized trial that will compare the efficacy of the ‘Brief Intervention for Tobacco when Diagnosed with Oral Cancer’ (BITDOC) and TAU, and will include 27 dyads in each of the two groups. Intervention will be delivered in three sessions, based on the principles of motivational interviewing and the 3As model. CONCLUSIONS This study will help in the evaluation of the attitude towards smokeless tobacco (SLT) in a population that has faced the adverse consequences from its use and changes brought by a diagnosis of HNC. It will also help in developing a cost-effective model for promotion of smoking cessation.
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Cheng WL, Chen KY, Lee KY, Feng PH, Wu SM. Nicotinic-nAChR signaling mediates drug resistance in lung cancer. J Cancer 2020; 11:1125-1140. [PMID: 31956359 PMCID: PMC6959074 DOI: 10.7150/jca.36359] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 10/26/2019] [Indexed: 02/07/2023] Open
Abstract
Lung cancer is the leading cause of cancer death worldwide. Cigarette smoking is the most common risk factor for lung carcinoma; other risks include genetic factors and exposure to radon gas, asbestos, secondhand smoke, and air pollution. Nicotine, the primary addictive constituent of cigarettes, contributes to cancer progression through activation of nicotinic acetylcholine receptors (nAChRs), which are membrane ligand-gated ion channels. Activation of nicotine/nAChR signaling is associated with lung cancer risk and drug resistance. We focused on nAChR pathways activated by nicotine and its downstream signaling involved in regulating apoptotic factors of mitochondria and drug resistance in lung cancer. Increasing evidence suggests that several sirtuins play a critical role in multiple aspects of cancer drug resistance. Thus, understanding the consequences of crosstalk between nicotine/nAChRs and sirtuin signaling pathways in the regulation of drug resistance could be a critical implication for cancer therapy.
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Affiliation(s)
- Wan-Li Cheng
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Kuan-Yuan Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.,Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
| | - Kang-Yun Lee
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.,Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.,Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Po-Hao Feng
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.,Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Sheng-Ming Wu
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.,Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
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Shadrina SS, Sivtseva AI, Sivtseva EN, Donskaya AA, Ivanova ON. Behavioural risk factors of arterial hypertension in the Evenk population of the Russian Arctic. Int J Circumpolar Health 2019; 78:1611329. [PMID: 31116098 PMCID: PMC6534235 DOI: 10.1080/22423982.2019.1611329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/25/2019] [Accepted: 04/19/2019] [Indexed: 11/29/2022] Open
Abstract
The urgency of the problem under study is determined by the high prevalence of arterial hypertension among the indigenous minorities of the North in modern socio-economic conditions. The following article is aimed to evaluate the prevalence of behavioural arterial hypertension risk factors according to the results of single-step epidemiological research of Evenk people in the Republic of Sakha (Yakutia), Russian Federation. The leading approach to the study of this problem was the questioning of the population using the international questionnaire for behavioural risk factors (CYNDI). As a result of research, widespread smoking was found among native population (52.0% of men and 23.7% of women). The frequency of alcohol consumption among the male Evenki is comparable to that in the Yakut population, and among the female, the number is much lower. Evenks including young men belong to the physically inactive population. The frequency of arterial hypertension (AH) cases along with the factors listed above are significantly influenced by: marital status, employment, education, and housing conditions. Article materials may be useful for a differentiated approach in the development of prevention and rehabilitation programs for the indigenous peoples of the North.
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36
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Sakhri L, Bertocchi M. [Bronchial carcinoma and tobacco: An update]. Rev Mal Respir 2019; 36:1129-1138. [PMID: 31767264 DOI: 10.1016/j.rmr.2018.06.013] [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: 05/01/2018] [Accepted: 06/18/2018] [Indexed: 11/29/2022]
Abstract
Lung cancer remains the most lethal cancer. The most common cause is smoking, which is also preventable, unlike the causes of other types of cancer. A genetic characteristic has emerged over several years, which explains particular profiles of smokers, or highly dependent smokers. The emergence of new therapies for the treatment of lung cancer, and the impact of tobacco on reducing the effectiveness of these therapies must challenge practitioners to obtain a complete cessation of smoking regardless of the stage of the disease.
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Affiliation(s)
- L Sakhri
- Institut de cancérologie Daniel-Hollard, groupe hospitalier mutualiste de Grenoble, 8, rue Docteur-Calmette, 38028 Grenoble cedex 1, France.
| | - M Bertocchi
- Service de pneumologie, centre hospitalier Annecy Genevois, 1, avenue de l'Hôpital, 74374 Pringy, France
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Wei YF, Huang WT, Liu TC, Shieh JM, Chian CF, Wu MF, Chang CC, Lin CH, Ko JC, Lin CM, Hsia TC. Factors associated with improvement in symptoms and quality of life for first-line EGFR-tyrosine kinase inhibitor treatment in patients with EGFR-mutated non-small-cell lung cancer - A multicenter prospective SMILE study. J Cancer 2019; 10:4151-4158. [PMID: 31417660 PMCID: PMC6692623 DOI: 10.7150/jca.30507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 04/28/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction: Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are a standard first-line treatment for advanced EGFR-mutated NSCLC patients. Factors associated with symptoms and quality of life (QOL) improvements have not been investigated. Methods: We conducted a multicenter, prospective study to evaluate improvements in QOL and symptoms in NSCLC patients treated with first-line EGFR-TKIs. QOL was assessed using the instrument of Functional Assessment of Cancer Therapy-Lung questionnaire (FACT-L) and Treatment Outcome Index (TOI). Assessment of symptoms was evaluated using the Lung cancer subscale (LCS). Results: Eligible subjects included 280 patients for endpoint analyses. The mean FACT-L score increased by 4.0 ± 15.56 at Week 2 (p<0.001), 5.1 ± 18.48 at Week 4 (p<0.001), and 4.2 ± 20.27 at Week 12 (p=0.001). Similarly, a 2.3 ± 11.65 (p<0.001), 3.2 ± 13.59 (p<0.001), and 2.4 ± 14.34 (p=0.009) increase in mean TOI score were observed at Weeks 2, 4 and 12, respectively. For LCS, it was slightly increased by 1.7 ± 4.61, 2.0 ± 5.50, and 2.0 ± 5.36 at Weeks 2, 4, and 12 (all p<0.001), respectively. Subgroup analyses showed patients who were ex-smokers or with at least 3 metastatic sites were associated with symptoms improvement. Patients who were ex-smokers, with at least 3 metastatic sites, a PS of 1, or treated with gefitinib were associated with QOL improvement. Conclusions: In EGFR -mutated NSCLC patients who were treated with first-line EGFR-TKIs, these ex-smokers or with 3 or more metastatic sites were associated with improvements in symptoms and QOL.
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Affiliation(s)
- Yu-Feng Wei
- Division of Chest Department, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Wen-Tsung Huang
- Division of Hematology-Oncology, Department of Internal Medicine, Chi Mei Medical Center Liouying, Tainan, Taiwan
| | - Tu-Chen Liu
- Department of Chest Medicine, Cheng Ching Hospital-Chung Kang Branch, Taichung, Taiwan
| | - Jiunn-Min Shieh
- Department of Internal Medicine, Chi Mei Medical Center - YongKang Branch, Tainan, Taiwan
| | - Chih-Feng Chian
- Division of Pulmonary and Critical Care Medicine, Internal Medicine Department, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ming-Fang Wu
- Division of Medical Oncology, Department of Internal Medicine, Chung Shan Medical University Hospital, and School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chih-Cheng Chang
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei, Taiwan.,Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University
| | - Ching-Hsiung Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Jen-Chung Ko
- Department of Internal Medicine, National Taiwan University Hospital - Hsinchu Branch, Hsinchu, Taiwan
| | - Chia-Mo Lin
- Sleep Center, Pulmonary and Critical Care Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Te-Chun Hsia
- Department of Respiratory Therapy, China Medical University, Taichung, Taiwan.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan
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Martínez Ú, Brandon KO, Sutton SK, Brandon TH, Simmons VN. Does smoking abstinence predict cancer patients' quality of life over time? Psychooncology 2019; 28:1702-1711. [PMID: 31212391 DOI: 10.1002/pon.5145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/30/2019] [Accepted: 06/06/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Smoking cessation improves quality of life (QOL) in the general population. However, there is limited information on the role of smoking status on QOL among cancer patients. Moreover, previous studies tended to analyze smoking status dichotomously and at a single point in time, potentially reducing the strength of the relation between smoking cessation and QOL. This study examined the association of smoking abstinence and QOL over time, including depression, pain, and fatigue in patients with a wide variety of cancers. METHODS Participants were 332 cancer patients (eg, gynecologic, breast, thoracic, head and neck, and genitourinary) who had been abstinent for at least 24 hours. Days abstinent and QOL were assessed at baseline and 2, 6, and 12 months later. Latent growth curve models examined if days abstinent was associated with QOL at each assessment. Baseline demographics (eg, sex and income) and smoking history variables (eg, nicotine dependence) were used as time-invariant covariates. RESULTS The final model for each QOL component had good-to-excellent fit. More days abstinent was associated with lower depression at all follow-ups and with lower fatigue at 12 months but was not associated with pain. CONCLUSIONS QOL was better among patients who quit smoking for longer periods. Findings suggest different timelines, with smoking abstinence most immediately associated with lower depression, followed by lower fatigue. Although pain decreased over time, it was not associated with length of smoking abstinence. Results reinforce the relationship between sustained smoking cessation and QOL, which should be communicated to patients.
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Affiliation(s)
- Úrsula Martínez
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Karen O Brandon
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Steven K Sutton
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center, Tampa, Florida.,Department of Psychology, University of South Florida, Tampa, Florida.,Department of Oncologic Sciences, University of South Florida, Tampa, Florida
| | - Thomas H Brandon
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida.,Department of Psychology, University of South Florida, Tampa, Florida.,Department of Oncologic Sciences, University of South Florida, Tampa, Florida
| | - Vani N Simmons
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida.,Department of Psychology, University of South Florida, Tampa, Florida.,Department of Oncologic Sciences, University of South Florida, Tampa, Florida
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Dacosta-Noble P, Costantini A, Dumenil C, Dumoulin J, Helly de Tauriers P, Giraud V, Labrune S, Emile JF, Alvarez JC, Chinet T, Giroux Leprieur E. Positive plasma cotinine during platinum-based chemotherapy is associated with poor response rate in advanced non-small cell lung cancer patients. PLoS One 2019; 14:e0219080. [PMID: 31260495 PMCID: PMC6602197 DOI: 10.1371/journal.pone.0219080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/14/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Patients with advanced non-small cell lung cancer (NSCLC) are most of the time treated with a first-line cytotoxic chemotherapy. Tobacco use is responsible for 90% of lung cancer. The aim of this study was to evaluate the impact of smoking continuation during first-line chemotherapy on tumor response in advanced-stage NSCLC. MATERIALS AND METHODS All patients with an advanced-stage NSCLC (IIIb or IV), treated with first-line platinum-based chemotherapy in our Department between June 2013 and July 2017 were included. Smoking status was assessed at inclusion by self-report, then at the tumor assessment consultation after 2 months of treatment, by both self-report and plasmatic cotinine measurement. Chemotherapy response, progression-free survival (PFS), overall survival (OS) and stage 3-4 toxicity were registered. RESULTS Ninety-seven patients were included: 8 (8%) declared to be non-smokers, 56 (58%) current smokers and 33 (34%) former smokers at diagnosis. At the first tumor evaluation, 24 (25%) self-reported as active smokers and 73 (75%) as non-smokers; overall response rate (ORR) was respectively 38% and 48% (p = 0.373). Fifty-four patients had a plasmatic cotinine evaluation at the first tumor evaluation. Seventeen patients (32%) had a positive cotinine rate (median 108ng/mL, IQR 31-236). Six patients (35%) had positive cotinine rate whereas declaring to be non-smokers at the first tumor evaluation. ORR was 18% in case of positive cotinine rate, and 57% when negative (p = 0.007). Regardless of the method for smoking status evaluation, PFS, OS and grade 3-4 toxicities were similar between smoker and non-smoker patients at the first tumor evaluation. CONCLUSION Smoking continuation during platinum-based chemotherapy, reflected by positive plasma cotinine rate, was associated with a poor ORR.
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Affiliation(s)
- Philippine Dacosta-Noble
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Adrien Costantini
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Coraline Dumenil
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Jennifer Dumoulin
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Pierre Helly de Tauriers
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Violaine Giraud
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Sylvie Labrune
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Jean-François Emile
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
- Centre de Ressources Biologiques, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Jean-Claude Alvarez
- AP-HP, Hôpital Raymond Poincaré, Service de Pharmacologie Toxicologie, INSERM U-1173, UVSQ, Université Paris-Saclay, Garches, France
| | - Thierry Chinet
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
- * E-mail:
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Zeng L, Yu X, Yu T, Xiao J, Huang Y. Interventions for smoking cessation in people diagnosed with lung cancer. Cochrane Database Syst Rev 2019; 6:CD011751. [PMID: 31173336 PMCID: PMC6554694 DOI: 10.1002/14651858.cd011751.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Lung cancer is one of the most common causes of death from cancer worldwide. Smoking induces and aggravates many health problems, including vascular diseases, respiratory illnesses and cancers. Tobacco smoking constitutes the most important risk factor for lung cancer. Most people with lung cancer are still active smokers at diagnosis or frequently relapse after smoking cessation. Quitting smoking is the most effective way for smokers to reduce the risk of premature death and disability. People with lung cancer may benefit from stopping smoking. Whether smoking cessation interventions are effective for people with lung cancer and whether one method of quitting is more effective than any other has not been systematically reviewed. OBJECTIVES To determine the effectiveness of smoking cessation programmes for people with lung cancer. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (accessed via PubMed) and Embase up to 22 December 2018. We also searched the American Society of Clinical Oncology (ASCO) Annual Meeting proceedings, the lung cancer sections of the proceedings of the ESMO Congress, the lung cancer sections of the proceedings of the European Conference of Clinical Oncology (ECCO) Congress, the World Conference on Lung Cancer proceedings, the Society for Research on Nicotine and Tobacco Annual Meeting from 2013, the Food and Drug Administration website, the European Medicine Agency for drug registration website, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal, ClinicalTrials.gov, and the metaRegister of Controlled Trials (mRCT) to 30 December 2018. We applied no restriction on language of publication. SELECTION CRITERIA We planned to include any randomised controlled trial (RCT) of any psychosocial or pharmacological smoking cessation intervention or combinations of both, compared with no intervention, a different psychosocial or pharmacological (or both) intervention or placebo for pharmacological interventions in people with lung cancer. DATA COLLECTION AND ANALYSIS Two review authors independently screened the studies from the initial search for potential trials for inclusion. We planned to use standard methodological procedures expected by Cochrane. We found no trials that met the inclusion criteria. MAIN RESULTS We identified no RCTs that met our inclusion criteria. Among the 1817 records retrieved using our search strategy, we retrieved 19 studies for further investigation. We excluded 15 trials: ten trials because we could not distinguish people with lung cancer from the other participants, or the participants were not people with lung cancer, four because they were not randomised, or RCTs. We excluded one trial because, though it was completed in 2004, no results are available. We assessed four ongoing trials for inclusion when data become available. AUTHORS' CONCLUSIONS There were no RCTs that determined the effectiveness of any type of smoking cessation programme for people with lung cancer. There was insufficient evidence to determine whether smoking cessation interventions are effective for people with lung cancer and whether one programme is more effective than any other. People with lung cancer should be encouraged to quit smoking and offered smoking cessation interventions. However, due to the lack of RCTs, the efficacy of smoking cessation interventions for people with lung cancer cannot be evaluated and concluded. This systematic review identified a need for RCTs to explore these.
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Affiliation(s)
- Linmiao Zeng
- Mindong Hospital Affiliated to Fujian Medical UniversityDepartment of Respiratory MedicineNo. 89, He'shan RoadFu'an CityFujian ProvinceChina355000
| | - Xiaolian Yu
- Fujian Mindong Medical SchoolNo. 65 Mancun RoadFu'an CityFujianChina355017
| | - Tingting Yu
- Fujian Vocational College of BioengineeringDepartment of ManagementNo.42 Hongshan bridgeCangshan DistrictFuzhouChina350002
| | - Jianhong Xiao
- Mindong Hospital Affiliated to Fujian Medical UniversityDepartment of Respiratory MedicineNo. 89, He'shan RoadFu'an CityFujian ProvinceChina355000
| | - Yushan Huang
- Medical College of Jinggangshan UniversityNo 28, Xueyuan RoadJi An CityJianXi ProvinceChina343000
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Abdel-Rahman O. Impact of current versus former smoking status on the outcomes of non-metastatic non-small cell lung cancer treated with upfront surgery; findings from the National Lung Screening Trial. Expert Rev Respir Med 2019; 13:585-591. [PMID: 31055993 DOI: 10.1080/17476348.2019.1615887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To evaluate the impact of current versus former smoking status on the outcomes of non-metastatic non-small cell lung cancer (NSCLC) treated with upfront surgery. Methods: This is a post-hoc analysis of patients diagnosed with NSCLC, stage I-III within the National Lung Screening Trial (NLST). Kaplan-Meier analysis was used to delineate the impact of smoking status on overall survival. Moreover, Cox regression analyses were utilized to assess factors predicting overall and lung cancer-specific survival. Results: A total of 773 patients were included in the current study. Former smokers (at the time of randomization of the NLST study) were 338 patients while current smokers were 435 patients. For overall survival, former smokers have better outcomes compared to current smokers (P = 0.023). Within multivariate Cox regression analysis, the following factors were predictive of worse overall survival: older age (P = 0.037), male gender (P = 0.022), current smoking (P = 0.022), advanced stage (P < 0.001) and preexisting stroke (P = 0.015). Likewise, the following factors were predictive of worse lung cancer-specific survival in multivariate Cox regression analysis: current smoking (P = 0.009) and advanced stage (P < 0.001). Conclusions: Among patients with early-stage NSCLC treated with upfront surgery, current smokers have worse overall and lung cancer-specific survival compared to former smokers. Expert opinion: Among patients with non-metastatic NSCLC treated with upfront surgical resection, current smokers have worse overall, lung cancer-specific and progression-free survival compared to former smokers. Smoking cessation counseling should be incorporated into management strategies of early stage NSCLC.
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Affiliation(s)
- Omar Abdel-Rahman
- a Clinical Oncology Department, Faculty of Medicine , Ain Shams University , Cairo , Egypt.,b Department of Oncology , University of Calgary, Tom Baker Cancer Centre , Calgary , Alberta , Canada
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Abstract
Tobacco smoking accounts for at least 30% of all cancer deaths and nearly 90% of lung cancer deaths. Smoking cessation significantly reduces the risk of developing tobacco-related malignancies. Smoking after cancer diagnosis is also associated with multiple risks, including worse tolerance of treatment, higher risk of a failure and second primary tumors, and poorer quality of life. Apart from disease site and stage, continued smoking is considered the strongest adverse predictor of survival in cancer patients. However, the benefits of smoking cessation are undervalued: many patients are not aware of harms related to continued tobacco use after cancer diagnosis. Furthermore, health care professionals often do not encourage their patients to quit, and do not provide tobacco cessation assistance for continuing tobacco users. Despite the apparent impact of tobacco use on treatment outcomes, data on current smoking status is only rarely captured in clinical trials This article reviews the most important clinical aspects of smoking after the diagnosis of cancer.
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Affiliation(s)
- Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
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Giuliani ME, Liu G, Xu W, Dirlea M, Selby P, Papadakos J, Abdelmutti N, Yang D, Eng L, Goldstein DP, Jones JM. Implementation of a Novel Electronic Patient-Directed Smoking Cessation Platform for Cancer Patients: Interrupted Time Series Analysis. J Med Internet Res 2019; 21:e11735. [PMID: 30964445 PMCID: PMC6477574 DOI: 10.2196/11735] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/20/2018] [Accepted: 12/31/2018] [Indexed: 01/16/2023] Open
Abstract
Background Continued smoking in cancer patients undergoing treatment results in significantly higher rates of treatment toxicities and persistent effects, increased risk of recurrence and second malignancy, and increased all-cause mortality. Despite this, routine tobacco use screening and the provision of smoking cessation treatment has yet to be implemented widely in the cancer setting. Objective The objective of this study was to implement and evaluate the adoption and impact of an innovative Smoking Cessation e-referral System (CEASE) to promote referrals to smoking cessation programs in cancer patients. Methods A patient-directed electronic smoking cessation platform (CEASE) was developed to promote smoking screening and referral and implemented at 1 of Canada’s largest cancer centers. The implementation and evaluation were guided by the Ottawa Model of Research Use. An interrupted time series design was used to examine the impact of CEASE on screening rates, referrals offered, and referrals accepted compared with a previous paper-based screening program. A subsample of smokers or recent quitters was also assessed and compared pre- and postimplementation to examine the effect of CEASE on subsequent contact with smoking cessation programs and quit attempts. Results A total of 17,842 new patients attended clinics over the 20-month study period. The CEASE platform was successfully implemented across all disease sites. Screening rates increased from 44.28% (2366/5343) using the paper-based approach to 65.72% (3538/5383) using CEASE (P<.01), and referrals offered to smokers who indicated interest in quitting increased from 18.6% (58/311) to 98.8% (421/426; P<.01). Accepted referrals decreased from 41% (24/58) to 20.4% (86/421), though the overall proportion of referrals generated from total current/recent tobacco users willing to quit increased from 5.8% (24/414) to 20.2% (86/426) due to the increase in referrals offered. At 1-month postscreening, there was no significant difference in the proportion that was currently using tobacco and had not changed use in the past 4 weeks (pre: 28.9% [24/83] and post: 28.8% [83/288]). However, contact with the referral program increased from 0% to 78% in the postCEASE cohort (P<.001). Conclusions CEASE is an innovative tool to improve smoking screening and can be implemented in both a time- and cost-effective manner which promotes sustainability. CEASE was successfully implemented across all clinics and resulted in improvements in overall screening and referral rates and engagement with referral services.
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Affiliation(s)
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Wei Xu
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Peter Selby
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | | | - Dongyang Yang
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lawson Eng
- Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Yang P. Maximizing quality of life remains an ultimate goal in the era of precision medicine: exemplified by lung cancer. PRECISION CLINICAL MEDICINE 2019; 2:8-12. [PMID: 35694702 PMCID: PMC8985777 DOI: 10.1093/pcmedi/pbz001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 11/23/2022] Open
Abstract
An ultimate goal of precision medicine in lung cancer treatment is to restore patient health with maximized quality of life (QOL). Results from Mayo Clinic studies show that a significant improvement in fatigue, dyspnea, and pain scales could lead to better overall QOL. Although treatments and guidelines for clinical implementation to alleviate these key symptoms are available, few cancer patients receive adequate therapy, mostly because of limitations in current care delivery systems and unclear clinicians’ roles. For optimal care of lung cancer survivors in different subpopulations, three barriers must be overcome: physicians’ lack of knowledge, unwarranted practice variation, and uncertainty regarding care provider roles. Appropriate culturally adapted, tested and validated tools for QOL measures must be developed, rather than directly translating existing tools between different languages and across cultures or diverse subpopulations. Finally, lack of sensitive, adequate, and relevant tools in measuring health-related QOL (HRQOL) has long been an issue for effective data collection, demanding a global consensus on a set of core components that reflect the needs of all critical parties for the best cure and care, supporting patients to achieve optimal HRQOL.
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Affiliation(s)
- Ping Yang
- Mayo Clinic College of Medicine and Science, Mayo Clinic Arizona, 13400 E. Shea Boulevard, Scottsdale, AZ, USA
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45
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Stokes SM, Wakeam E, Antonoff MB, Backhus LM, Meguid RA, Odell D, Varghese TK. Optimizing health before elective thoracic surgery: systematic review of modifiable risk factors and opportunities for health services research. J Thorac Dis 2019; 11:S537-S554. [PMID: 31032072 PMCID: PMC6465421 DOI: 10.21037/jtd.2019.01.06] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 12/31/2018] [Indexed: 12/20/2022]
Abstract
Despite progress in many different domains of surgical care, we are still striving toward practices which will consistently lead to the best care for an increasingly complex surgical population. Thoracic surgical patients, as a group, have multiple medical co-morbidities and are at increased risk for developing complications after surgical intervention. Our healthcare systems have been focused on treating complications as they occur in the hopes of minimizing their impact, as well as aiding in recovery. In recent years there has emerged a body of evidence outlining opportunities to optimize patients and likely prevent or decrease the impact of many complications. The purpose of this review article is to summarize four major domains-optimal pain control, nutritional status, functional fitness, and smoking cessation-all of which can have a substantial impact on the thoracic surgical patient's course in the hospital-as well as to describe opportunities for improvement, and areas for future research efforts.
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Affiliation(s)
- Sean M. Stokes
- Division of General Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Elliot Wakeam
- Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Mara B. Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson, Cancer Center, Houston, TX, USA
| | - Leah M. Backhus
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Robert A. Meguid
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, CO, USA
| | - David Odell
- Division of Thoracic Surgery, Department of Surgery, Northwestern University, Chicago, IL, USA
| | - Thomas K. Varghese
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
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Cooley ME, Poghosyan H, Sprunck-Harrild K, Winickoff JP, Edge SB, Emmons KM. Tobacco treatment implementation within 28 commission on cancer accredited programs in the Northeast region of the USA: A pilot study. Transl Behav Med 2019. [PMID: 29528457 DOI: 10.1093/tbm/ibx024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cancer survivors are a rapidly growing population and an important target for tobacco treatment interventions. Continued smoking after the diagnosis of cancer is associated with a higher risk of cancer recurrence and mortality. Systematic tobacco cessation programs are effective. This study surveyed American College of Surgeons Commission on Cancer (CoC) programs in the Northeast region of the USA regarding their tobacco control programs. Seventy percent of cancer survivors are treated within CoC programs. The purpose of this study was to describe the extent of implementation of tobacco treatment and determine the organizational delivery of tobacco treatment as measured by the presence of goals to address smoking, leadership support, and integration of tobacco treatment guidelines into care delivery. Data were collected by a survey. The Assessment of Chronic Illness Care questionnaire was used to collect data on implementation of tobacco treatment services. Descriptive statistics were used to analyze the data. Most programs (78.6%) had an electronic health record and of these 68% captured smoking status. Implementation of tobacco treatment was not optimal for identifying smokers, providing patients with community linkages or self-care cessation support. Implementation of decision aides for pharmacotherapy and reassessment of smoking status were the least developed areas. Moreover, the organizational delivery for tobacco treatment was less than optimal. Many cancer programs have not implemented systems to deliver optimal tobacco treatment. Efforts should be made to help cancer programs develop sustainable system-wide programs that address the urgent need to deliver tobacco treatment to all cancer survivors.
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Affiliation(s)
| | | | | | | | - Stephen B Edge
- American College of Surgeons Commission on Cancer, Chicago, IL, USA.,Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Karen M Emmons
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Pollak KI, Fish LJ, Sutton LM, Gao X, Lyna P, Owen L, Patel ML, Somers TJ. A smoking cessation and pain management program for cancer survivors. J Cancer Surviv 2018; 12:821-827. [PMID: 30328056 DOI: 10.1007/s11764-018-0719-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/24/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Many cancer survivors continue to smoke. Further, most survivors also report high levels of persistent pain and smoke in response to pain. The investigators tested the feasibility, acceptability, and preliminary efficacy of a smoking cessation program paired with a pain management program for cancer survivors. METHODS The investigators conducted a two-arm, wait-list randomized controlled pilot study in which they delivered a combined smoking cessation and pain management intervention. RESULTS The investigators randomized 30 survivors (14 intervention and 16 wait-list control). Seventy-one percent of the survivors who received the intervention rated it as extremely useful (5 out of 5) in helping them quit smoking. Further, 86% would recommend the program to other survivors. Although we could not conduct inferential statistics, 14% of those in the intervention arm, compared to 6% in the control condition had biochemically validated cessation at 2-months post-randomization. Survivors in the intervention also reported less pain, had improvements in depressive symptoms, and better physical function than those in the control arm. CONCLUSIONS Our pilot data suggest the feasibility, acceptability, and preliminary efficacy of this approach. The next step is to conduct a large randomized controlled trial to fully test the efficacy of the intervention. IMPLICATIONS FOR CANCER SURVIVORS A combined smoking cessation and pain program might help improve both issues simultaneously.
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Affiliation(s)
- Kathryn I Pollak
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, USA. .,Department of Population Health Sciences, Duke School of Medicine, 2424 Erwin Road, Suite 602, Durham, NC, 27705, USA.
| | - Laura J Fish
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, USA.,Department of Medicine, Duke School of Medicine, Durham, NC, USA
| | - Linda M Sutton
- Duke Cancer Network, Duke Cancer Institute, Durham, NC, USA.,Department of Psychology and Neuroscience, Duke School of Medicine, Durham, NC, USA
| | - Xiaomei Gao
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, USA
| | - Pauline Lyna
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, USA
| | - Lynda Owen
- Duke Cancer Network, Duke Cancer Institute, Durham, NC, USA
| | - Michele L Patel
- Department of Psychiatry and Behavioral Sciences, Duke School of Medicine, Durham, NC, USA
| | - Tamara J Somers
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, USA.,Faculty Practice in Psychiatry Erwin Square, Duke School of Medicine, 2200 W. Main Street Suite 340, Durham, NC, 27705, USA
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Christensen NL, Løkke A, Dalton SO, Christensen J, Rasmussen TR. Smoking, alcohol, and nutritional status in relation to one-year mortality in Danish stage I lung cancer patients. Lung Cancer 2018; 124:40-44. [DOI: 10.1016/j.lungcan.2018.07.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/19/2018] [Accepted: 07/19/2018] [Indexed: 01/01/2023]
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Dimunová L, Dankulincová Veselská Z, Raková J, Bednarek A. Relationship between quality of life of lung cancer patients and smoking. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2018. [DOI: 10.15452/cejnm.2018.09.0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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50
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Williamson TJ, Choi AK, Kim JC, Garon EB, Shapiro JR, Irwin MR, Goldman JW, Bornyazan K, Carroll JM, Stanton AL. A Longitudinal Investigation of Internalized Stigma, Constrained Disclosure, and Quality of Life Across 12 Weeks in Lung Cancer Patients on Active Oncologic Treatment. J Thorac Oncol 2018; 13:1284-1293. [PMID: 29981926 PMCID: PMC6291203 DOI: 10.1016/j.jtho.2018.06.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/19/2018] [Accepted: 06/27/2018] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Internalized lung cancer stigma (i.e., feelings of regret, shame, and self-blame about one's lung cancer) is related to poorer psychological outcomes. Less is known about how internalized stigma relates to physical and functional outcomes or how constrained disclosure (i.e., avoidance of or discomfort about disclosing one's lung cancer status to others) relates to well-being. Furthermore, no study has examined whether internalized stigma and constrained disclosure predict changes in well-being for lung cancer patients. This longitudinal study characterized relationships of internalized stigma and constrained disclosure with emotional and physical/functional outcomes. METHODS Participants (N = 101, 52.4% male, 63.4% currently/formerly smoked) were lung cancer patients on active medical treatment who completed questionnaires on stigma and well-being at study entry and at 6- and 12-week follow-up. Multivariable linear regressions characterized relationships of internalized stigma and constrained disclosure with emotional and physical/functional well-being at study entry and across time. RESULTS Participants who currently or formerly smoked reported higher levels of internalized stigma (but not constrained disclosure), compared to never smokers (p < 0.001). Higher internalized stigma and constrained disclosure were uniquely associated with poorer emotional and physical/functional well-being at study entry (all p < 0.05), beyond sociodemographic characteristics, time elapsed since diagnosis, and smoking status. Higher internalized stigma predicted significant declines in emotional well-being across 6 and 12 weeks (all p < 0.01) and declines in physical/functional well-being across 6 weeks (p < 0.05). CONCLUSIONS Internalized lung cancer stigma and constrained disclosure relate to emotional and physical/functional maladjustment. Findings carry implications for provider- and patient-focused interventions to reduce internalized stigma and promote well-being.
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Affiliation(s)
- Timothy J Williamson
- Department of Psychology, University of California-Los Angeles, Los Angeles, California
| | - Alyssa K Choi
- Department of Psychology, University of California-Los Angeles, Los Angeles, California
| | - Julie C Kim
- Department of Psychology, University of California-Los Angeles, Los Angeles, California
| | - Edward B Garon
- Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, California
| | - Jenessa R Shapiro
- Department of Psychology, University of California-Los Angeles, Los Angeles, California; Anderson School of Management, University of California-Los Angeles, Los Angeles, California
| | - Michael R Irwin
- Department of Psychology, University of California-Los Angeles, Los Angeles, California; Department of Psychiatry/Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, California; Cousins Center for Psychoneuroimmunology, University of California-Los Angeles, Los Angeles, California
| | - Jonathan W Goldman
- Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, California
| | - Krikor Bornyazan
- Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
| | - James M Carroll
- Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
| | - Annette L Stanton
- Department of Psychology, University of California-Los Angeles, Los Angeles, California; Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, California; Department of Psychiatry/Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, California; Cousins Center for Psychoneuroimmunology, University of California-Los Angeles, Los Angeles, California.
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