Smoking cessation interventions in cancer care: opportunities for oncology nurses and nurse scientists

Tobacco Cessation Interventions in Non-Respiratory Cancers: A Systematic Review With Meta-analysis of Randomized Controlled Trials

BACKGROUND

Considering the high rates of persistent tobacco use, effective cessation interventions are needed for cancer patients and caregivers. Despite the need, there is a significant lack of research on tobacco cessation, especially for non-respiratory cancers (breast, prostate, colorectal, cervical, and bladder cancer).

PURPOSE

The objective was to evaluate tobacco use and tobacco cessation interventions among patients and caregivers for non-respiratory cancers.

METHODS

Randomized controlled trials assessing tobacco cessation interventions were identified. Five electronic databases were searched in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines through July 2023. Studies exclusive to lung, oral, thoracic, and head and neck cancers were excluded. Effect sizes were estimated; risk of bias was assessed.

RESULTS

Of 3,304 studies, 17 were included. Interventions included behavioral (n = 6), pharmacotherapy (n = 2), and a combination (n = 9) treatment. Eight studies included a health behavior model; mean behavioral change techniques were 5.57. Pooled magnitude of the odds of cessation was positive and significant (odds ratio = 1.24, 95% confidence interval [Lower Limit 1.02, Upper Limit 1.51]) relative to usual care/placebo. Cumulative meta-analysis examined the accumulation of results over-time and demonstrated that studies have been significant since 2020. Two studies included caregivers' who were involved in the provision of social support.

CONCLUSIONS

Current interventions have the potential to reduce tobacco use in non-respiratory cancers. Results may be beneficial for promoting tobacco cessation among non-respiratory cancers. There is a considerable lack of dyadic interventions for cancer survivors and caregivers; researchers are encouraged to explore dyadic approaches.

Smoking patterns and the intention to quit in German cancer patients: a cross-sectional study

BACKGROUND

Continued smoking after a cancer diagnosis can be associated with lower treatment tolerance, poorer outcomes, and reduced quality of life compared to non-smoking cancer patients or to those who have quit. Yet about 60% of patients continue to smoke after being diagnosed and find it difficult to quit. To address this problem, it is necessary to identify current and past smoking patterns (e.g., frequency of use, types of tobacco products) and determine whether there is motivation to quit. Similarly, factors associated with continued smoking should be identified. These data will provide the basis for the development of smoking cessation programs tailored to the needs of cancer patients.

METHODS

A questionnaire was distributed to cancer patients older than 18 years in a German Comprehensive Cancer Center. Participating cancer patients were divided into three main groups: 1) patients who stopped smoking before being diagnosed with cancer (Ex-before); 2) patients who stopped smoking after a cancer diagnosis (Ex-after); and 3) patients who currently smoke cigarettes (CS). Sociodemographic, medical, and psychosocial data were collected, as well as smoking patterns and the motivation to quit smoking.

RESULTS

About half of patients (51%) who smoked before diagnosis continue to smoke after a cancer diagnosis. Being diagnosed with a tobacco-related cancer type was associated with a decreased probability of continued smoking. Patients with tobacco-related tumors and receiving positive support in burdensome situations were more likely to have a higher cigarette dependence. Of all CS, 59.1% had intention to quit, and 22.7% reported having taken action to quit. The support by a smoking cessation program was considered important. CS were willing to spend up to €100 for support and were open to multiple sessions per week, group sessions, one-on-one sessions and/or online support.

CONCLUSION

These findings underscore the importance of educating cancer patients about the consequences of smoking and to provide them with support to quit. Identified risk factors may further help to recognize cancer patients with high risk of continued smoking after diagnosis.

TRIAL REGISTRATION

The study was registered at OSF ( https://osf.io/3c9km ) and published as a study protocol at " https://bmjopen.bmj.com/content/13/4/e069570 ".

Smoking cessation interventions in patients diagnosed with head and neck cancers: A systematic review of randomized controlled trials

Objective

According to findings from the previous studies, quitting smoking can significantly reduce mortality from all causes and is linked to better treatment results. Even though quitting smoking has many benefits, little is known about the evidence supporting the particular quit services offered to smokers after a cancer diagnosis.

Methods

To find the articles related to area in question, different electronic databases including PubMed/Medline, Google Scholar, and EBSCO were searched on April 1st, 2023. All full text randomized controlled trials with one or more intervention and control groups that assessed the outcomes of smoking cessation interventions were included. Participants of included studies were adults diagnosed with head and neck cancer (HNC) and current smokers or those who had recently quit. There were interventions (pharmacological and/or pharmacological) that aimed to help patients with HNC succeed in quitting smoking.

Results

We identified 15352 papers from the initial search from different electronic databases, 2560 remained after excluding duplicates. After screening titles and abstracts for relevance, 2345 articles were removed. Full text articles of remaining 215 papers were assessed in depth by two reviewers for their eligibility, amongst which, 210 articles were excluded. Finally, we included five papers that met the inclusion criteria in the present systematic review.

Conclusion

According to the findings of this review, a multi - component strategy might very well benefit patients with HNC who smoke cigarettes after diagnosis. More studies with high methodological quality and standardized outcome measures must be conducted in this population to inform the development of smoking cessation program.

Development and Demonstration of Tobacco Treatment Measures for Cancer Registries: Novel Metrics for Quality Improvement

BACKGROUND

Individuals undergoing cancer treatment have better outcomes when they discontinue tobacco use. Few cancer centers systematically provide evidence-based cessation services. As part of a national quality improvement initiative [Cancer Center Cessation Initiative (C3i)], we collaborated with our cancer registry to develop and implement two tobacco treatment metrics for tracking the provision of behavioral support and pharmacotherapy.

METHODS

Post-development, the tobacco treatment metrics were integrated into the registry for all future patients. We used means and frequencies to summarize tobacco treatment for cases treated between 2017 and 2019, coinciding with the timeframe of C3i participation.

RESULTS

Of 17,735 cancer cases reviewed, both measures were captured on 17,654 (99.5%) of patients, with 3,091 (17.4%) identified as users of tobacco. Across the 3 years, 557 (18%) of individuals who used tobacco received either tobacco cessation pharmacotherapy or behavioral support; with 478 (15.5%) receiving behavioral counseling, 352 (11.4%) receiving pharmacotherapy, and 273 (8.8%) receiving both-considered gold standard care. Tobacco treatment varied substantially across cancer types. The odds of receiving gold standard care were 2.37 times greater in 2019 compared with 2017. (OR, 2.37; 95% confidence interval, 1.63-3.46; P < 0.0001).

CONCLUSIONS

The new metrics demonstrated high completion rates and their potential to track quality improvement efforts over time. They identified suboptimal treatment reach, but a potential increase in treatment over time and greater treatment among tobacco-related versus nontobacco-related cancers.

IMPACT

Continued tobacco use worsens cancer care outcomes. Integrating measures into cancer registries is a viable option for tracking tobacco treatment and cessation in the context of cancer care.

Smoking patterns and the intention to quit in German patients with cancer: study protocol for a cross-sectional observational study

INTRODUCTION

Patients who continue to smoke cigarettes after a cancer diagnosis can experience poorer treatment tolerance and outcomes than those who quit immediately. Identifying risk factors specific to patients with cancer who smoke, as well as their smoking behaviours (eg, frequency of use, types of tobacco products), dependency level and quit intentions, is necessary to better inform patients and encourage quitting smoking after a cancer diagnosis. This study aims to examine the occurrence of smoking in patients with cancer treated at specialised oncology departments and outpatient clinics based within the metropolitan region of Hamburg, Germany, and presents an analysis of their smoking patterns. This understanding is the first step in developing an adequate smoking cessation intervention and shall contribute to a sustainable improvement in the treatment results, long-term survival and quality of life of patients with cancer.

METHODS AND ANALYSIS

A questionnaire will be administered to patients with cancer (N=865) aged 18 years and above in the catchment area of Hamburg, Germany. Data acquisition includes sociodemographic, medical and psychosocial data as well as information on current smoking patterns. To identify the associations between smoking patterns and sociodemographic characteristics, disease-related variables, and psychological risk factors, descriptive statistics and multiple logistic as well as multinomial regressions will be performed.

ETHICS AND DISSEMINATION

This study was registered at Open Science Framework (https://doi.org/10.17605/OSF.IO/PGBY8). It was approved by the ethics committee of the local psychological Ethic committee at the centre of psychosocial medicine Hamburg, Germany (LPEK) (tracking number: LPEK-0212). The study will be carried out in accordance with the Code of Ethics of the Declaration of Helsinki. The results will be published in peer-reviewed scientific journals.

Development and Design of E_MOTIV: A Theory-Based Adaptive E-Learning Program to Support Nurses' Provision of Brief Behavior Change Counseling

Brief counseling, when provided by adequately trained nurses, can motivate and support patient health behavior change. However, numerous barriers can impede nurses' capability and motivation to provide brief counseling. Theory-based interventions, as well as information and communication technologies, can support evidence-based practice by addressing these barriers. The purpose of this study was to document the development process of the E_MOTIV asynchronous, theory-based, adaptive e-learning program aimed at supporting nurses' provision of brief counseling for smoking cessation, healthy eating, and medication adherence. Development followed French's stepwise theory- and evidence-based approach: (1) identifying who needs to do what, differently, that is, provision of brief counseling in acute care settings by nurses; (2) identifying determinants of the provision of brief counseling; (3) identifying which intervention components and mode(s) of delivery could address determinants; and (4) developing and evaluating the program. The resulting E_MOTIV program, guided by the Theory of Planned Behavior, Cognitive Load Theory, and the concept of engagement, is unique in its adaptive functionality-personalizing program content and sequence to each learners' beliefs, motivation, and learning preferences. E_MOTIV is one of the first adaptive e-learning programs developed to support nurses' practice, and this study offers key insights for future work in the field.

Cocreation of a conversational agent to help patients adhere to their varenicline treatment: A study protocol

Objective

Varenicline is the most efficacious approved smoking cessation medication, making it one of the most cost-effective clinical interventions for reducing tobacco-related morbidity and mortality. Adhering to varenicline is strongly associated with smoking cessation. Healthbots have the potential to help people adhere to their medications by scaling up evidence-based behavioral interventions. In this protocol, we outline how we will follow the UK's Medical Research Council's guidance to codesign a theory-informed, evidence-based, and patient-centered healthbot to help people adhere to varenicline.

Methods

The study will utilize the Discover, Design and Build, and Test framework and will include three phases: (a) a rapid review and interviews with 20 patients and 20 healthcare providers to understand barriers and facilitators to varenicline adherence (Discover phase); (b) Wizard of Oz test to design the healthbot and get a sense of the questions that chatbot has to be able to answer (Design phase); and (c) building, training, and beta-testing the healthbot (Building and Testing phases) where the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability framework will be used to develop the healthbot using the simplest sensible solution, and 20 participants will beta test the healthbot. We will use the Capability, Opportunity, Motivation-Behavior (COM-B) model of behavior change and its associated framework, the Theoretical Domains Framework, to organize the findings.

Conclusions

The present approach will enable us to systematically identify the most appropriate features for the healthbot based on a well-established behavioral theory, the latest scientific evidence, and end users' and healthcare providers' knowledge.

Demographic and Clinical Predictors of Engaging in Tobacco Cessation Counseling at a Comprehensive Cancer Center

PURPOSE

To address challenges promoting tobacco cessation in oncology settings, it is important to understand characteristics associated with patient engagement in tobacco cessation treatment. This analysis examined predictors of participating in at least one tobacco cessation counseling session among patients referred to a comprehensive cancer center's Tobacco Intervention and Psychosocial Support (TIPS) service.

METHODS

Patients with cancer who reported current smoking or recently quitting and referred to TIPS between June 2017 and February 2020 were included in the analysis. Independent variables included sex, race and ethnicity, insurance type, cancer diagnosis (tobacco-related or not), age, nicotine dependence, and cigarettes smoked per day at baseline. The outcome variable was completion of at least one tobacco cessation counseling session among those assessed by the TIPS program. Unadjusted and adjusted analyses tested associations between the independent variables and tobacco cessation counseling engagement.

RESULTS

Of 360 oncology patients referred to the TIPS program, 224 (62.2%) were assessed and 120 (33%) engaged in at least one counseling session. After controlling for sociodemographics and tobacco use, the results demonstrated that patients diagnosed with tobacco-related cancers were 45.3% less likely to engage in the tobacco cessation program compared with those with non-tobacco-related cancers (P = .041).

CONCLUSION

Patients diagnosed with tobacco-related cancers were less likely to engage in TIPS. Additional therapeutic resources may be needed to engage these patients to address potential explanatory factors, such as stigma, guilt, and fatalism. More research is needed to explore the impact of a tobacco-related cancer diagnosis on treatment engagement.

Healthcare professionals' perceptions of risky health behaviours: A qualitative evaluation of preventative measures for populations with cystic fibrosis

OBJECTIVES

Previous qualitative data highlight why individuals with Cystic Fibrosis may be motivated to initiate in risky behaviours (smoking, excessive alcohol consumption and illicit drug use). To inform interventions aimed to reduce the occurrence of risky behaviours, we investigated how Cystic Fibrosis health care professionals perceive the issue of risky behaviours, providing insight into what interventions could work in practice.

METHODS

This research had two phases of data collection. In phase one, nine Cystic Fibrosis Specialist Nurses participated in a semi-structured interview via telephone. In phase two, health care professionals, who work within a Cystic Fibrosis multi-disciplinary team, participated in a dissemination meeting.

RESULTS

Cystic Fibrosis health care professionals identified that although risky behaviours were a major concern within the Cystic Fibrosis population, education regarding the adverse health effects of such behaviours is not embedded within practice, with the issue of risky behaviours being addressed on an individualised basis. Health care professionals suggested that they would welcome interventions, and that such interventions first need to raise health care professionals awareness and knowledge regarding risky behaviours before focusing upon patients.

DISCUSSION

Within this research, health care professionals provided practical insight into the need for policy change for the prevention and reduction of risky behaviours by informing current advice and practice.

Delivering Opportunistic Behavior Change Interventions: a Systematic Review of Systematic Reviews

Opportunities for healthcare professionals to deliver health behavior change interventions are often missed, but understanding the barriers and enablers to this activity is limited by a focus on defined specialisms/health conditions. This systematic review of systematic reviews collates all the evidence across professional groups to provide guidance to policy makers for implementing healthcare professional delivery of behavior change interventions. Eight electronic databases were searched for systematic reviews reporting patient-facing healthcare professionals’ (e.g., general practitioners, nurses) barriers and enablers to delivering behavior change interventions (diet, physical activity, alcohol reduction, smoking cessation, and weight management). A narrative synthesis was conducted. Thirty-six systematic reviews were included. Four themes emerged as both barriers and enablers: (1) perceptions of the knowledge or skills needed to support behavior change with patients, (2) perceptions of the healthcare professional role, (3) beliefs about resources and support needed, and (4) healthcare professionals’ own health behavior. There were four cross-disciplinary barriers: (1) perceived lack of time, (2) perceived lack of prioritization of health behavior change, (3) negative attitudes towards patients and perceptions of patient risk, and (4) perceptions of patient motivation. The three enablers were as follows: (1) training, (2) context, and (3) attitudes towards delivering interventions. To enhance healthcare professionals’ delivery of behavior change interventions, policy makers should (a) address perceptions about patient need for interventions, (b) support diverse professional groups to identify opportunities to deliver interventions, and (c) encourage professionals to focus on prevention and management of health conditions.

Smoking Assessment and Current Smoking Status Among Adolescents in Primary Care Settings

INTRODUCTION

Initiating tobacco use in adolescence increases the risk of nicotine dependence and continued use into adulthood. Primary care visits provide opportunities for the assessment and treatment of tobacco use; however, little is known about prevalence and correlates of assessing smoking status and current use among adolescents in these settings.

AIMS AND METHODS

Using electronic health record data from the OCHIN network, we identified adolescents with greater than or equal to one primary care visit to a study clinic (n = 366 clinics from 15 US states) during January 1, 2016 to December 31, 2017. We estimated odds ratios of smoking assessment and current smoking status by patient covariates.

RESULTS

Of 140 887 patients, 87.4% were assessed for smoking. Being Latino or Black (adjusted odds ratio = 1.22, 95% confidence interval: 1.13-1.32; adjusted odds ratio = 1.17, 95% confidence interval: 1.07-1.29, respectively, vs. non-Hispanic White), publicly insured, having more visits, and having an asthma diagnosis or other respiratory symptoms were associated with higher odds of assessment. Odds were lower if the patient was male and uninsured. Of those assessed, 1.6% identified as current smokers. Being older, having more visits, an asthma diagnosis, other respiratory symptoms, and lower household income was associated with higher odds of being a current smoker. Latinos and Blacks had lower odds than non-Hispanic Whites.

CONCLUSIONS

Although some commonly reported tobacco-related disparities were not present, smoking assessment and current smoking status differed significantly by most patient demographics. Implementation of adolescent tobacco assessment protocols and the development of interventions to target subpopulations of adolescents with higher rates of smoking could mitigate disparate rates of assessment and smoking, respectively.

IMPLICATIONS

Clinical guidelines recommend screening adolescents for tobacco use in primary care settings. We found that most adolescents seen in US safety-net primary care clinics were assessed for smoking. We also found that smoking assessment and current smoking status differed significantly by most patient demographics. Implementing tobacco assessment protocols specific to adolescents could mitigate disparate rates of assessment and ensure accurate documentation of all forms of tobacco use, given the evolution of alternative tobacco products and poly use among adolescents. Interventions to target subpopulations of adolescents with higher smoking rates are needed to prevent the negative health effects of continued smoking.

Change in Health-Related Quality of Life Among Individuals With Cancer Undergoing Smoking Cessation Treatment Involving Varenicline

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.

Negative affect and the utilization of tobacco treatment among adult smokers with cancer

OBJECTIVE

We investigated the patterns of tobacco treatment utilization among US adult smokers with cancer and the role of negative affect as potential individual-level psychosocial barriers and facilitators influencing quit attempts and tobacco treatment utilization.

METHODS

We analyzed data from the adult sample in Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) Study. Using structural equation modeling, we examined (1) the association between cancer diagnosis and negative affect (e.g., depressive mood, anxiety, and distress) and (2) the associations between negative affect and smoking cessation behaviors (i.e., quit attempts and tobacco treatment utilization).

RESULTS

Compared to adults without cancer, cancer survivors were more likely to have attempted to quit tobacco use in the past 12 months (p < 0.05) and experienced increased negative affect (p < 0.01). However, negative affect appeared to be a psychological barrier to quit attempts, as it was associated with lower likelihood of attempting to quit (p < 0.05). On the other hand, among past-12-month quit attempters, negative affect was related to higher likelihood of using any type of tobacco treatment (p < 0.001).

CONCLUSIONS

Negative affect may be a potential underlying mechanism in the relationship between cancer diagnosis status and quit attempts and tobacco treatment utilization, influencing the utilization of tobacco treatment among smokers with cancer. Research is needed to investigate whether integrating emotional management in the oncology setting may effectively aid smoking cessation among patients with cancer.

Investigating the Smoking Cessation Informational Needs of Cancer Patients and Informal Caregivers

Continued smoking at the time of a cancer diagnosis can severely impact the efficacy of cancer patient treatment and survival. The time of diagnosis can serve as a "teachable moment" for smoking cessation education, since patients may be receptive to discussions about quitting. Caregivers may have a pivotal role in supporting patients with their cessation efforts. The purpose of this study was to identify the smoking cessation informational needs of cancer patients and their caregivers. A needs assessment survey was administered to both patients and caregivers that assessed information needs across five domains: (1) General Information and Support; (2) Smoking, Health and Disease; (3) Relationships; (4) Testimonials; (5) Interventions. Mean importance scores were determined based on the proportion of respondents who ranked how important individual items were within the broader domains. Forty patients and twenty-two caregivers completed the survey. Among patients, the mean age was 61 years, with 35% diagnosed with a head and neck malignancy and 62% reporting as current smokers. Among caregivers, the mean age was 58 years, with 81% reporting to be the patient's immediate family member and 50% as current smokers. The General Information and Support domain was rated as the most important domain for both cancer patients and caregivers. The top preferred modality for receiving smoking cessation education across all domains was pamphlets for both groups. This study identifies the key informational elements that should be considered in the development of smoking cessation resources to meet the informational needs of cancer patients and caregivers.

Can Cancer Diagnosis Help in Quitting Tobacco? Barriers and Enablers to Tobacco Cessation Among Head and Neck Cancer Patients from a Tertiary Cancer Center in South india

BACKGROUND

Tobacco use contributes to almost 40% of the cancers in India. Considering the potential threat, many preventive measures have been instigated in the country. However, tobacco cessation for hospitalized cancer patients is an unexplored territory in India. This study aims to understand the quit status and to explore the reasons to quit or continue the use of tobacco after the diagnosis of head and neck cancer (HNC).

METHODS

HNC patients admitted between February and April 2016 were assessed for their tobacco use status. A DT was used to assess the psychological distress. Users were assessed for their readiness to quit and dependence on tobacco. An in-depth interview was conducted among 25 patients (seven current users and 18 recent quitters), and themes that emerged were discussed.

RESULTS

Of the 119 HNC patients, 71 were tobacco users and 48 had quit tobacco after the diagnosis. The reasons to quit were the perceived benefits of quitting, advice from the physicians, and awareness about cancer and its association with tobacco. In contrast, the reasons to continue the use of tobacco were attributed to coping mechanisms, nihilistic perception about the outcome of the cancer, and a lack of understanding about cancer and its association with tobacco.

CONCLUSION

The recent quitters comprehended the benefits of quitting and were able to prioritize their needs after the diagnosis. However, one-third of the HNC patients continued to use tobacco even after the diagnosis of cancer. Hence, tobacco cessation services need to be integrated into oncology services for achieving better treatment outcomes.

Positive plasma cotinine during platinum-based chemotherapy is associated with poor response rate in advanced non-small cell lung cancer patients

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.

Tobacco treatment implementation within 28 commission on cancer accredited programs in the Northeast region of the USA: A pilot study

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.

Dual cigarette and e-cigarette use in cancer survivors: an analysis using Population Assessment of Tobacco Health (PATH) data

PURPOSE

Cancer survivors who smoke cigarettes face health risks from continued smoking. Some smokers use e-cigarettes to reduce combustible cigarette use, but research on whether cancer survivors do the same is limited. Research is needed to understand whether smokers who are cancer survivors use e-cigarettes at higher rates than smokers never diagnosed with cancer, to inform provider-patient discussions about e-cigarettes.

METHODS

Using cross-sectional data from current cigarette smokers in Wave 1 (2013-2014) of the Population Assessment of Tobacco Health (PATH) study, we compared cancer survivors (n = 433) and those without a prior cancer diagnosis (n = 10,872) on e-cigarette use and reasons for use.

RESULTS

Among smokers, 59.4% of cancer survivors and 63.2% of those without a cancer diagnosis had ever used e-cigarettes, and nearly one-quarter of both groups (23.1% and 22.3%, respectively) reported being current users. Multivariate results, however, suggest that cancer survivors might be more likely to be ever (OR = 1.28; p = .05) or current (OR = 1.25; p = .06) e-cigarette users compared to those never diagnosed, although results were marginally significant. The majority of both groups (> 71%) reported using e-cigarettes for perceived health-related reasons-including smoking reduction.

CONCLUSIONS

Our study found that among smokers, cancer survivors were using e-cigarettes at similar rates as never-diagnosed smokers and both groups used e-cigarettes largely for perceived health-related reasons.

IMPLICATIONS FOR CANCER SURVIVORS

Clinicians who treat cancer survivors may need to routinely ask their patients who smoke about e-cigarette use and address the limited research on the efficacy of e-cigarettes as a cessation aid as compared to other evidence-based options.

Systematic review evaluating randomized controlled trials of smoking and alcohol cessation interventions in people with head and neck cancer and oral dysplasia

BACKGROUND

Smoking and alcohol increase the risk of head and neck cancer and affect treatment outcomes. Interventions modifying these behaviors may improve posttreatment outcomes and survival. We systematically reviewed evidence of the effectiveness of smoking/alcohol interventions in head and neck cancer and oral dysplasia.

METHODS

The AMED, CINAHL, Embase, MEDLINE, and Web of Science databases were searched for randomized controlled trials (RCTs) of smoking/alcohol interventions in people with head and neck cancer. A qualitative synthesis of the studies was conducted.

RESULTS

Three RCTs were identified: 2 smoking interventions and 1 smoking and alcohol intervention. One intervention, which was comprised of a smoking intervention based on Cognitive Behavioral Therapy and pharmacologic management compared to usual care, reduced smoking prevalence.

CONCLUSION

Further research is required into the underlying mechanisms that lead to cessation and interventions that include both pharmacological and behavioral therapy. Future RCTs should include suitable control conditions and sufficient power to assess clinical outcomes.

Perceptions of Continued Smoking and Smoking Cessation Among Patients With Cancer

PURPOSE

Continued smoking after a cancer diagnosis leads to poorer treatment outcomes, survival, and quality of life. We evaluated the perceptions of the effects of continued smoking on quality of life, survival, and fatigue among patients with cancer after a cancer diagnosis and the effects of these perceptions on smoking cessation.

PATIENTS AND METHODS

Patients with cancer from all disease subsites from Princess Margaret Cancer Centre (Toronto, Ontario) were surveyed between April 2014 and May 2016 for sociodemographic variables, smoking history, and perceptions of continued smoking on quality of life, survival, and fatigue. Multivariable regression models evaluated the association between patients' perceptions and smoking cessation and the factors influencing patients' perceptions of smoking.

RESULTS

Among 1,121 patients, 277 (23%) were smoking cigarettes up to 1 year before diagnosis, and 54% subsequently quit; 23% had lung cancer, and 27% had head and neck cancers. The majority felt that continued smoking after a cancer diagnosis negatively affected quality of life (83%), survival (86%), and fatigue (82%). Current smokers during the peridiagnosis period were less likely to perceive that continued smoking was harmful when compared with ex-smokers and never-smokers ( P < .01). Among current smokers, perceiving that smoking negatively affected quality of life (adjusted odds ratio [aOR], 2.68 [95% CI, 1.26 to 5.72]; P = .011), survival (aOR, 5.00 [95% CI, 2.19 to 11.43]; P < .001), and fatigue (aOR, 3.57 [95% CI, 1.69 to 7.54]; P < .001) were each strongly associated with smoking cessation. Among all patients, those with a greater smoking history were less likely to believe that smoking was harmful in terms of quality of life (aOR, 0.98 [95% CI, 0.98 to 0.99]; P < .001), survival (aOR, 0.98 [95% CI, 0.98 to 0.99]; P < .001), and fatigue (aOR, 0.99 [95% CI, 0.98 to 0.99]; P < .001).

CONCLUSION

The perceptions of continued smoking after a cancer diagnosis among patients with cancer are strongly associated with smoking cessation. Counseling about the harms of continued smoking in patients with cancer, and in particular among those who have lower risk perceptions, should be considered when developing a smoking cessation program.

Cancer-related disease factors and smoking cessation treatment: Analysis of an ongoing clinical trial

OBJECTIVE

Smoking cessation treatment should be an important aspect of cancer care. In this study, we evaluated whether cancer-related disease factors adversely influence smoking cessation treatment.

METHODS

Smokers with cancer (within 5 years of diagnosis, any tumor site) were recruited for an ongoing trial of varenicline for smoking cessation. Disease factors, assessed at baseline, included tumor site, cancer treatment, time since diagnosis, and health-related quality of life. Medication adherence was defined by 132 of 165 pills taken and counseling adherence was defined by 4 of 4 behavioral counseling sessions attended. Abstinence was bioverified at Week 12. Using logistic regression analysis, we assessed the relationship between disease factors and 12-week medication adherence, counseling adherence, and abstinence.

RESULTS

Of 144 participants, 56% were medication adherent, 74% were counseling adherent, and 39% were abstinent. Health-related quality of life predicted medication adherence (OR: 1.08, 95% CI, 1.01-1.16, P = .019, d = 0.20) but not counseling adherence or 12-week abstinence. Tumor site, cancer treatment, and time since diagnosis did not predict any smoking cessation treatment outcomes.

CONCLUSIONS

Cancer-related disease factors did not predict cancer survivors' engagement or success in smoking cessation treatment. Findings support National Comprehensive Cancer Network Clinical Practice guidelines that recommend smoking cessation treatment for all smokers with cancer, regardless of time since diagnosis.

Treating Nicotine Dependence and Preventing Smoking Relapse in Cancer Patients

INTRODUCTION

Despite the well-documented harmful effects of smoking, many cancer patients continue to smoke. Smoking cessation is critical to address in this population given the associated increase in treatment toxicity, risk of second primary tumors, decrease in treatment response and higher disease-specific and all-cause mortality with continued smoking following a cancer diagnosis. This review seeks to summarize the latest recommendations and guidelines on smoking cessation treatment for patients diagnosed with cancer, and the evidence behind those recommendations.

AREAS COVERED

We reviewed the latest evidence for smoking cessation treatments for cancer patients and the clinical guidelines and recommendation available for oncologists and health care providers. The unique aspects of nicotine dependence among patients diagnosed with cancer, and key challenges and barriers that cancer survivors and health care providers experience when considering smoking cessation treatments, and available clinical resources, are also discussed. Lastly, the authors summarize future directions in the field of smoking cessation treatment for cancer patients.

EXPERT COMMENTARY

While there are areas of improvement in research of smoking cessation treatment for cancer patients, critical under-explored areas remain. Nonetheless, providers should adhere to the NCCN guidelines and offer a brief counseling intervention to motivate patients to quit smoking when appropriate resources are not available.

Smoking cessation care among patients with head and neck cancer: a systematic review

OBJECTIVE

To examine the effectiveness of smoking cessation interventions in improving cessation rates and smoking related behaviour in patients with head and neck cancer (HNC).

DESIGN

A systematic review of randomised and non-randomised controlled trials.

METHODS

We searched the following data sources: CENTRAL in the Cochrane Library, MEDLINE, EMBASE, PsycINFO and CINAHL up to February 2016. A search of reference lists of included studies and Google Scholar (first 200 citations published online between 2000 and February 2016) was also undertaken. The methodological quality of included studies was assessed using the Effective Public Health Practice Project Quality Assessment Tool (EPHPP). 2 study authors independently screened and extracted data with disagreements resolved via consensus.

RESULTS

Of the 5167 studies identified, 3 were eligible and included in the review. Trial designs of included studies were 2 randomised controlled trials and 1 non-randomised controlled trial. 2 studies received a weak methodological rating and 1 received a moderate methodological rating. The trials examine the impact of the following interventions: (1) nurse delivered cognitive-behaviour therapy (CBT) via telephone and accompanied by a workbook, combined with pharmacotherapy; (2) nurse and physician brief advice to quit and information booklets combined with pharmacotherapy; and (3) surgeon delivered enhanced advice to quit smoking augmented by booster sessions. Only the trial of the nurse delivered CBT and pharmacotherapy reported significant increases in smoking cessation rates. 1 study measured quit attempts and the other assessed consumption of cigarettes per day and readiness to change. There was no significant improvement in quit attempts or cigarettes smoked per day among patients in the intervention groups, relative to control.

CONCLUSIONS

There are very few studies evaluating the effectiveness of smoking cessation interventions that report results specific to the HNC population. The 3 trials identified reported equivocal findings. Extended CBT counselling coupled with pharmacotherapy may be effective.

TRIAL REGISTRATION NUMBER

CRD42016016421.

Helping cancer patients quit smoking by increasing their risk perception: a study protocol of a cluster randomized controlled trial

Background

Despite smoking cessation can largely improve cancer prognosis and quality of life, many patients continued smoking after the diagnosis of cancer. This study aims to test the effectiveness of a smoking cessation intervention using risk communication approach to help cancer patients quit smoking, and to improve their health related quality of life.

Methods

A cluster randomized controlled trial will be employed. Cancer patients who continued smoking after the diagnosis of cancer and have medical follow-up at the out-patient clinics of the five acute hospitals in Hong Kong will be invited to participate. Subjects in the experimental group will receive (1) health warnings of smoking based on a special designed leaflet; and (2) a patient-centred counseling from nurse counselors with emphasis on risk perceptions of smoking to cancer prognosis. Additionally, they will receive two more telephone counseling at 1-week and 1-month. Control group receive standard care and a generic self-help smoking cessation booklet. Outcomes measure include (a) self-reported and the biochemically validated quit rate, (b) patient’s smoking reduction by at least 50 % compared to baseline, (c) quit attempt(s), (d) change in the intention to quit, (e) change in risk perceptions of smoking, and (f) change in health related quality of life.

Discussion

This study will make an important contribution to evidence-based practice by testing the effectiveness of a tailored smoking cessation intervention for cancer patients. The results will support the development of clinical practice guidelines to promote smoking cessation in cancer patients to improve their prognosis and quality of life.

Trial registration

ClinicalTrials.gov NCT01685723. Registered 9 November 2012.

Helping cancer patients to quit smoking by understanding their risk perception, behavior, and attitudes related to smoking

BACKGROUND

Evidence shows that smoking is a major cause of cancer, and cancer patients who continue smoking are at greater risk for all causes of mortality, cancer recurrence, and second primary cancers. Nevertheless, many cancer patients still smoke and are not willing to quit. This study aimed at understanding the needs and concerns of current and ex-smoking cancer patients, including their risk perceptions, and the behavior and attitudes related to smoking.

METHODS

A qualitative research was conducted in an oncology outpatient clinic. A one-to-one semi-structured interview was conducted with current Chinese smokers and ex-smokers after they had been diagnosed with cancer. Data saturation was achieved after interviewing a total of 20 current smokers and 20 ex-smokers.

RESULTS

A total of 241 patients who were smokers prior to their diagnosis of cancer were identified. Of 241 patients, 208 (86.31%) quitted and 33 (13.69%) continued smoking after receiving a cancer diagnosis. In general, patients who refused to quit smoking subsequent to a cancer diagnosis thought that the perceived barriers to quitting outweighed the perceived benefits of quitting. In contrast, most cancer patients who quit after their cancer diagnoses thought that the perceived benefits of quitting greatly outweighed the perceived barriers to quitting.

CONCLUSIONS

It is vital that healthcare professionals should help cancer patients to quit smoking. Understanding how current smokers and ex-smokers perceive the risks of smoking, and their behavior, attitudes, and experiences related to smoking is an essential prerequisite for the design of an effective smoking cessation intervention.

National cancer institute conference on treating tobacco dependence at cancer centers

The National Cancer Institute cancer centers possess the credibility to help smokers quit. With the greater life expectancies forecast for patients with cancer, addressing smoking at cancer centers has taken on greater importance.

Smoking Cessation Interventions and Cessation Rates in the Oncology Population

Objectives

To evaluate tobacco smoking cessation interventions and cessation rates in the oncology population through a systematic review and meta-analysis.

Data Sources

The literature was searched using PubMed, Google Scholar, Medline, EMBASE, and the Cochrane Library (inception to October 2012) by 3 independent review authors.

Review Methods

Studies were included if they were randomized controlled trials (RCTs) or prospective cohort (PCs) studies evaluating tobacco smoking cessation interventions with patients assigned to a usual care or an intervention group. The primary outcome measure was smoking cessation rates. Two authors extracted data independently for each study. When applicable, disagreements were resolved by consensus.

Results

The systematic review identified 10 RCTs and 3 PCs. Statistical analysis was conducted using StatsDirect software (Cheshire, UK). Pooled odds ratios (ORs) for smoking cessation interventions were calculated in 2 groups based on follow-up duration. The therapeutic interventions included counseling, nicotine replacement therapy, buproprion, and varenicline. Smoking cessation interventions had a pooled odds ratio of 1.54 (95% confidence interval [CI], 0.909-2.64) for patients in the shorter follow-up group and 1.31 (95% CI, 0.931-1.84) in the longer follow-up group. Smoking cessation interventions in the perioperative period had a pooled odds ratio of 2.31 (95% CI, 1.32-4.07).

Conclusion

Our systematic review and meta-analysis demonstrate that tobacco cessation interventions in the oncology population, in both the short-term and long-term follow-up groups, do not significantly affect cessation rates. The perioperative period, though, may represent an important teachable moment with regard to smoking cessation.

Correlates of continued smoking versus cessation among survivors of smoking-related cancers

OBJECTIVE

We examined correlates of continued smoking versus cessation among a sample of survivors of smoking-related cancers who were actively smoking at the time of cancer diagnosis.

METHODS

Participants with a history of smoking and a smoking-related cancer diagnosis (lung, oral, pharynx, larynx, esophagus, bladder, stomach, cervix, kidney, pancreas, acute myeloid leukemia) within the past 4 years were identified in the electronic medical record. We recruited 613 individuals to complete a mail-based survey and received 139 completed surveys (22.7% response rate). We focused on 105 participants who smoked at the time of diagnosis and dichotomized them to having either quit since diagnosis (48.6%; n = 51) or continued smoking (51.4%; n = 54). We assessed sociodemographics, type of cancer and treatment(s), and psychosocial factors (depressive symptoms, social support, hope, quality of life). We then conducted structured interviews with a subset of 21 survey respondents.

RESULTS

Binary logistic regression indicated that, controlling for age, gender, ethnicity, marital status, and income, factors associated with continued smoking versus cessation included being diagnosed with other smoking-related cancers versus lung or head and neck cancer (OR = 11.21, CI 2.85, 44.02) and having significant depressive symptoms (OR = 1.25, CI 1.08, 1.45). Qualitative findings highlighted motivators for cessation (impact of being diagnosed with cancer, doctor advice to quit, social influences) and barriers to cessation (hopelessness, stress, addiction).

CONCLUSIONS

These findings highlight the need to address depressive symptoms among cancer survivors, particularly those continuing to smoke and the importance of exploring messages cancer survivors are given regarding the need for cessation post cancer diagnosis.

Harm reduction and cessation efforts and interest in cessation resources among survivors of smoking-related cancers

PURPOSE

Despite the well-established risks associated with persistent smoking, many cancer survivors who were active smokers at the time of cancer diagnosis continue to smoke. In order to guide the development of tobacco cessation interventions for cancer survivors, a better understanding is needed regarding post-diagnosis quitting efforts. Thus, we examined quitting and reduction efforts and interest in cessation resources among cancer survivors who self-identified as current smokers at the time of diagnosis.

METHODS

We conducted analyses of survey participants (n = 54) who were current smokers at the time of cancer diagnosis and were continued smokers at the time of assessment. We also conducted semi-structured interviews (n = 21) among a subset of those who either continued to smoke or quit smoking post-cancer diagnosis.

RESULTS

Among our survey participants, 22.2 % had ever used behavioral cessation resources and 66.7 % had use pharmacotherapy, while 62.8 % had interest in future use of behavioral cessation resources and 75.0 % had interest in pharmacotherapy. The majority reported some quitting efforts including making quit attempts, using cessation medications, and reducing their daily cigarette consumption. Semi-structured interview data revealed various strategies used to aid in smoking reduction and cessation as well as variability in preferences for cessation resources.

CONCLUSIONS

Cancer patients who smoke following diagnosis often engage in smoking reduction and cessation-related behaviors, which may reflect their motivation to reduce their smoking-related risks. They also report high interest in cessation resources. Thus, it is important to explore the acceptability and effectiveness of different cessation intervention components among this group.

IMPLICATIONS FOR CANCER SURVIVORS

Cancer survivors who smoke demonstrate actions toward harm reduction and cessation. They should inquire about potential resources that might facilitate their efforts among their healthcare providers and enlist support and advice from others around them to bolster their efforts.

Why do cancer patients smoke and what can providers do about it?

Despite the widespread dissemination of information about the health risks associated with smoking, many cancer patients continue to smoke, which results in a decreased quality of life, an increased probability of cancer recurrence, and a decreased survival time. Efficacious interventions are available to assist cancer patients to quit smoking, yet smoking cessation interventions are often not implemented. This review describes how clinicians, administrators, insurers, and purchasers can encourage a culture of health care in which tobacco cessation interventions are implemented consistent with evidenced-based standards of care. Implementing efficacious tobacco cessation interventions can reduce morbidity and mortality among cancer patients.

Patient-reported receipt of and interest in smoking-cessation interventions after a diagnosis of cancer

BACKGROUND

Smoking cessation is essential after the diagnosis of cancer to enhance clinical outcomes. Although effective smoking-cessation treatments are available, <50% of smokers with cancer report receiving treatment. Reasons for the low dissemination of such treatment are unclear.

METHODS

Data were collected from questionnaires and medical record reviews from 160 smokers or recent quitters with lung or head and neck cancer. Descriptive statistics, Cronbach alpha coefficients, and logistic regression were used in the analyses. The median age of participants was 57 years, 63% (n = 101) were men, 93% (n = 149) were white, and 57% (n = 91) had lung cancer.

RESULTS

Eight-six percent (n = 44) of smokers and 75% (n = 82) of recent quitters reported that healthcare providers gave advice to quit smoking. Sixty-five percent (n = 33) of smokers and 47% (n = 51) of recent quitters reported that they were offered assistance from their healthcare providers to quit smoking. Fifty-one percent (n = 26) of smokers and 20% (n = 22) of recent quitters expressed an interest in a smoking-cessation program. An individualized smoking-cessation program was the preferred type of program. Among smokers, younger patients with early stage disease and those with partners who were smokers were more interested in programs.

CONCLUSIONS

Although the majority of patients received advice and were offered assistance to quit smoking, approximately 50% of smokers were interested in cessation programs. Innovative approaches to increase interest in cessation programs need to be developed and tested in this population.