Addressing Tobacco Use in Patients With Cancer: A Survey of American Society of Clinical Oncology Members

Warren, Graham; Marshall, James R.; Cummings, K. Michael; Toll, Benjamín A.; Gritz, Ellen R.; Hutson, Alan D.; Dibaj, Seyedeh; Herbst, Roy S.; Mulshine, James L.; Hanna, Nasser H.; Dresler, Carolyn

doi:10.1200/jop.2013.001025

Cited by 136 publications

(166 citation statements)

References 28 publications

(28 reference statements)

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“…Even though 70% of cancer patients who smoke are motivated to quit smoking, only 56% of physicians recommend that their cancer patients who smoke stop smoking 52 and most oncology providers do not provide smoking interventions beyond advice to quit. 53 Our work 54 and the work of others [55][56][57][58][59] have shown that the major barriers to providers implementing smoking cessation services included lack of expertise and time. Education programs for health care providers as well as dedicated smoking cessation programs would improve tobacco treatment for cancer patients.…”

Section: Discussionmentioning

confidence: 94%

Does Quitting Smoking Make a Difference Among Newly Diagnosed Head and Neck Cancer Patients?

Choi

Terrell

Bradford

et al. 2016

NICTOB

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Introduction: To determine if smoking after a cancer diagnosis makes a difference in mortality among newly diagnosed head and neck cancer patients. Methods: Longitudinal data were collected from newly diagnosed head and neck cancer patients with a median follow-up time of 1627 days (N = 590). Mortality was censored at 8 years or September 1, 2011, whichever came first. Based on smoking status, all patients were categorized into four groups: continuing smokers, quitters, former smokers, or never-smokers. A broad range of covariates were included in the analyses. Kaplan-Meier curves, bivariate and multivariate Cox proportional hazards models were constructed. Results: Eight-year overall mortality and cancer-specific mortality were 40.5% (239/590) and 25.4% (150/590), respectively. Smoking status after a cancer diagnosis predicted overall mortality and cancer-specific mortality. Compared to never-smokers, continuing smokers had the highest hazard ratio (HR) of dying from all causes (HR = 2.71, 95% confidence interval [CI] = 1.48-4.98). Those who smoked at diagnosis, but quit and did not relapse-quitters-had an improved hazard ratio of dying (HR = 2.38, 95% CI = 1.29-4.36) and former smokers at diagnosis with no relapse after diagnosis-former smokers-had the lowest hazard ratio of dying from all causes (HR = 1.68, 95% CI = 1.12-2.56). Similarly, quitters had a slightly higher hazard ratio of dying from cancer-specific reasons (HR = 2.38, 95% CI = 1.13-5.01) than never-smokers, which was similar to current smokers (HR = 2.07, 95% CI = 0.96-4.47), followed by former smokers (HR = 1.70, 95% CI = 1.00-2.89). Conclusions: Compared to never-smokers, continuing smokers have the highest HR of overall mortality followed by quitters and former smokers, which indicates that smoking cessation, even after a cancer diagnosis, may improve overall mortality among newly diagnosed head and neck cancer patients. Health care providers should consider incorporating smoking cessation interventions into standard cancer treatment to improve survival among this population. Implications: Using prospective observational longitudinal data from 590 head and neck cancer patients, this study showed that continuing smokers have the highest overall mortality relative to never-smokers, which indicates that smoking cessation, even after a cancer diagnosis, may have beneficial effects on long-term overall mortality. Health care providers should consider incorporating smoking cessation interventions into standard cancer treatment to improve survival among this population.

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Section: Discussionmentioning

confidence: 94%

Does Quitting Smoking Make a Difference Among Newly Diagnosed Head and Neck Cancer Patients?

Choi

Terrell

Bradford

et al. 2016

NICTOB

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“…About half of cancer patients who smoked prior to diagnosis continue to smoke [23]. [25]; yet, only 40% of oncologists discuss medications with patients who smoke and only 38% actively treat their patients for tobacco dependence [26]. Critical opportunities to improve oncological outcomes and extend patient survival are being missed.…”

Section: Smoking Cessation Treatment In Cancer Patientsmentioning

confidence: 99%

Tobacco Cessation in Oncology Care

2018

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Globally, tobacco use is a major modifiable risk factor and leading cause of many forms of cancer and cancer death. Tobacco use contributes to poorer prognosis in cancer care. This article reviews the current state of tobacco cessation treatment in oncology. Effective behavioral and pharmacological treatments exist for tobacco cessation, but are not being widely used in oncology treatment settings. Comprehensive tobacco treatment increases success with quitting smoking and can improve oncological and overall health outcomes. This article describes the components of a model treatment program, which includes automatic referrals for all current tobacco users and recent quitters, motivational interviewing during initial and follow-up contacts, combined behavioral and pharmacological interventions for cessation, and systematic follow-up phone calls for relapse prevention.

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“…Two recent international surveys of cancer specialists found that less than one-half routinely offered patients smoking cessation treatment; common concerns were that intervention would be ineffective, and cancer patients would resist treatment. 18,19 Even so, we have previously reported that patients treated surgically for lung cancer express a wish for much greater involvement of clinicians a Cancer subgroup patients and matched CHD control patients: lung, n = 2,340; bladder, n = 944; UAT, n = 422.…”

Section: Interpretation Of Findings and Comparison With Existing Studiesmentioning

confidence: 99%

“…Support for smoking cessation in secondary care is low, however, and it is unlikely to be the main source of cessation support. [17][18][19][20] As with all studies based on health care records, it is possible that the general practitioners provided advice to quit or on how to quit which they did not record. Although underreporting would underestimate the true rate of intervention, it is likely to underestimate the frequency of intervention in patients with cancer and CHD equally and is thus an implausible explanation for the findings.…”

Section: Strengths and Weaknessesmentioning

confidence: 99%

“…Hospital physicians infrequently offer active support for smoking cessation, so primary care support is crucial. [17][18][19][20] For context, we compared patients who had cancer with patients who had coronary heart disease (CHD), a similarly serious smoking-related condition that also motivates patients to try to stop smoking and for which there is evidence that smoking cessation improves disease outcomes. 21 A second aim was to examine the effect of incentive payments on management of smoking in patients with CHD.…”

Section: Introductionmentioning

confidence: 99%

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Physician Support of Smoking Cessation After Diagnosis of Lung, Bladder, or Upper Aerodigestive Tract Cancer

et al. 2017

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PURPOSE Smoking cessation after a diagnosis of lung, bladder, and upper aerodigestive tract cancer appears to improve survival, and support to quit would improve cessation. The aims of this study were to assess how often general practitioners provide active smoking cessation support for these patients and whether physician behavior is influenced by incentive payments. METHODSUsing electronic primary care records from the UK Clinical Practice Research Datalink, 12,393 patients with incident cases of cancer diagnosed between 1999 and 2013 were matched 1 to 1 to patients with incident cases of coronary heart disease (CHD) diagnosed during the same time. We assessed differences in the proportion for whom physicians updated smoking status, advised quitting, and prescribed cessation medications, as well as the proportion of patients who stopped smoking within a year of diagnosis. We further examined whether any differences arose because the physicians were offered incentives to address smoking in patients with CHD and not cancer. RESULTSAt diagnosis, 32.0% of patients with cancer and 18.2% of patients with CHD smoked tobacco. Patients with cancer were less likely than patients with CHD to have their general practitioners update smoking status (OR = 0.18; 95% CI, 0.17-0.19), advise quitting (OR = 0.38; 95% CI, 0.36-0.40), or prescribe medication (OR = 0.67; 95% CI, 0.63-0.73), and they were less likely to have stopped smoking (OR = 0.76; 95% CI, 0.69-0.84). One year later 61.7% of patients with cancer and 55.4% with CHD who were smoking at diagnosis were still smoking. Introducing incentive payments was associated with more frequent interventions, but not for patients with CHD specifically.CONCLUSIONS General practitioners were less likely to support smoking cessation in patients with cancer than with CHD, and patients with cancer were less likely to stop smoking. This finding is not due to the difference in incentive payments. 2017;15:443-450. https://doi Ann Fam Med

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Addressing Tobacco Use in Patients With Cancer: A Survey of American Society of Clinical Oncology Members

Cited by 136 publications

References 28 publications

Does Quitting Smoking Make a Difference Among Newly Diagnosed Head and Neck Cancer Patients?

Does Quitting Smoking Make a Difference Among Newly Diagnosed Head and Neck Cancer Patients?

Tobacco Cessation in Oncology Care

Physician Support of Smoking Cessation After Diagnosis of Lung, Bladder, or Upper Aerodigestive Tract Cancer

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