Care to Quit: a stepped wedge cluster randomised controlled trial to implement best practice smoking cessation care in cancer centres

Abstract

Background Cigarette smoking in people with cancer is associated with negative treatment-related outcomes including increased treatment toxicity and complications, medication side effects, decreased performance status and morbidity. Evidence-based smoking cessation care is not routinely provided to patients with cancer. The purpose of this study is to determine the effectiveness of a smoking cessation implementation intervention on abstinence from smoking in people diagnosed with cancer. Methods A stepped wedge cluster randomised design will be used. All sites begin in the control condition providing treatment as usual. In a randomly generated order, sites will move to the intervention condition. Based on the Theoretical Domains Framework, implementation of Care to Quit will include (i) building the capability and motivation of a critical mass of key clinical staff and identifying champions; and (ii) identifying and implementing cessation care models/pathways. Two thousand one hundred sixty patients with cancer (diagnosed in the prior six months), aged 18+, who report recent combustible tobacco use (past 90 days or in the 30 days prior to cancer diagnosis) and are accessing anti-cancer therapy, will be recruited at nine sites. Assessments will be conducted at baseline and 7-month follow-up. The primary outcome will be 6-month abstinence from smoking. Secondary outcomes include biochemical verification of abstinence from smoking, duration of quit attempts, tobacco consumption, nicotine dependence, provision and receipt of smoking cessation care, mental health and quality of life and cost effectiveness of the intervention. Discussion This study will implement best practice smoking cessation care in cancer centres and has the potential for wide dissemination. Trial registration The trial is registered with ANZCTR (www.anzctr.org.au): ACTRN (ACTRN12621000154808) prior to the accrual of the first participant and will be updated regularly as per registry guidelines.

The Tobacco Endgame—A New Paradigm for Smoking Cessation in Cancer Clinics

“…Focussed training for health care workers and the appointment of “clinical champions” improved the implementation of a smoking cessation checklist in three Australian hospital oncology services, two metropolitan and one rural [ 31 ]. Systematic implementation of smoking cessation in cancer centres has not had extensive study and the Care to Quit Study, a stepped wedge cluster randomized, controlled trial (RCT), will investigate this across multiple sites in Australia [ 32 ]. Clinicians in cancer centres do need more training and may respond better to “micro interventions” such as short videos and brief courses than to comprehensive, multi-day courses that may be hard to balance with a busy clinical workload [ 29 ].…”

Building staff capability, opportunity, and motivation to provide smoking cessation to people with cancer in Australian cancer treatment centres: development of an implementation intervention framework for the Care to Quit cluster randomised controlled trial

“…The Care to Quit stepped wedge cluster randomised trial is funded by the National Health and Medical Research Council and administered by The University of Newcastle, Australia. The trial is managed by a committee comprising academic researchers, governing authorities, and health service providers with behavioural, cancer and smoking cessation expertise (Paul et al 2020(Paul et al , 2021 and will be rolled out across nine Australian cancer treatment services in metropolitan and regional New South Wales (NSW) and Victoria (VIC).…”

“…This methodological study describes the steps and approaches used to develop the implementation strategies for the Care to Quit cluster randomised controlled trial (Paul et al 2021 ), which was established in collaboration with key stakeholders who directed the development from conception through mapping, rating, review and refinement of strategies and principles. This involved a structured plan to comprehensively address barriers to provision of smoking cessation care using the Theoretical Domains Framework (TDF) (French et al 2012 ), a determinant framework, and the Behaviour Change Wheel (BCW) (Michie et al 2011 ), which is a behavioural model aimed at characterising interventions within a system, matching the behaviour with intervention functions and policy categories (Michie et al 2011 ).…”

Female tabagism associated mastitis: a case report related to low quality cigarettes consumption in Magé, Rio de Janeiro

“…Although a smoking specialist be available at healthcare system SUS, it is presumed that high smoking relapse rates occur even in the oncology setting, which indicates the need to provide such support to those who report recently quitting smoking as well as those who report being current smokers (Warren, 2021). Besides, if social vulnerability is a point, a stronger social and psychological support be essential, even though cancer history is not emphasized, despite lifetime risk related to the mastitis also exists.…”