Does Free nicotine Replacement Improve Smoking Cessation Rates in Cancer Patients?

Abstract

Background Cigarette smoking is carcinogenic and has been linked to inferior treatment outcomes and complication rates in cancer patients. Here, we report the results of an 18-month pilot smoking cessation program that provided free nicotine replacement therapy (nrt).Methods In January 2017, the smoking cessation program at our institution began offering free nrt for actively cigarette-smoking patients with cancer. The cost of 4 weeks of nrt was covered by the program, and follow-up was provided by smoking cessation champions.Results From January 2017 to June 2018, 8095 patients with cancer were screened for cigarette use, of whom 1135 self-identified as current or recent smokers. Of those 1135 patients, 117 enrolled in the program and accepted a prescription for nrt. The rates of patient referral and patients attending a referral appointment were significantly higher in 2018–2018 than they had been in 2015–2016 (100% vs. 80.3%, p < 0.001, and 27.6% vs. 11.3%, p < 0.001, respectively). Median follow-up was 9.0 months (25%–75% interquartile range: 5.7–11.6 months). Of the patients who accepted nrt and who also had complete data (n = 71), 25 (35.2%) reported complete smoking cessation, and 32 (45.1%) reported only decreased cigarette smoking. On univariable analysis, no factors were significantly predictive of smoking cessation, although initial cigarette use (>10 vs. ≤10 initial cigarettes) was significantly predictive of smoking reduction (odds ratio: 5.04; 95% confidence interval: 1.46 to 17.45; p = 0.011).Conclusions This pilot study of free nrt demonstrated rates of referral and acceptance of nrt that were improved compared with historical rates, and most referred patients either decreased their use of cigarettes or quit entirely.

Implementing Smoking Cessation Interventions for Tobacco Users Within Oncology Settings

“…Of the 43 studies, 10 (23%) were RCTs and 33 (77%) were nonrandomized study designs . The majority of studies were conducted in the US (n = 34; 79%) .…”

“…The nonrandomized controlled trials generally had a low risk of confounding, selection, classification, and reporting bias, with moderate bias in measurement and mixed performance and attrition bias (eTable 5 in Supplement 2). The 10 studies showing a moderate overall bias resulted from unblinded outcome assessors (D6), patient outcome data missing (D5), lack of patient adherence (D4), gap in data collection (D2), and different intervention components across implementation sites (ie, opt-out approach) (D1).…”

“…After categorizing strategies according to the taxonomy described in the ERIC study, the most commonly reported implementation strategies were supporting clinicians (n = 34; 77%), training and educating stakeholders (n = 24; 56%), changing infrastructure (n = 21; 49%), evaluative and iterative (n = 12; 28%), and developing stakeholder relationships (n = 12; 28%) . See eTable 6 in Supplement 1.…”

“…In most cases, supporting clinicians meant helping them to revise their roles (65%), including reminding clinicians of the program/intervention (11%) and providing clinical supervision (5%) . Training and educating stakeholders involved conducting training (34%) and conducting educational meetings (52%), including the development and distribution of educational materials (30%) . Infrastructure changes were the third most popular implementation strategy, which encompassed changing record systems (23%), changing referral systems (32%) or both (46%) …”

Evolution of a Systematic Approach to Smoking Cessation in Ontario’s Regional Cancer Centres

“…This has led to several natural experiments and an attempt to identify best implementation practices for smoking cessation in cancer care settings [ 8 ]. For example, in 2017, the London Regional Cancer Program launched a pilot to provide free nicotine replacement therapy (NRT) to improve the low referral rates identified in an evaluation of their smoking cessation program [ 9 , 10 ]. The pilot demonstrated that provision of free NRT significantly improved referral rates, and most referred patients either reduced their cigarette smoking or quit completely.…”