Intensive Smoking Cessation Counseling for Patients With Cancer

Abstract

Smoking remains the leading cause of preventable death in the United States. 1,2 Tobacco use increases the risk of multiple cancers, including lung, oropharyngeal, pancreas, bladder, stomach, and colon. 3 Continued tobacco use following a cancer diagnosis increases the risk of cancer recurrence, new primary cancers, and adverse treatment-related outcomes, including postoperative pulmonary complications, poor surgical healing, and decreased response to chemotherapeutic drugs. 4 In contrast, tobacco cessation after cancer diagnosis is often associated with improved quality of life, fewer complications related to cancer treatment, and longer survival. 4 In a 2018 study, the prevalence of cigarette smoking among adult cancer survivors was 11.8%, 5 and many cancer survivors who quit smoking after a diagnosis may resume smoking. 6 Failure to address the unique challenges of cessation contributes to lack of success in initial cancer treatment due to ongoing smoking and has been associated with an estimated incremental cost of nearly $11 000 per year per smoking patient. 7 Tobacco abstinence is the strongest predictor of cancer survival, after cancer type and stage at the time of diagnosis. 8 While guidelines from the National Comprehensive Cancer Network recommend cessation counseling and pharmacologic treatment for patients with cancer who are interested in quitting smoking, 4 a survey of 1153 physicians of the International Association for the Study of Lung Cancer found that only 44% reported treating their patients' tobacco dependence. 9 Barriers to cessation treatment in oncology include time constraints and lack of tobacco cessation training. 10 A 2019 metaanalysis of randomized clinical trials of tobacco cessation among patients with cancer found no consistently effective interventions, despite similar studies showing efficacy in the general population. 11 It is in this context that the study by Park et al 12 in this issue of JAMA provides an important contribution to the oncology literature. In this unblinded study conducted at 2 National Cancer Institute (NCI) Comprehensive Cancer Centers, the authors randomly assigned 303 patients with newly diagnosed cancer who smoked cigarettes to an intensive treatment group, with 4 weekly, 4 biweekly, and 3-monthly smoking cessation telephone counseling sessions coupled with 12 weeks of free cessation medication (either nicotine replacement therapy, bupropion, or varenicline) or to a standard treatment group, with 4 weekly telephone counseling sessions and medication advice, without provision of free medication. Intention-to-treat analysis of the 221 patients who completed the study (78.1% completion rate) showed that patients in the intensive treatment group achieved biochemically confirmed,

Attitudes and Behaviors That Impact Skin Cancer Risk among Men

“…Finally, research shows that riskier perceptions towards tanning are more amenable when such counseling is given verbally [ 22 ]. By knowing these areas of emphasis, clinicians can emulate other very successful clinical interventions, such as counseling patients to quit tobacco or alcohol [ 23 ].…”

Mixed-methods Economic Evaluation of the Implementation of Tobacco Treatment Programs in National Cancer Institute-designated Cancer Centers

“…Given that fee-for-service reimbursement is predicated upon evaluation and management physician billing codes for treatment, intensive counseling delivered by unlicensed tobacco treatment specialists can only be reimbursed at low rates using preventive counseling codes. The current reimbursement rates do not incentivize additional counseling and are insu cient to sustain intensive cessation counseling [53]. However, programs that employ tobacco treatment specialists with either a social work degree (e.g., LCSW) or psychology degree (e.g., PhD/PsyD) can indeed bill at higher rates, but face higher labor costs.…”

“…Additional research is needed to improve the understanding of economic barriers and facilitators to the adoption and sustainment of tobacco treatment programs in oncology settings. Future research should also consider strategies to inform decision makers on coverage for tobacco treatment as an alternative for current fee-for-service models that do not allow for the integration of sustainable intensive tobacco cessation counseling into cancer care [53]. Given that fee-for-service reimbursement is predicated upon evaluation and management physician billing codes for treatment, intensive counseling delivered by unlicensed tobacco treatment specialists can only be reimbursed at low rates using preventive counseling codes.…”

Cardio-oncology rehabilitation: are we ready?

“…Abstinence from tobacco is a strong predictor of survival after cancer diagnosis 40 and must be pursued even with interventions that are not particularly complex: a ‘simple’ telephone consultation lasting 12 weeks, co-ordinated by a nurse, associated with a free supply of anti-smoking drugs, has been shown to significantly increase the number of quitters. 41 …”