Patient-Level Factors Associated with Oncology Provider-Delivered Brief Tobacco Treatment Among Recently Diagnosed Cancer Patients

Abstract

Background: A cancer diagnosis is seen as a “teachable moment” for patients to consider changing their behavioral risk factors, such as smoking. It also offers an opportunity for oncology providers to engage in a dialogue about how they can support patients changing their smoking behaviors. Brief, evidence-based tobacco cessation treatment delivered by oncology providers through the 5As (Ask, Advise, Assess, Assist Arrange) model is recommended, but provision to cancer patients remains suboptimal. Aim: Explore patient-level factors associated with 5As receipt among current smokers with a newly diagnosed cancer. Method: A total of 303 patients self-reported whether they received each of the 5As during their most recent oncology care visit. Multivariable regression analyses were conducted to identify patient-level factors associated with 5As receipt. Results: Oncology provider-delivered 5As rates ranged from 81.5% (Ask) to 30.7% (Arrange). 5As receipt was associated with: reporting lower illness-related stigma, diagnosis of a comorbid smoking-related disease, diagnosis of a smoking-related cancer, and diagnosis of a non-advanced cancer. Conclusion: Findings support previous literature in which smoking-related diagnoses were associated with greater receipt of 5As; however, disparities in the receipt of 5As existed for patients with more advanced cancer diagnoses and illness-related stigma. Inequities in the provision of quit assistance may further decrease treatment effectiveness and survival expectancy among certain patient populations. These findings are, therefore, important as they identify specific patient-level factors associated with lower 5As receipt among newly diagnosed cancer patients.

Patient-Reported Receipt of Oncology Clinician-Delivered Brief Tobacco Treatment (5As) Six Months following Cancer Diagnosis

“…Sociodemographic characteristics associated with 5As receipt were gender and age. Extending our previously reported baseline findings [ 23 ], female gender was associated with lower odds of Arrange at follow-up, which is consistent with prior research demonstrating that although women are more likely to be asked about smoking, they are equally (or less) likely than men to be recommended a specific treatment or to receive follow-up tobacco treatment [ 31 – 33 ]. Gender differences in receipt of Arrange are concerning given evidence that women may experience greater difficulty maintaining long-term smoking abstinence than men [ 34 ].…”

“…Although baseline analyses identified clinical characteristics (diagnosis of a smoking-related cancer or comorbid smoking-related disease) as increasing a patient’s odds of reporting receipt of Ask, Advise, Assist-Medication, or Arrange [ 23 ], patients with a smoking-related cancer actually had a lower probability of being advised to quit at follow-up. This finding was unexpected in the context of our baseline analyses and previous cross-sectional research demonstrating that smoking-related cancer diagnoses typically increase the likelihood that patients receive smoking cessation counseling and assistance [ 38 ].…”

“…2 ). While baseline analyses represented pre-intervention 5As as raw percentages [ 23 ], we use valid percentages (percent endorsing each A out of the total number providing follow-up data at 3 and 6 months rather than total baseline sample) so as not to under-represent rates of 5As at 3 and 6 months due to loss to follow-up.…”

Internalized stigma among cancer patients enrolled in a smoking cessation trial: The role of cancer type and associations with psychological distress

“…One factor that may contribute to this is feedback and counseling received from their physicians. We've previously shown that clinicians are more likely to advise patients on smoking cessation when they are diagnosed with a smoking‐related cancer versus a non smoking‐related cancer 31 . This may be a pathway through which patients with other smoking‐related cancers come to recognize that smoking contributed to their cancer diagnosis.…”

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

“…In a prior study, patients with tobacco-related cancers were more likely to report being asked about their smoking and receiving advice to quit smoking from oncology clinicians when compared with patients without tobacco-related cancers. 30 However, recent studies have suggested that these discussions are not always implemented in a way that would address these feelings. 24,31 Patients with tobacco-related cancers may require proactive outreach to address depressive symptoms and stigma following a referral to programs such as TIPS.…”