Practice Patterns and Perceptions of Thoracic Oncology Providers on Tobacco Use and Cessation in Cancer Patients

Abstract

Introduction Tobacco use is associated with poor outcomes in cancer patients, but there is little information on the practice patterns or perceptions of tobacco use and smoking cessation by oncology providers. Methods An online survey of practices, perceptions, and barriers to tobacco assessment and cessation in cancer patients was conducted in members of the International Association for the Study of Lung Cancer (IASLC). Responses of physician level respondents were analyzed and reported. Results Responses from 1,507 IASLC members who completed the survey are reported representing 40.5% of IASLC members. Over 90% of physician respondents believe current smoking affects outcome and that cessation should be a standard part of clinical care. At the initial patient visit, 90% ask patients about tobacco use, 79% ask patients if they will quit, 81% advise patients to stop tobacco use, but only 40% discuss medication options, 39% actively provide cessation assistance, and fewer yet address tobacco at follow-up. Dominant barriers to physician cessation effort are pessimism regarding their ability to help patients stop using tobacco (58%) and concerns about patient resistance to treatment (67%). Only 33% report themselves adequately trained to provide cessation interventions. Discussion Physicians who care for lung cancer patients recognize the importance of tobacco cessation as a necessary part of clinical care, but many still do not routinely provide assistance to their patients. Increasing tobacco cessation will require increased assessment and cessation at diagnosis and during follow-up, increased clinician education, and improved tobacco cessation methods.

Oncology Healthcare Providers‘ Pivotal role in Smoking Cessation and Relapse Prevention

“…This finding is in line with our previous formative work suggesting that providers do not feel qualified to provide smoking cessation assistance and prefer to refer patients to other resources [10]. Other frequently cited barriers by providers include feeling unable to help the patient to quit, patient resistance and time constraints [10,16]. Together, these data support the need for greater training for healthcare providers to increase knowledge of evidence-based smoking cessation interventions, and to enhance awareness that patients with cancer are motivated to quit smoking and that providers can make an impact with brief interventions (i.e., lasting <3 min).…”

“…For example, a survey completed by Warren and colleagues with lung cancer physicians found that only 33% felt adequately trained to provide cessation interventions [16]. This finding is in line with our previous formative work suggesting that providers do not feel qualified to provide smoking cessation assistance and prefer to refer patients to other resources [10].…”

“…Previous research, however, suggests that in both general and oncology settings, adherence to these recommendations is poor. For example, in a prior study, we examined cancer patients' perceptions of the implementation of the 5As model by their providers and found that, consistent with other research, there was a steep decline in reported execution of the steps beyond the first 2As (i.e., Ask and Advise to quit [15,16,101]). …”

Prevalence and Correlates of Smoking and Cessation-Related Behavior among Survivors of Ten Cancers: Findings from a Nationwide Survey Nine Years after Diagnosis

“…Increasing all survivors' access to cessation support from oncologists, however, will be necessary to translate motivation to actual success in quitting. Prior research indicates that while oncologists do ask about smoking and quitting and are supportive of providing cessation assistance to patients with cancer who smoke, in practice their provision of cessation assistance and follow-up of smoking status is much lower (30,31). Whatever the reasons (e.g., reluctance to address tobacco use in older patients, time constraints), this could be ameliorated by automated systems that screen for tobacco use and provide referrals to available treatments (32), regardless of smoking level or age.…”

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

“…20 In a recent large survey of thoracic oncology providers, 90% of respondents believed that tobacco cessation is an important part of cancer care, but most did not routinely provide cessation support. 21 The purpose of this study is to report patterns of tobacco use assessment and cessation support by ASCO members and to identify perceptions of tobacco use as well as barriers to implementing cessation support for patients with cancer.…”