Smoking Cessation Treatment and Outcomes in Medium to Heavy Cigarette Smokers being Treated for Cancer in Jordan

Abstract

Background: Studies evaluating smoking cessation treatment outcomes in cancer patients are scarce, despite smoking cessation importance in cancer care. We sought to add to the literature by evaluating smoking cessation in a challenging group of cancer patients (medium-to-heavy smokers) visiting an out-patient smoking cessation clinic (SCC) in a cancer center in Amman, Jordan. Materials and Methods: Patients smoking >9 cigarettes per day (CPD) and referred to the SCC between June 2009 and May 2012 were studied. Clinic records were reviewed to measure demographic and baseline clinical characteristics, and longitudinal (3-, 6-and 12-month) followup by phone/clinic visit was conducted. At each follow-up, patients were asked if they experienced medication side-effects, if they had returned to smoking, and reasons for failing to abstain. Descriptive and multivariable logistic regression analyses were performed. Results: A total of 201 smokers were included in the analysis. The 3-month abstinence was 23.4% and significantly associated with older age, being married, and presenting with lower (≤10ppm) baseline carbon monoxide (CO) levels. On a multivariable level, lower CO levels, a higher income (relative to the lowest income group), being older, and reporting severe dependence (relative to dependence reported as 'somewhat' or 'not') were significant predictors of higher odds of abstinence at three months. Reasons for failing to quit included not being able to handle withdrawal and seeing no value in quitting. Longterm ARs did not reach 7%. Conclusions: In a sample of Jordanian smokers (>9CPD) with cancer and receiving smoking cessation treatment, ARs were low and further declined with time. Results underscore the need for more aggressive patient management and rigorous follow-up during and after smoking cessation treatment, particularly when this takes place in challenging settings. Observed reasons for failure to abstain should be used to tailor counseling practices.

Helping patients to reduce tobacco consumption in oncology: a narrative review

“…Nonetheless, an antismoking pathway should not be experienced by patients as a further stressor, and we suggest that health personnel could play a vital role in helping patients to approach the problem in a balanced fashion, to reduce stress and maximize benefits. Since a number of studies on cancer patients demonstrate moderate smoking cessation success following the general principles of evidence-based smoking cessation protocol (Gritz et al 2014 ) a targeted and interdisciplinary approach should be adopted using systematic monitoring of patients’ needs and behavior in order to sustain long-term abstinence (Hawari et al 2013 ). However, when this is not possible, physicians and nurses should act as valuable information carriers, addressing relevant issues and encouraging patients to search for support in external services.…”

“…Experimental group (N = 32): varenicline (12 weeks) plus counseling (9 sessions) 2 weeks–2 months Thoracic cancer Varenicline plus counseling increased quitting rate 2012 de Bruin-Visser et al Method not stated Examining the efficacy of nursing-delivered smoking cessation intervention 145 Nursing-delivered smoking cessation program (counseling plus nicotine replacement therapy) 6 months–12 months Head-and-neck; Lung; Breast; Sarcoma; Bladder cancer Counseling plus nicotine replacement therapy seem to improve smoking cessation rate both 6 months and 12 months 2013 Bastian et al Randomized controlled trial Assessing the efficacy of proactive telephone counseling combined with a tailored self-directed intervention comparing to tailored self-directed intervention alone 596 Control group (N = 251): transdermal nicotine patches. Experimental group (N = 245): proactive telephone counseling plus transdermal nicotine patches 2 weeks–6 months–12 months Lung cancer No difference 2013 Hawari et al Prospective observational study Evaluating the abstinence rates in cancer patients that they underwent to smoking cessation program 210 Tobacco Intervention: medical counselling, pharmacologic management (varenicline or bupropion), plus NRT 3- 6 and 12- months lung, urinary bladder, head and neck cancers and myeloid leukemia Abstinence rates declined with time 3 months: relapse related to withdrawal 6 months: relapse rated to personal and professional stressful 12 months: relapse rated to personal and professional stressful 2013 Ostroff et al Randomized controlled trial Assessing the efficacy of short smoking intervention pre-surgical 185 Control group: counseling plus pharmacotherapy. Experimental group: short smoking intervention pre-surgical plus counseling and pharmacotherapy 3 months–6 months …”

Tobacco cessation programs and factors associated with their effectiveness in the Middle East: A systematic review

“…The outcomes and aims of the included studies are summarized in Table 3. The most commonly reported outcome was the quit rate (n=18) 36,37,40,[42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] , followed by cessation rate (n=8) 39,41,[56][57][58][59][60][61] , sustained abstinence (n=1) 35 , fail to quit (n=1) 62 , cessation survival rate (n=1) 38 , and success rate (n=1) 35 . The majority of studies utilized a self-reported questionnaire to estimate quit rates, while some others used the carbon monoxide breath test to determine quitting state (n=19) 35-37,39-41,43,44,46-48,50-53, 55-57,59 .…”

“…A number of individual factors are associated with the effectiveness of TC programs. For example, factors found to be associated with reduced effectiveness include individual withdrawal symptoms 39,45,47,57,63 , high nicotine dependence rate 36,38,43,49,52,60,62,63 , poor knowledge on how to quit 45 , change in attitudes and behaviors 43,56 , stress 47,48 , number of cigarettes smoked per day 62,63 , inability to afford higher priced medications 49,50,62 , and concern about gaining weight 51,63 . Other individual factors that were found to be associated with effective TC programs included older age 51,62 , female gender 61 , knowledge on the benefits of tobacco cessation 35,59 , health issues 41,47,53,54,59,[61][62][63] , higher education level 48,54 , religious beliefs 59 , and adherence to treatment 51 .…”

“…The organizational factors in our review were represented by the type of services provided in TC programs. Services that were linked to effective TC programs included using NRT [39][40][41]43,44,47,48,51 , individual counseling 43,54 , combined programs, such as combining NRT with Cognitive Behavioral Thereby (CBT) 41,46,53,58 , follow-up and frequent visits to TC clinics 35,37,51,54,61 , long duration of treatment 41 , applying TTM in designing programs 43,56 , providing advice through health professionals 45 , and use of harm reduction approach in the programs 55 .…”