Smoking Cessation, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology

Shields, Peter G.; Bierut, Laura J.; Balis, David S.; Cinciripini, Paul M.; Davis, James N.; Edmondson, Donna; Feliciano, J M; Hitsman, Brian; Hudmon, Karen Suchanek; Jaklitsch, Michael T.; Leone, Frank T.; Ling, Pamela; McCarthy, Danielle E.; Ong, Michael; Park, Elyse R.; Prochaska, Judith J.; Sandoval, Argelia; Sheffer, Christine E.; Spencer, Sharon; Studts, Jamie L.; Tanvetyanon, Tawee; Tindle, Hilary A.; Tong, Elisa K.; Triplette, Matthew; Urbanic, James J.; Videtic, Gregory M.M.; Warner, David O.; Whitlock, C. Will; McCullough, Beth

doi:10.6004/jnccn.2023.0013

Cited by 16 publications

(22 citation statements)

References 195 publications

(263 reference statements)

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“…18 The National Comprehensive Cancer Network recommends asking every patient with cancer at every visit about smoking status and documenting responses in the electronic medical record (EMR). 18 The American Association for Cancer Research has a policy statement that includes universal assessment and documentation of tobacco use as standard of care. 17 Furthermore, the American Association for Cancer Research policy statement says that cancer care providers should receive training in tobacco treatment and be incentivized for treatment referral and delivery.…”

Section: Introductionmentioning

confidence: 99%

“…[15][16][17] The National Comprehensive Cancer Network Clinical Practice Guidelines for Smoking Cessation state that tobacco treatment should be standard of care, integrated throughout cancer care from workup to curative treatment to end-of-life care. 18 The National Comprehensive Cancer Network recommends asking every patient with cancer at every visit about smoking status and documenting responses in the electronic medical record (EMR). 18 The American Association for Cancer Research has a policy statement that includes universal assessment and documentation of tobacco use as standard of care.…”

Section: Introductionmentioning

confidence: 99%

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Tobacco Use and Tobacco Treatment Referral Response of Patients With Cancer: Implementation Outcomes at a National Cancer Institute–Designated Cancer Center

Burris

Borger

Shelton

et al. 2022

JCO Oncology Practice

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PURPOSE: Smoking after a cancer diagnosis is linked to cancer-specific and all-cause mortality, among other adverse outcomes. Yet, 10%-20% of US cancer survivors are current smokers. Implementation of evidence-based tobacco treatment in cancer care facilities is widely recommended, yet rarely accomplished. This study focuses on the early outcomes of a population-based tobacco treatment program integrated within an National Cancer Institute–designated cancer center. METHODS AND MATERIALS: The sample consists of 26,365 patients seen at the cancer center during the first 18 months of program implementation. The study is a retrospective chart review of patients' tobacco use and, among current users, patients' treatment referral response. RESULTS: More than 99% of patients were screened for tobacco use. Current (past month) use was observed in 21.05% of patients; cigarettes were the most popular product. Only 17.22% of current users accepted a referral for tobacco treatment; among current users who declined, the majority were not ready to quit (65.84%) or wanted to quit on their own (27.01%). Multiple demographic variables were associated with tobacco use and treatment referral response outcomes. CONCLUSION: Despite cancer diagnosis presenting a teachable moment for tobacco cessation, patients with cancer may not be ready to quit or engage with treatment. Clinically proven strategies to increase motivation, prompt quit attempts, and encourage treatment use should be key components of tobacco treatment delivery to patients with cancer.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Tobacco Use and Tobacco Treatment Referral Response of Patients With Cancer: Implementation Outcomes at a National Cancer Institute–Designated Cancer Center

Burris

Borger

Shelton

et al. 2022

JCO Oncology Practice

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“…Specifically, the relative risk of a second primary lung cancer in patients who have SCLC is 16.0 (95% CI, 8.4‐27.0) compared with that in the general population 291 . This further emphasizes the role of smoking cessation (see the contemporary smoking cessation guideline in the report by Shields et al 292 289,291 .…”

Section: Surveillance and Follow‐upmentioning

confidence: 93%

“…[289][290][291] Specifically, the relative risk of a second primary lung cancer in patients who have SCLC is 16.0 (95% CI, 8.4-27.0) compared with that in the general population. 291 This further emphasizes the role of smoking cessation (see the contemporary smoking cessation guideline in the report by Shields et al 292 ) because quitting smoking after successful therapy significantly decreases the risk of secondary malignancies. 289,291 Nevertheless, if a new pulmonary nodule develops after a longer period of stable disease, it should prompt evaluation for new primary lung cancer.…”

Section: Surveillance and Follow-upmentioning

confidence: 96%

Clinical insights into small cell lung cancer: Tumor heterogeneity, diagnosis, therapy, and future directions

Gay

Popper

Pirker

et al. 2023

CA A Cancer J Clinicians

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Small cell lung cancer (SCLC) is characterized by rapid growth and high metastatic capacity. It has strong epidemiologic and biologic links to tobacco carcinogens. Although the majority of SCLCs exhibit neuroendocrine features, an important subset of tumors lacks these properties. Genomic profiling of SCLC reveals genetic instability, almost universal inactivation of the tumor suppressor genes TP53 and RB1, and a high mutation burden. Because of early metastasis, only a small fraction of patients are amenable to curative‐intent lung resection, and these individuals require adjuvant platinum‐etoposide chemotherapy. Therefore, the vast majority of patients are currently being treated with chemoradiation with or without immunotherapy. In patients with disease confined to the chest, standard therapy includes thoracic radiotherapy and concurrent platinum‐etoposide chemotherapy. Patients with metastatic (extensive‐stage) disease are treated with a combination of platinum‐etoposide chemotherapy plus immunotherapy with an anti‐programmed death‐ligand 1 monoclonal antibody. Although SCLC is initially very responsive to platinum‐based chemotherapy, these responses are transient because of the development of drug resistance. In recent years, the authors have witnessed an accelerating pace of biologic insights into the disease, leading to the redefinition of the SCLC classification scheme. This emerging knowledge of SCLC molecular subtypes has the potential to define unique therapeutic vulnerabilities. Synthesizing these new discoveries with the current knowledge of SCLC biology and clinical management may lead to unprecedented advances in SCLC patient care. Here, the authors present an overview of multimodal clinical approaches in SCLC, with a special focus on illuminating how recent advancements in SCLC research could accelerate clinical development.

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“…Taking the perspective of a clinician in the current environment in which both varenicline and CNRT are recommended first-line treatments, this study addressed the following questions: First, what is the probability of abstinence between these 2 treatments on an initial quit attempt? Second, what is the best subsequent treatment approach for those nonabstinent after initial treatment?…”

Section: Introductionmentioning

confidence: 99%

Smoking Cessation After Initial Treatment Failure With Varenicline or Nicotine Replacement

Cinciripini,

Green,

Shete

et al. 2024

JAMA

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ImportanceMost people who smoke do not quit on their initial attempt.ObjectiveTo determine the best subsequent strategy for nonabstinence following initial treatment with varenicline or combined nicotine replacement therapy (CNRT).Design, Setting, and ParticipantsUsing a double-blind, placebo-controlled, sequential multiple assignment randomized trial, 490 volunteers were randomized to receive 6 weeks of varenicline or CNRT. After 6 weeks, nonabstainers were rerandomized to continue, switch, or increase medication dosage for 6 additional weeks. The study was conducted from June 2015 through October 2019 in a Texas tobacco treatment clinic.InterventionsThe initial treatment was 2 mg/d of varenicline or the combined replacement therapy of a 21-mg patch plus 2-mg lozenge. The rerandomized participants either continued with their initial therapies, switched between varenicline and CNRT, or increased dosages either to 3-mg or more of varenicline or to a 42-mg patch and lozenges. All received weekly brief counseling.Main Outcomes and MeasuresBiochemically verified 7-day point prevalence abstinence at the end of treatment at 12 weeks.ResultsThe 490 randomized participants (210 female [43%], 287 non-Hispanic White [58%], mean age, 48.1 years) smoked an average of 20 cigarettes per day. After the first phase, 54 participants in the CNRT group were abstinent and continued their therapy; of the 191 who were not abstinent, 151 were rerandomized, and the 40 who did not return for rerandomization were assigned to continue their initial CNRT condition in phase 2. The end-of-treatment abstinence rate for the 191 phase 1 nonabstainers was 8% (95% credible interval [CrI], 6% to 10%) for the 90 (47%) who continued at the dosage condition, 14% (CrI, 10% to 18%) for the 50 (33%) who increased their dosage, and 14% (95% CrI, 10% to 18%) for the 51 (34%) who switched to varenicline (absolute risk difference [RD], 6%; 95% CrI, 6% to 11%) with more than 99% posterior probability that either strategy conferred benefit over continuing the initial dosage. After the first phase, 88 participants in the varenicline group were abstinent and continued their therapy; of the 157 who were not abstinent, 122 were rerandomized and 35 who did not return for rerandomization were assigned to continue with the varenicline condition. The end-of-treatment abstinence rate for the 157 phase 1 nonabstainers was 20% (95% CrI, 16% to 26%) for the 39 (32%) who increased their varenicline dosage, 0 (95% CrI, 0 to 0) for the 41 (34%) who switched CNRT, and 3% (95% CrI, 1% to 4%) for the 77 (49%) who were assigned to the continued varenicline condition (absolute RD, −3%; 95% CrI, −4% to −1%) with more than 99% posterior probability that continuing varenicline at the initial dosage was worse than switching to a higher dosage. Furthermore, increasing the varenicline dosage had an absolute RD of 18% (95% CrI, 13% to 24%) and a more than 99% posterior probability of conferring benefit. The secondary outcome of continuous abstinence at 6 months indicated that only increased dosages of the CNRT and varenicline provided benefit over continuation of the initial treatment dosages.Conclusions and RelevanceFor individuals who smoked but did not achieve abstinence after treatment with varenicline, increasing the dosage enhanced abstinence vs continuing, whereas for nonabstainers initially treated with CNRT, a dosage increase or switch to varenicline enhanced abstinence and may be viable rescue strategies.Trial RegistrationClinicalTrials.gov Identifier: NCT02271919

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Smoking Cessation, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology

Cited by 16 publications

References 195 publications

Tobacco Use and Tobacco Treatment Referral Response of Patients With Cancer: Implementation Outcomes at a National Cancer Institute–Designated Cancer Center

Tobacco Use and Tobacco Treatment Referral Response of Patients With Cancer: Implementation Outcomes at a National Cancer Institute–Designated Cancer Center

Clinical insights into small cell lung cancer: Tumor heterogeneity, diagnosis, therapy, and future directions

Smoking Cessation After Initial Treatment Failure With Varenicline or Nicotine Replacement

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