The Impact of Persistent Smoking After Surgery on Long-term Outcomes After Stage I Non-small Cell Lung Cancer Resection

Heiden, Brendan T.; Eaton, D.; Chang, Su‐Hsin; Yan, Yan; Schoen, Martin W.; Chen, Li‐Shiun; Smock, Nina; Patel, Mayank R.; Kreisel, Daniel; Nava, Ruben G.; Meyers, Bryan F.; Kozower, Benjamin D.

doi:10.1016/j.chest.2021.12.634

Cited by 13 publications

(16 citation statements)

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“…While the ethicality of rationing care in such scenarios is highly debated, perhaps a far more reasonable focus would be for routine implementation of guideline-concordant tobacco treatment programs for patients being considered for surgery. Our data suggest that, despite strong evidence supporting the use of such programs 5 , tobacco treatment among surgical patients remains severely underutilized 11 . Implementing low-burden interventions that systematically address smoking cessation in surgical clinics may reduce this variation 8 .…”

Section: Discussionmentioning

confidence: 77%

Underutilization of Guideline-Concordant Smoking Cessation Treatments in Surgical Patients: Lessons From a Learning Health System

Heiden¹,

Smock²,

Pham³

et al. 2022

Annals of Surgery Open

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Section: Discussionmentioning

confidence: 77%

Underutilization of Guideline-Concordant Smoking Cessation Treatments in Surgical Patients: Lessons From a Learning Health System

Heiden¹,

Smock²,

Pham³

et al. 2022

Annals of Surgery Open

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“…Of note, while several sampling guidelines currently exist for early-stage NSCLC, we chose a count-based standard, as these were prevailing recommendations during the study period . Additional patient-, treatment-, and tumor-related covariates were also extracted, as described previously by our group …”

Section: Methodsmentioning

confidence: 99%

“…31 Additional patient-, treatment-, and tumor-related covariates were also extracted, as described previously by our group. 7,10,25,26 Outcomes Our primary outcome was OS, defined as the time between date of surgery and death from any cause. Overall survival was assessed using the VHA Vital Status Files 32 and was censored at the end of the study follow-up period (May 1, 2020).…”

Section: Meaningmentioning

confidence: 99%

“…23 The Veterans Health Administration (VHA) is the largest integrated health care system in the US. 24 Although the VHA serves a unique patient population, 25,26 patterns of lung cancer care (including rates of adherence to intraoperative QMs) and outcomes are similar between veterans and the general US population. 10 Standardization of lung cancer treatment quality within the VHA may therefore have a disproportionate impact on early-stage NSCLC outcomes among veterans and provide a road map for implementation in the general US population.…”

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confidence: 99%

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Association Between Surgical Quality Metric Adherence and Overall Survival Among US Veterans With Early-Stage Non–Small Cell Lung Cancer

et al. 2023

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ImportanceSurgical resection remains the preferred treatment for functionally fit patients diagnosed with early-stage non–small cell lung cancer (NSCLC). Process-based intraoperative quality metrics (QMs) are important for optimizing long-term outcomes following curative-intent resection.ObjectiveTo develop a practical surgical quality score for patients diagnosed with clinical stage I NSCLC who received definitive surgical treatment.Design, Setting, and ParticipantsThis retrospective cohort study used a uniquely compiled data set of US veterans diagnosed with clinical stage I NSCLC who received definitive surgical treatment from October 2006 through September 2016. The data were analyzed from April 1 to September 1, 2022. Based on contemporary treatment guidelines, 5 surgical QMs were defined: timely surgery, minimally invasive approach, anatomic resection, adequate lymph node sampling, and negative surgical margin. The study developed a surgical quality score reflecting the association between these QMs and overall survival (OS), which was further validated in a cohort of patients using data from the National Cancer Database (NCDB). The study also examined the association between the surgical quality score and recurrence-free survival (RFS).ExposuresSurgical treatment of early-stage NSCLC.Main Outcomes and MeasuresOverall survival and RFS.ResultsThe study included 9628 veterans who underwent surgical treatment between 2006 and 2016. The cohort consisted of 1446 patients who had a mean (SD) age of 67.6 (7.9) years and included 9278 males (96.4%) and 350 females (3.6%). Among the cohort, 5627 individuals (58.4%) identified as being smokers at the time of surgical treatment. The QMs were met as follows: timely surgery (6633 [68.9%]), minimally invasive approach (3986 [41.4%]), lobectomy (6843 [71.1%]) or segmentectomy (532 [5.5%]), adequate lymph node sampling (3278 [34.0%]), and negative surgical margin (9312 [96.7%]). The median (IQR) follow-up time was 6.2 (2.5-11.4) years. An integer-based score (termed the Veterans Affairs Lung Cancer Operative quality [VALCAN-O] score) from 0 (no QMs met) to 13 (all QMs met) was constructed, with higher scores reflecting progressively better risk-adjusted OS. The median (IQR) OS differed substantially between the score categories (score of 0-5 points, 2.6 [1.0-5.7] years of OS; 6-8 points, 4.3 [1.7-8.6] years; 9-11 points, 6.3 [2.6-11.4] years; and 12-13 points, 7.0 [3.0-12.5] years; P &lt; .001). In addition, risk-adjusted RFS improved in a stepwise manner between the score categories (6-8 vs 0-5 points, multivariable-adjusted hazard ratio [aHR], 0.62; 95% CI, 0.48-0.79; P &lt; .001; 12-13 vs 0-5 points, aHR, 0.39; 95% CI, 0.31-0.49; P &lt; .001). In the validation cohort, which included 107 674 nonveteran patients, the score remained associated with OS.Conclusions and RelevanceThe findings of this study suggest that adherence to intraoperative QMs may be associated with improved OS and RFS. Efforts to improve adherence to surgical QMs may improve patient outcomes following curative-intent resection of early-stage lung cancer.

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“…Cigarette smoking remains the leading cause of preventable death in the USA 1–3. While smoking trends have steadily decreased over the last several decades,4 new types of inhaled nicotine-based products—namely electronic cigarettes (‘e-cigarettes’ or electronic nicotine delivery systems)—have rapidly emerged and gained popularity among both adults and adolescents 5–8.…”

Section: Introductionmentioning

confidence: 99%

Assessment of formal tobacco treatment and smoking cessation in dual users of cigarettes and e-cigarettes

Heiden

Baker

Smock

et al. 2022

Thorax

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BackgroundThe utility of electronic cigarettes (‘e-cigarettes’) as a smoking cessation adjunct remains unclear. Similarly, it is unclear if formal tobacco treatment (pharmacotherapy and/or behavioural support) augments smoking cessation in individuals who use both cigarettes and e-cigarettes.MethodsWe performed a longitudinal cohort study of adult outpatients evaluated in our tertiary care medical centre (6/2018–6/2020). E-cigarette use, smoking status and formal tobacco treatment (deterrent pharmacotherapy and/or behavioural support) were assessed in 6-month blocks (eg, cohort 1 (C1)=6/2018–12/2018, C2=1/2019–6/2019 and so on) using our electronic health record. We assessed the relationship between e-cigarette use (either with or without formal tobacco treatment) and point prevalence of smoking cessation at 6 and 12 months.Results111 823 unique patients were included in the study. The prevalence of dual use of cigarettes and e-cigarettes increased significantly over the study period (C1=0.8%; C2=1.1%; C3=1.8%; C4=2.3%; p<0.001). The prevalence of smoking cessation at 12 months was higher among e-cigarette users (20.8%) compared with non-users (16.8%) (risk difference, 4.0% (95% CI 2.5% to 5.5%); adjusted relative risk (aRR) 1.354, 95% CI 1.252 to 1.464, p<0.0001). Further, among dual users of cigarettes and e-cigarettes, the prevalence of smoking cessation at 12 months was higher among individuals who received tobacco treatment (29.1%) compared with individuals who did not receive tobacco treatment (19.6%) (risk difference, 9.5% (95% CI, 4.6% to 14.4%); aRR 1.238, 95% CI 1.071 to 1.432, p=0.004).InterpretationThese results suggest that dual users of cigarettes and e-cigarettes benefit from formal tobacco treatment. Clinicians should consider offering formal tobacco treatment to such patients, though future trials are needed.

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The Impact of Persistent Smoking After Surgery on Long-term Outcomes After Stage I Non-small Cell Lung Cancer Resection

Cited by 13 publications

References 35 publications

Underutilization of Guideline-Concordant Smoking Cessation Treatments in Surgical Patients: Lessons From a Learning Health System

Underutilization of Guideline-Concordant Smoking Cessation Treatments in Surgical Patients: Lessons From a Learning Health System

Association Between Surgical Quality Metric Adherence and Overall Survival Among US Veterans With Early-Stage Non–Small Cell Lung Cancer

Assessment of formal tobacco treatment and smoking cessation in dual users of cigarettes and e-cigarettes

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