Supporting cancer patients quit smoking: the initial evaluation of our tobacco cessation intervention program

2019 ◽  
Vol 19 (2) ◽  
pp. 163-172 ◽  
Author(s):  
Ernest Osei ◽  
Rahil Kassim ◽  
Kelly A. Cronin ◽  
Barbara-Anne Maier

AbstractBackground:Tobacco is a known addictive consumer product and its use has been reported to be associated with several health problems as well as the leading cause of premature, preventable mortality worldwide. For patients undergoing cancer treatment, tobacco smoking can potentially compromise treatment effectiveness; however, there is sufficient evidence suggesting numerous health benefits of smoking cessation interventions for cancer patients.Methods:The Grand River Regional Cancer Centre (GRRCC) smoking cessation program began in October 2013 to provide evidence-based intensive tobacco intervention to patients. All new patients are screened for tobacco use and those identified as active smokers are advised of the benefits of cessation and offered referral to the program where a cessation nurse offers counseling. Patients’ disease site, initial cessation goal, quit date, number of quit attempts and mode of contact are collected by the cessation nurse. This study reports on the initial evaluation of the smoking cessation program activities at GRRCC.Results:There are 1,210 patients who were screened, accepted a referral and counseled in the program. The referral pattern shows a modest increase every year and most of the patients (58%) indicated readiness to quit smoking. Overall, 29 and 26% of patients either quit or cut-back smoking, respectively. Among 348 patients who quit smoking, 300 (86%) were able to quit at the first attempt. The data indicated that 309 (44%) out of the 698 patients who indicated their initial intent to quit smoking were able to quit, whereas about 242 (35%) were able to cutback. A total of 15 patients out of 32 who indicated initial readiness to ‘cutback’ smoking were able to reduce tobacco use and three patients actually ended up quitting, although their initial goal was ‘ready-to-cut-back’.Conclusions:GRRCC smoking cessation program started in October 2013 to provide evidence-based intensive smoking cessation interventions for patients with cancer. Most patients referred to the program indicated a readiness to quit smoking affirming that if patients become aware of the various risks associated with continual smoking or if they are informed of the benefits associated with cessation with regard to their treatment, they will be more likely to decide to quit. Therefore, it is essential that patients, their partners and families are counseled on the health and treatment benefits of smoking cessation and sustainable programs should be available to support them to quit smoking. It is imperative then, that oncology programs should consistently identify and document the smoking status of cancer patients and support those who use tobacco at the time of diagnosis to quit. Evidence-based smoking cessation intervention should be sustainably integrated into the cancer care continuum in all oncology programs from prevention of cancer through diagnosis, treatment, survivorship and palliative care.

2018 ◽  
Vol 14 (2) ◽  
pp. 112-124
Author(s):  
Daniel J. Kilpatrick ◽  
Kathleen B. Cartmell ◽  
Abdoulaye Diedhiou ◽  
K. Michael Cummings ◽  
Graham W. Warren ◽  
...  

Introduction: Continued smoking by cancer patients causes adverse cancer treatment outcomes, but few patients receive evidence-based smoking cessation as a standard of care.Aim: To evaluate practical strategies to promote wide-scale dissemination and implementation of evidence-based tobacco cessation services within state cancer centers.Methods: A Collaborative Learning Model (CLM) for Quality Improvement was evaluated with three community oncology practices to identify barriers and facilitate practice change to deliver evidence-based smoking cessation treatments to cancer patients using standardized assessments and referrals to statewide smoking cessation resources. Patients were enrolled and tracked through an automated data system and received follow-up cessation support post-enrollment. Monthly quantitative reports and qualitative data gathered through interviews and collaborative learning sessions were used to evaluate meaningful quality improvement changes in each cancer center.Results: Baseline practice evaluation for the CLM identified the lack of tobacco use documentation, awareness of cessation guidelines, and awareness of services for patients as common barriers. Implementation of a structured assessment and referral process demonstrated that of 1,632 newly registered cancer patients,1,581 (97%) were screened for tobacco use. Among those screened, 283 (18%) were found to be tobacco users. Of identified tobacco users, 207 (73%) were advised to quit. Referral of new patients who reported using tobacco to an evidence-based cessation program increased from 0% at baseline across all three cancer centers to 64% (range = 30%–89%) during the project period.Conclusions: Implementation of quality improvement learning collaborative models can dramatically improve delivery of guideline-based tobacco cessation treatments to cancer patients.


2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 90s-90s
Author(s):  
M. Halligan ◽  
D. Keen

Background: Evidence indicates that smoking cessation improves the effectiveness of treatment and likelihood of survival among all cancer patients, not just those with tobacco-related disease, yet smoking is rarely addressed in oncology practice. Prior to 2016, only 3 provinces in Canada (out of a total of 10 provinces and three territories) reported implementation of smoking cessation for ambulatory cancer patients. Aim: Based on this evidence, the Canadian Partnership Against Cancer (CPAC) implemented a systems change initiative to promote adoption of evidence-based smoking cessation within provincial and territorial cancer systems across Canada. Methods: In 2016, CPAC funded seven provinces and two territories over a 15-month period to plan, implement or evaluate integration of evidence-based smoking cessation for ambulatory cancer patients within cancer systems. Funds were used to plan (2 provinces and 2 territories), implement (3 provinces) or evaluate (2 provinces) systematic, evidence-based approaches to smoking cessation within ambulatory cancer care settings (e.g., establishing routine systems for identification of smoking cancer patients and system to support patients to quit). Funds could not be used for direct service delivery (e.g., cessation counseling). Results: After 15-months of funding from CPAC, 6 provinces reported implementation of smoking cessation for ambulatory cancer patients. The remaining province and 2 territories funded by CPAC reported development of plans for adoption of smoking cessation for cancer patients in the future. Within provinces reporting implementation of smoking cessation for cancer patients, between 65%-97% of ambulatory cancer patients were screened for smoking status; 22%-80% of these patients were offered a referral to cessation services, and 21%-45% of cancer patients accepted a referral. Conclusion: Despite provincial and territorial variations in readiness to uptake evidence-based smoking cessation for cancer patients, CPAC's approach has led to substantial progress in adoption of this approach across Canada. While progress has been made, adoption of smoking cessation and relapse prevention by cancer systems is not yet widespread in Canada. Scale-up to remaining provinces and territory, and spread within existing provinces and territories is required to reach all cancer patients and families who require support to quit smoking. Framing smoking cessation as a therapeutic intervention, not prevention, and a routine part of cancer treatment will be critical for sustainability of this work.


Author(s):  
James M. Davis ◽  
Leah C. Thomas ◽  
Jillian E. H. Dirkes ◽  
H. Scott Swartzwelder

Most people who smoke and develop cancer are unable to quit smoking. To address this, many cancer centers have now opened smoking cessation programs specifically designed to help cancer patients to quit. An important question has now emerged—what is the most effective approach for engaging smokers within a cancer center in these smoking cessation programs? We report outcomes from a retrospective observational study comparing three referral methods—traditional referral, best practice advisory (BPA), and direct outreach—on utilization of the Duke Cancer Center Smoking Cessation Program. We found that program utilization rate was higher for direct outreach (5.4%) than traditional referral (0.8%), p < 0.001, and BPA (0.2%); p < 0.001. Program utilization was 6.4% for all methods combined. Inferring a causal relationship between referral method and program utilization was not possible because the study did not use a randomized design. Innovation is needed to generate higher utilization rates for cancer center smoking cessation programs.


2018 ◽  
Vol 25 (3) ◽  
pp. 226 ◽  
Author(s):  
S. M. Davidson ◽  
R.G. Boldt ◽  
A.V. Louie

Background Because continued cigarette smoking after a cancer diagnosis is associated with detrimental outcomes, supporting cancer patients with smoking cessation is imperative. We evaluated the effect of the Smoking Cessation Program at the London Regional Cancer Program (lrcp) over a 2-year period.Methods The Smoking Cessation Program at the lrcp began in March 2014. New patients are screened for tobacco use. Tobacco users are counselled about the benefits of cessation and are offered referral to the program. If a patient accepts, a smoking cessation champion offers additional counselling. Follow-up is provided by interactive voice response (ivr) telephone system. Accrual data were collected monthly from January 2015 to December 2016 and were evaluated.Results During 2015–2016, 10,341 patients were screened for tobacco use, and 18% identified themselves as current or recent tobacco users. In 2015, 84% of tobacco users were offered referral, but only 13% accepted, and 3% enrolled in ivr follow-up. At the lrcp in 2016, 77% of tobacco users were offered referral to the program, but only 9% of smokers accepted, and only 2% enrolled in ivr follow-up.Conclusions The Smoking Cessation Program at the lrcp has had modest success, because multiple factors influence a patient’s success with cessation. Limitations of the program include challenges in referral and counselling, limited access to nicotine replacement therapy (nrt), and minimal follow-up. To mitigate some of those challenges, a pilot project was launched in January 2017 in which patients receive free nrt and referral to the local health unit.


2019 ◽  
Vol 19 (1) ◽  
pp. 84-92 ◽  
Author(s):  
Rahil Kassim ◽  
Ernest Osei ◽  
Kelly A. Cronin

AbstractBackground:The adverse health effects associated with smoking tobacco have been well investigated, and its detrimental effects on cancer treatment outcomes, efficacy and quality of life (QOL) for cancer patients have also been well documented. Tobacco smoke contains many thousands of chemicals, including a plethora of carcinogens, and the exposure of human cells to these carcinogens, and their metabolic activation, is the main mechanism by which smoking-related cancer is initiated.Materials and Methods:This paper reports on a narrative review of recent studies in the field of effects of tobacco smoking on cancer treatment, including the effects of carcinogens in smoke on carcinogenesis, cell mutations and the immune system. The health effects of smokeless tobacco, effects of tobacco smoking on cancer treatment, and its impact on surgery, radiation therapy and chemotherapy are reported. The potential risks of second primary cancers or recurrence from tobacco use, the effects of second-hand smoking and cancer treatment, the impact of smoking on the QOL after cancer treatment and the need to integrate smoking cessation programs into the cancer care continuum are also reported.Conclusions:Tobacco use has a direct impact on cellular function by inhibiting apoptosis, stimulating proliferation and decreasing the efficacy of cancer treatment; therefore, quitting its use has the potential to improve treatment response rates and survival, as well as reduces the risk of developing second cancers and potentially improves the QOL after treatment. Smoking cessation is one of the most important interventions to prevent cancer and is also essential after the diagnosis of cancer to improve clinical outcomes. Due to the numerous benefits of smoking cessation, it should become a critical component of the cancer care continuum in all oncology programs – from prevention of cancer through diagnosis, treatment, survivorship and palliative care. Evidence-based smoking cessation intervention should be sustainably integrated into any comprehensive cancer program, and the information should be targeted to the specific benefits of cessation in cancer patients.


2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Nicholas J. K. Breitborde ◽  
Brittney Keller-Hamilton ◽  
Aubrey M. Moe ◽  
Jacob G. Pine ◽  
Nicholas Nelson ◽  
...  

Introduction. Individuals with psychotic-spectrum disorders may smoke due to the ameliorating effect of nicotine on the cognitive deficits that accompany these illnesses. Metacognitive remediation therapy (MCR) has been shown to produce improvements in cognitive functioning among individuals with psychotic-spectrum disorders and provides a foundation for a novel smoking cessation intervention for this population. Aims. To complete an open investigation of pharmacotherapy and a modified version of MCR [MCR to Quit (MCR-Q)] in promoting smoking cessation among individuals with psychotic-spectrum disorders. Methods. Forty-nine individuals with a psychotic-spectrum disorder and who currently smoke cigarettes participated in MCR-Q while also receiving evidence-based smoking cessation pharmacotherapy. Tobacco use was assessed as follows: (i) prior to MCR-Q, (ii) immediately after completing MCR-Q, and (iii) six weeks after completion of MCR-Q. Results/Findings. During participation in MCR-Q, nearly 80% of participants made a 24-hour quit attempt. Following the completion of MCR-Q, participants experienced reductions in level of nicotine dependency and exhaled carbon monoxide, with reductions in nicotine dependency sustained six weeks after completion of MCR-Q. Over the course of their participation in MCR-Q, participants reported strong therapeutic alliance with their MCR-Q therapist and high levels of intrinsic motivation with regard to completing MCR-Q exercises. Conclusions. The results from the current study suggest cautious optimism with regard to the use of MCR-Q in combination with medication for individuals with psychotic-spectrum disorders who want to quit smoking.


2019 ◽  
Author(s):  
David Pócs ◽  
Tímea Óvári ◽  
Csaba Hamvai ◽  
Oguz Kelemen

BACKGROUND Smoking cessation support on Facebook (FB) is a cost-effective and extensible way to reduce tobacco use among young people. Motivational interviewing (MI) is a practical counselling style in face-to-face smoking cessation support and can be useful in web-based interventions as well. OBJECTIVE This study aimed at identifying which post creation strategies based on MI could achieve positive changes in FB post characteristics and FB users’ comments. METHODS We included MI-adherent posts (N=701) which were not boosted and were targeted at tobacco users. These FB posts have been categorized into five different groups according to specific MI strategies. The control group comprised entertaining and informative posts. Primary outcomes seem to highlight how the content has stimulated interactions (engagement rate), inhibited interactions (negative feedback) or appealed to the audience of the FB page (fan-total reach ratio). The first comments received on the FB posts were evaluated and used as secondary outcomes. We applied the classification of MI approach: change talk (CT), sustain talk (ST), desire, ability, reason, need (DARN), and commitment, activation, taking steps (CAT). RESULTS FB posts which used MI strategies were associated with significantly higher engagement rate (p=.010), higher fan-total reach ratio (p<.001), and more CT (p<.001), DARN (p=.005), or CAT comments (p=.003) compared to the control group. ‘Elaborating CT’ strategies elicited considerably more CT (p<.001) and DARN comments (p=.020). ‘Affirming CT’ strategies obtained higher fan-total reach ratio (p=.011) and generated significantly more CT (p=.006) and CAT comments (p<.001). ‘Reflecting CT’ strategies received significantly higher fan-total reach ratio (p<.001). Finally, ‘relational MI’ strategies achieved significantly higher engagement rate (p<.001) compared to the control group. It should be noted that we did not find significant difference in negative feedback and the number of ST comments. CONCLUSIONS Post creation strategies based on MI stimulated interactions with FB users and generated conversation about tobacco use cessation without relevant negative feedback. Our findings suggest that MI strategies may play a remarkable role in post creation within a web-based smoking cessation intervention. In the future, these strategies could be applicable to other online platforms, such as public health websites, health blogs, mobile applications or social networking groups.


2021 ◽  
Vol 14 ◽  
pp. 1179173X2110659
Author(s):  
Heather Leutwyler ◽  
Erin Hubbard

Background The high rates of smoking in adults with serious mental illness (SMI) increases risk for COVID-19 infection. The purpose of this paper is to present the results of a smoking cessation intervention that was adapted to be offered by phone during a Shelter in Place (SIP) period in San Francisco, California, at the beginning of the COVID-19 pandemic. Methods During the SIP, we offered counseling sessions by phone to five participants. At the end of each session, we assessed readiness to quit, tobacco cessation or reduction, and inquired about the impact of the shelter in place on smoking habits and mental health. Grounded theory guided data collection and analysis. Results The categories that emerged around barriers and facilitators for smoking cessation were COVID-19–related stressors, having purpose, structure and feelings of connections, and the importance of quitting aides for smoking cessation. Conclusion Offering telephone based smoking cessation counseling to adults with SMI while they shelter in place may improve their readiness to quit.


LGBT Health ◽  
2018 ◽  
Vol 5 (3) ◽  
pp. 197-202 ◽  
Author(s):  
Conall O'Cleirigh ◽  
Steven A. Elsesser ◽  
Dana King ◽  
Peter P. Ehlinger ◽  
Judith B. Bradford ◽  
...  

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