“Stop smoking!” Do we say it enough?

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 268-268
Author(s):  
Jessica Ann Reifer Hildebrand ◽  
Sangeeta Sastry ◽  
Ashley Adams
Keyword(s):  
Smoking Cessation ◽  
Smoking Status ◽  
Medical Center ◽  
Performance Status ◽  
Tobacco Dependence ◽  
Poor Performance Status ◽  
Second Primary ◽  
Smoking Cessation Counseling ◽  
Significant Difference ◽  
Improvement Programs

268 Background: There are clear benefits of smoking cessation after the diagnosis of Bronchogenic Carcinoma (BC). Patients who quit smoking report lower levels of pain and are less likely to develop a second primary tumor when compared to patients who continue to smoke after they are diagnosed with BC. Persistent smoking is also associated with poor performance status and survival outcomes. Evidence suggests that smokers are more likely to quit if they are counseled by their physicians yet, there may be a prevailing belief among physicians that treating tobacco dependence is futile in this population. The purpose of this study was to investigate whether physicians addressed smoking cessation with patients who were diagnosed with BC. Methods: A retrospective chart review of patients who were diagnosed with BC was conducted at a community medical center between 2008 and 2010, using the hospital’s cancer registry. Demographic information including age, race, sex, AJCC stage, and smoking status at the time of diagnosis was collected. Evidence of tobacco cessation counseling was sought through billing codes, physician notes, and orders surrounding the time of diagnosis. Results: A total of 948 patients were diagnosed with lung cancer between 2008 and 2010. 438 were current smokers at diagnosis, 422 were former smokers, and 88 had never smoked. Of the 438 smokers, only 36% were counseled on smoking cessation. On average, each patient encountered 3 different physicians in both the inpatient and outpatient settings. Of note, stage I patients were 1.7 times more likely to be counseled than those with stage IV disease (p=0.017). There was no significant difference between the counseled group and the non-counseled group in regards to age, race, or sex. Conclusions: In spite of evidence that smoking cessation is beneficial even after the diagnosis of BC, physicians are not counseling their patients sufficiently. Reasons physicians may fail to counsel include an inability to effectively assess tobacco dependence, competing concerns during patient encounters, and reduced awareness of current quality measures. With the implementation of quality improvement programs, it will be interesting to see if smoking cessation counseling for patients with BC improves in the community setting.

“Stop smoking!”: Do we say it enough?

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e17500-e17500
Author(s):  
Jessica Ann Reifer Hildebrand ◽  
Sangeeta Sastry ◽  
Ashley Adams
Keyword(s):  
Smoking Cessation ◽  
Smoking Status ◽  
Medical Center ◽  
Performance Status ◽  
Tobacco Dependence ◽  
Poor Performance Status ◽  
Second Primary ◽  
Smoking Cessation Counseling ◽  
Significant Difference ◽  
Improvement Programs

e17500 Background: There are clear benefits of smoking cessation after the diagnosis of Bronchogenic Carcinoma (BC). Patients who quit smoking after the diagnosis of BC report lower levels of pain and are less likely to develop a second primary tumor when compared to patients who continue to smoke after they are diagnosed. Persistent smoking is also associated with poor performance status and survival outcomes. Evidence suggests that smokers are more likely to quit if they are counseled by their physicians. Yet, there may be a prevailing belief among physicians that treating tobacco dependence is futile in this population. The purpose of this study was to investigate whether physicians addressed smoking cessation with patients who were diagnosed with BC. Methods: A retrospective chart review of patients who were diagnosed with BC was conducted at a community medical center between 2008 and 2010, using the hospital’s cancer registry. Demographic information including age, race, sex, AJCC stage, and smoking status at the time of diagnosis was collected. Evidence of tobacco cessation counseling was sought through billing codes, physician notes, and orders surrounding the time of diagnosis. Results: A total of 948 patients were diagnosed with lung cancer between 2008 and 2010. 438 were current smokers at diagnosis, 422 were former smokers, and 88 had never smoked. Of the 438 smokers, only 36% were counseled on smoking cessation. On average, each patient encountered 3 different physicians in both the inpatient and outpatient settings. Of note, Stage I patients were 1.7 times more likely to be counseled than those with Stage IV disease (p=0.017). There was no significant difference between the counseled group and the non counseled group in regards to age, race, or sex. Conclusions: In spite of evidence that smoking cessation is beneficial even after the diagnosis of BC, physicians are not counseling their patients sufficiently. Reasons physicians may fail to counsel include: an inability to effectively assess tobacco dependence, competing concerns during patient encounters, and reduced awareness of current quality measures. With the implementation of quality improvement programs, we suspect that smoking cessation counseling for patients with BC will improve in the community setting.

scholarly journals Factors Correlated with Smoking Cessation Success in Older Adults: A Retrospective Cohort Study in Taiwan

2019 ◽  
Vol 16 (18) ◽  
pp. 3462
Author(s):  
Chih-Po Chang ◽  
Wei-Hsin Huang ◽  
Ching-Hui You ◽  
Lee-Ching Hwang ◽  
I-Jung Lu ◽  
...  
Keyword(s):  
Older Adults ◽  
Smoking Cessation ◽  
Success Rate ◽  
Smoking Status ◽  
Medical Center ◽  
The Elderly ◽  
Treatment Method ◽  
Daily Consumption ◽  
Significant Difference ◽  
Baseline Characteristics

Smoking cessation in the elderly is very important. This study aims to explore the success rate of smoking cessation in the elderly and the factors that predict the success of smoking cessation. We collected data from smokers ≥60 years who visited a medical center in Taiwan during 2017. All patients were prescribed either varenicline or nicotine replacement therapy (NRT) for smoking cessation. The participants were asked about their smoking status after treatment. In total, 129 participants were enrolled. The three- or six-month point abstinence rate was 48.1%. No significant difference was found among baseline characteristics (including age, gender, underlying diseases, smoking duration, daily consumption amount of cigarette, carbon monoxide concentration, Fagerström test for nicotine dependence scores, and treatment method) between quitters and non-quitters, except for the type of medication used. The proportion of quitters using varenicline was significantly higher than that of non-quitters. Multivariate regression analyses showed that the patients who received varenicline were 3.22 times more likely to quit smoking than those who received NRT. Therefore, we suggest that varenicline use may help in smoking cessation in older adults, compared to NRT. Other baseline characteristics may not affect the success rate of smoking cessation in this population.

scholarly journals Development of Machine Learning Models for Prediction of Smoking Cessation Outcome

2021 ◽  
Vol 18 (5) ◽  
pp. 2584
Author(s):  
Cheng-Chien Lai ◽  
Wei-Hsin Huang ◽  
Betty Chia-Chen Chang ◽  
Lee-Ching Hwang
Keyword(s):  
Machine Learning ◽  
Smoking Cessation ◽  
Success Rate ◽  
Prediction Models ◽  
Smoking Status ◽  
Medical Center ◽  
Machine Learning Algorithms ◽  
Classification And Regression Tree ◽  
Support Vector ◽  
Smoking Cessation Outcome

Predictors for success in smoking cessation have been studied, but a prediction model capable of providing a success rate for each patient attempting to quit smoking is still lacking. The aim of this study is to develop prediction models using machine learning algorithms to predict the outcome of smoking cessation. Data was acquired from patients underwent smoking cessation program at one medical center in Northern Taiwan. A total of 4875 enrollments fulfilled our inclusion criteria. Models with artificial neural network (ANN), support vector machine (SVM), random forest (RF), logistic regression (LoR), k-nearest neighbor (KNN), classification and regression tree (CART), and naïve Bayes (NB) were trained to predict the final smoking status of the patients in a six-month period. Sensitivity, specificity, accuracy, and area under receiver operating characteristic (ROC) curve (AUC or ROC value) were used to determine the performance of the models. We adopted the ANN model which reached a slightly better performance, with a sensitivity of 0.704, a specificity of 0.567, an accuracy of 0.640, and an ROC value of 0.660 (95% confidence interval (CI): 0.617–0.702) for prediction in smoking cessation outcome. A predictive model for smoking cessation was constructed. The model could aid in providing the predicted success rate for all smokers. It also had the potential to achieve personalized and precision medicine for treatment of smoking cessation.

Follicular large-cell lymphoma: intermediate or low grade?

1994 ◽  
Vol 12 (7) ◽  
pp. 1349-1357 ◽  
Author(s):  
N L Bartlett ◽  
M Rizeq ◽  
R F Dorfman ◽  
J Halpern ◽  
S J Horning
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Medical Center ◽  
Performance Status ◽  
Survival Rates ◽  
Large Cell ◽  
Poor Performance Status ◽  
Low Grade ◽  
Curative Intent ◽  
Overall Survival Rates

PURPOSE To evaluate the benefit of anthracycline-based chemotherapy, identify prognostic factors, and determine the value of the International Prognostic Factors Index for patients with follicular large-cell (FLC) lymphoma. PATIENTS AND METHODS This retrospective study includes 96 patients with FLC lymphoma treated at Stanford University Medical Center between 1969 and 1991. Fifty-five patients received doxorubicin plus cyclophosphamide-containing chemotherapy regimens, 21 patients received other chemotherapy regimens, 15 patients received radiotherapy only, and five patients received no initial therapy. Thirty-four patients had stage I or II disease and 62 patients had stage III or IV disease. RESULTS With a median follow-up duration of 5.2 years (range, 1 to 18), the actuarial 5- and 10-year overall survival rates were 75% and 54%, with actuarial 5- and 10-year freedom from progression (FFP) rates of 53% and 42%, respectively. Patients treated with chemotherapy regimens that contained both doxorubicin and cyclophosphamide had a superior actuarial 10-year FFP rate (55% v 25%, P = .06) and overall survival rate (65% v 42%, P = .04) compared with patients treated with other chemotherapy regimens. Only one patient treated with doxorubicin plus cyclophosphamide relapsed after 3 years. In the multivariate analysis, discordant lymphoma and treatment with chemotherapy regimens not containing both cyclophosphamide and doxorubicin predicted for worse FFP and overall survival rates. In addition, poor performance status and increasing areas of diffuse histology predicted for a worse survival, while anemia and male sex predicted for a worse FFP. The age-specific International Index was useful in predicting outcome; however, few patients with FLC lymphoma had high-risk features. CONCLUSION The plateau in FFP implies that patients with FLC lymphoma enjoy sustained remissions after standard anthracycline-based chemotherapy. FLC lymphoma should continue to be approached as an intermediate-grade lymphoma with curative intent.

Alkylator-Based Conditioning for Allogeneic Hematopoietic Stem Cell Transplantation (alloHSCT) in Lymphoma: A Registry Study Comparing Thiotepa-, Busulfan-, Melphalan- and Treosulfan-Containing Regimens On Behalf of the EBMT Lymphoma Working Party

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2033-2033
Author(s):  
Peter Dreger ◽  
Herve Finel ◽  
Renato Fanin ◽  
Paolo Corradini ◽  
Michele Falda ◽  
...  
Keyword(s):  
Cell Lymphoma ◽  
Performance Status ◽  
Conditioning Regimen ◽  
Working Party ◽  
B Cell Lymphoma ◽  
Poor Performance Status ◽  
Unrelated Donor ◽  
Hematopoietic Stem ◽  
Remission Status ◽  
Significant Difference

Abstract Abstract 2033 Background: Thiotepa (TT) is an alkylating agent approved for conditioning for alloHSCT. TT-based alloHSCT has been pioneered in a variety of lymphoma subtypes with promising results, but the available information about the value of thiotepa in this indication compared to other alkylator-based regimens is still limited. Primary objective was to compare the outcome of TT-based alloHSCT with that of alloHSCT conditioned with other alkylator regimens (non-TT) separately for diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), and peripheral T Cell lymphoma (PTCL). Primary endpoint was event-free survival (EFS); secondary endpoints were overall survival, non-relapse mortality (NRM), and relapse incidence. Eligible were patients >18 years who had received TT-, busulfan (BU)-, melphalan- (MEL), or treosulfan- (TREO) based conditioning for T-replete alloHSCT between 2003–2010 for FL, DLBCL, or PTCL. Statistical analysis was based on multivariable comparisons using stratified Cox and Fine & Gray regression models. Results: 201 patients with TT fulfilled the inclusion criteria and were compared with 578 non-TT patients (BU 55%, MEL 35%, TREO 10%). The most frequently used specific regimens were TT-cyclophosphamide combinations (75%) in the TT group and BU-fludarabine combinations (52%) in the non-TT group. Of the total 779 patients, 43%% had FL, 39% DLBCL, and 18% PTCL. TT and non-TT patients were comparable for age, sex, time from diagnosis, remission status at HSCT, and proportion of unrelated donor transplants. However, the TT group contained significantly more patients with PTCL (24% vs 15%), with poor performance status (PS; 12.5% vs 3%), and with BM as HSCT source (14% vs 9%). By multivariate comparisons considering conditioning, age, sex, remission status, PS, and time from diagnosis, EFS was significantly affected by active disease at HSCT and poor PS in all three lymphoma subtypes. In contrast, conditioning with TT had no significant impact (Hazard ratio (HR) 1.06 (0.67–1.67) for FL; 1.01 (0.67–1.51) for DLBCL; 1.33 (0.75–2.36 for PTCL) on EFS or any other endpoint. Similar results were seen when the analysis was broken down to specific conditioning regimens (TT-CY vs BU-based). MEL- and TREO-based regimens did not show a significant difference compared to BU for any endpoint. Conclusions: This study failed to identify significant outcome differences between the four conditioning regimen types tested. However, the limitations inherent to registry analyses have to be considered. In particular, conclusions on differential regimen toxicity apart from NRM will require additional, ideally prospective studies. Disclosures: Dreger: Riemser G, Greifswald, Germany: Consultancy, Honoraria, Research Funding. Off Label Use: Treosulfan for conditioning for allogeneic HSCT. Schmitz:Riemser AG, Greifswald, Germany: Honoraria.

Predicting survival in resected pancreatic cancer: A Canadian provincial experience.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 361-361
Author(s):  
Gillian Gresham ◽  
Sylvia Ng ◽  
Anderson Chang ◽  
Shannon Valdez ◽  
Sharlene Gill
Keyword(s):  
Pancreatic Cancer ◽  
Histological Grade ◽  
Performance Status ◽  
Poor Performance ◽  
Poor Performance Status ◽  
Significant Difference ◽  
Cancer Agency ◽  
Trial Outcomes ◽  
Grade 3 ◽  
Poor Outcomes

361 Background: Surgical resection offers the only hope for long-term disease control in patients (pts) with pancreatic adenocarcinoma. Randomized trials (ESPAC 1, ESPAC3) further support a role for adjuvant chemotherapy (AC) in the management of pancreatic cancer (PC). Trial outcomes may not reflect clinical reality due to pt selection bias, and it is often difficult to predict which pts are most likely to benefit from adjuvant intervention. Methods: Consecutive pts between 2003 and 2008 referred to the BC Cancer Agency (BCCA) with operative intent at diagnosis (dx) were retrospectively reviewed. Results: 145 pts were identified; median age 65 years (y) (range 38-84), male/female (45.5%, 54.5%). EUS/PET staging was performed in 21% of pts. Median CA19-9 value at dx was 210 ku/L. Pancreaticoduodenectomy was performed in 65% of pts. Complete resection (RO) of tumours occurred in 87 pts (60%) overall. 66% of pts were node positive. 43% of pts were subsequently treated with adjuvant therapy (AT) where 5% of these pts received chemoradiotherapy and 95% received AC (65% gemcitabine). There was no statistically significant difference in either OS (p=0.39) or DFS (p=0.28) amongst resected pts who were treated by sx alone versus pts who received AC. In subgroup analysis, AC was associated with significantly improved OS in pts (n=58) with positive margins (R1) (median 17.3 mos vs 8.9 mos, p=0.0045) but benefit was not seen in R0 pts (n=87) (22.9 mos vs 22.4 mos, p=0.20). In multivariate analysis, poor performance status (ECOG 3-4), weight loss of more than 10% of initial body weight, baseline CA19-9 value greater than 210 ku/L, positive nodes, R1 status and histological grade 3-4 were significant adverse prognostic factors. Conclusions: PC continues to have poor outcomes with a 5yOS of 5% in pts treated with sx alone. Among pts with resectable PC treated at the BCCA, AC tended towards increased DFS and OS. Although R1 status was associated with inferior OS, the benefit of AT was greater in this subgroup. [Table: see text]

The impact of steroid use on efficacy of immunotherapy among patients with lung cancer who have developed immune-related adverse events.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e20583-e20583
Author(s):  
Kazushige Wakuda ◽  
Taichi Miyawaki ◽  
Eriko Miyawaki ◽  
Nobuaki Mamesaya ◽  
Takahisa Kawamura ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Adverse Events ◽  
Checkpoint Inhibitors ◽  
Smoking Status ◽  
Performance Status ◽  
Objective Response ◽  
Systemic Steroid ◽  
Steroid Group ◽  
Significant Difference ◽  
The Impact

e20583 Background: Systemic steroids use before starting immune checkpoint inhibitors (ICI) has negative impacts on survival. The aim of this study was to evaluate whether steroid against immune-related adverse events (irAE) reduces efficacy in patients with non-small cell lung cancer (NSCLC). Methods: We retrospectively reviewed patients who had advanced NSCLC and undergone ICI therapy between December 2015 and June 2018. Patients whose irAE was treated with ≥ 10mg/day of predonisone were classified into steroid group (S), otherwise into non-steroid group (N). Results: A total of 257 patients (pts) were treated with ICI and irAEs was observed in 103 pts (40%). Twenty-eight pts were S-group and 75 patients were N-group. There was no significant difference in age, sex, stage, performance status, histology, smoking status, gene alteration, expression of PD-L1, or treatment line between the groups. Main irAEs included pneumonitis (43% in S-group / 12% in N-group), diarrhea or colitis (25% / 9%), rash (21% / 20%), and hypothyroidism (14% / 37%). Grade 2 or higher irAEs were pneumonitis in 39% / 0%, diarrhea or colitis in 21% / 5%, hypothyroidism in 7% / 19%. Among S-group, steroids were used for pneumonitis in 11 pts, diarrhea or colitis in 7 pts, stomatitis in 2 pts, and rash in 2 pts. There was no significant difference in overall survival (median; 14.5 vs 30.0 months, P = 0.30, Hazard ratio, 0.69), progression-free survival (median; 7.8 vs 9.6 months, p = 0.11, Hazard ration, 0.65), and objective response rate (46% vs 41%, p = 0.64), respectively. Conclusions: Systemic steroid was mainly used in pts with ≥Gr2 pneumonitis or colitis. This study indicated that steroids use did not reduce efficacy of ICI. Thus, steroid should not be avoided in patients with moderate to severe irAEs with concern over reducing efficacy.

Neoadjuvant cisplatin-based chemotherapy in patients with ureteral obstruction secondary to muscle invasive bladder cancer.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 523-523
Author(s):  
Marshall Strother ◽  
Alexander Kutikov ◽  
Bianca Lewis ◽  
Mengying Deng ◽  
Elizabeth A. Handorf ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Ureteral Obstruction ◽  
Smoking Status ◽  
Performance Status ◽  
Categorical Variables ◽  
Ecog Performance Status ◽  
Significant Difference ◽  
Group A ◽  
Muscle Invasive ◽  
Group B

523 Background: Neoadjuvant cisplatin-based chemotherapy (NAC) followed by cystectomy is the standard of care for muscle-invasive urothelial bladder cancer (MIBC). 15-35% of MIBC patients present with ureteral obstruction. Poor renal function increases cisplatin toxicity. It is unknown whether patients with ureteral obstruction which has been relieved (whether by nephrostomy tube or nephroureteral stent) have the same risk of toxicity as patients without ureteral obstruction. Methods: We retrospectively reviewed an institutional database of all patients undergoing NAC for MIBC with either dose dense MVAC (ddMVAC) or gemcitabine and cisplatin (GC) from January 2004 through May 2017. Patients without ureteral obstruction prior to initiation of NAC (Group A) were compared to those who had ureteral obstruction which was relieved prior to undergoing NAC (Group B). Continuous variables were compared using the Wilcoxon rank-sum test and categorical variables were compared using Fisher’s exact test. The primary outcome was premature discontinuation of NAC, which was defined as failure to complete all planned cycles. Logistic regression was used to test for differences between the groups in this outcome adjusting for age, ECOG performance status, and baseline glomerular filtration rate (GFR). Results: 160 patients in Group A and 59 patients in Group B were identified. Baseline age, Charlson Comorbidity Index, race, smoking status, and ECOG performance status were similar. Patients in Group B had lower GFR (99.2% vs 78.8% p <0.001) and were more likely to be female (21.9% vs 27.3% p <0.025) and to receive ddMVAC (65.0% vs. 83.1% p =0.012). There was no significant difference between groups in rates of premature NAC discontinuation (15.8% vs 22.0% p = 0.284) or grade ≥3 adverse events (23.4% vs 30.5% p = 0.285). Adjusted analysis showed no significant difference between the groups in frequency of premature NAC discontinuation (OR 1.96, 95% CI 0.84-4.57 p=0.12). Conclusions: We detected no difference in frequency of premature discontinuation of NAC in patients with relieved malignant ureteral obstruction relative to patients without obstruction. NAC for MIBC is likely safe in this population.

Cigarette Smoking Status and Smoking Cessation Counseling of Chinese Physicians in Wuhan, Hubei Province

2008 ◽  
Vol 20 (3) ◽  
pp. 183-192 ◽  
Author(s):  
Han Zao Li ◽  
Weixing Sun ◽  
Fangmei Cheng ◽  
Xiangrong Wang ◽  
Weiping Liu ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Cigarette Smoking ◽  
Smoking Status ◽  
Female Physicians ◽  
Smoking Cessation Counseling ◽  
Cigarette Smokers ◽  
Perceived Success ◽  
Quit Smoking ◽  
Current Cigarette ◽  
Chinese Physicians

Among the 347 physicians surveyed, 58% of the male physicians and 18.8% of the female physicians were current cigarette smokers; 54.4% of the male and 70.4% of the female physicians often or always provided smoking cessation counseling for patients; 37.5% of the physicians thought that for a Chinese smoker, cigarette smoking served as a social lubricant; 31.5% thought it a habit; 21.7% thought it a stress reliever; and 9.2% thought it a social status symbol. The following 5 variables were significantly associated with physicians' smoking cessation counseling frequency: their smoking status, perceived success in their past counseling, perceived influence, perceived exemplary role, and perceived responsibility. To increase physicians' smoking cessation counseling, the Chinese Ministry of Health would need to discourage physicians to smoke and appeal to their sense of responsibility to help patients quit smoking.

scholarly journals The Effects of Smoking-Cessation Counseling Based on the Stages-of-Change Model in Dental Patients; Semi-Experimental Study

2019 ◽  
Author(s):  
Zahra Ghorbani ◽  
Arezoo Ebn Ahmady ◽  
Zahra Hosseini ◽  
Somayyeh Azimi
Keyword(s):  
Smoking Cessation ◽  
Stages Of Change ◽  
Intervention Group ◽  
Dental Student ◽  
Control Group ◽  
Smoking Cessation Counseling ◽  
Dental Patients ◽  
Significant Difference ◽  
And Control

Abstract Background Dentists may take part in smoking cessation counseling of dental patients by using the time they are engaged in dental procedures and by emphasizing on oral manifestations of smoking. The present study aimed to evaluate the effects of smoking cessation counseling by a dentist on preparation for change to quit smoking in smoker patients. Methods This study was performed on 150 smoking patients admitted to Dental School of Shahid Beheshti University of Medical sciences, Tehran, Iran. The patients were randomly divided into two groups of 75 patients. The intervention group received smoking cessation counseling by a single senior dental student. A self-administered questionnaire containing questions regarding the position of the individual in change cycle stages was completed by both intervention and control group at baseline and at one-month follow up. For statistical analysis, paired t-tests, Mann-Whitney U and multivariate linear regression models was used with a significance level of P<0.05. Results At baseline, there were no significant differences between the intervention and control groups in terms of change cycle stages of smoking cessation. Also, there was no significant difference between change cycle stages at baseline and one-month follow up in control group; but this difference in intervention group was significant (p=0.006). The proportion of patients in the pre-contemplation stage decreased by 43% while the proportion of patients in the contemplation and action stages increased by 20% and 16% respectively. Conclusions The smoking cessation counseling enhances forward movement through the stages-of-change of smoking cessation. Measurement of this movement may be an important intermediary in evaluating small clinical trials of counseling.

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