Smoking Cessation Program in Cancer Setting Associated With High Abstinence Rates

The availability of comprehensive tobacco treatment in the oncology setting was associated with sustained high abstinence rates among patients with cancer and cancer survivors, according to results of a prospective study published in JAMA Network.

Researchers evaluated a prospective cohort of smokers who were treated in a tobacco treatment program (TTP) at a comprehensive cancer center between January 1, 2006, and August 31, 2015. They sought to describe a potential model TTP that was implemented in an oncologic setting, to report on its long-term outcomes, and to highlight its importance regarding quality care among patients with cancer. Data analysis in the prospective cohort of patients being investigated was conducted between November 2017 and December 2018.

A total of 3245 individuals participated in the study, 2343 of whom had a current diagnosis of cancer, 309 with prior cancer, and 593 with no history of cancer, all of whom were obtained from a population of 5061 smokers who had been referred to treatment in the TTP. The treatment included an in-person medical consultation, 6 to 8 in-person and telephone follow-up counseling sessions, and 10 to 12 weeks of pharmacotherapy. Study exclusion criteria were follow-up for a noncancerous condition, no medical consultation, smoking <1 cigarette per day, or death prior to the 9-month follow-up.

The primary study outcome was the 9-month 7-day point-prevalence abstinence assessed via use of time-specific (3-, 6-, and 9-month follow-ups) and longitudinal covariate-adjusted and unadjusted regression models. The Fagerström Test for Cigarette Dependence was utilized as a measure of dependence (range, 0-10, with higher numbers representing greater dependence).

Of the 3245 smokers who participated, 1588 were men, 322 were of black race/ethnicity, 172 were of Hispanic race/ethnicity, and 2498 were of white race/ethnicity. The mean participant age was 54±11.4 years. The mean number of cigarettes smoked per day was 17.1±10.7, the mean Fagerström Test for Cigarette Dependence score was 4.41±2.2, and the mean number of years having smoked was 33±13.2 years. Overall, 1393 of the patients had ≥1 psychiatric comorbidity.

Self-reported abstinence was 45.1% at 3 months, 45.8% at 6 months, and 43.7% at

9 months for the multiply imputed data (which were averaged over 10 imputed datasets). Moreover, results across all models were consistent, implying that compared with smokers who had no history of cancer, abstinence rates in this TTP program did not differ significantly among smokers who had current cancer, were cancer survivors, or had smoking-related cancers. Patients with head and neck cancer, however, were among patients with the highest abstinence rates, with the rates in this population significantly higher at 9 months (relative risk [RR], 1.31; 95% CI, 1.11-1.56; P =.001) and in longitudinal models (RR, 1.24; 95% CI, 1.08-1.42; P =.002).

The investigators concluded that the findings suggest that offering comprehensive tobacco treatment in the cancer setting can be associated with sustained high abstinence rates among all patients with cancer and cancer survivors, and should be included as a standard of care to ensure the best possible treatment outcomes in patients with cancer.

Reference

Cinciripini PM, Karam-Hage M, Kypriotakis G, et al. Association of a comprehensive smoking cessation program with smoking abstinence among patients with cancer.JAMA Netw Open. 2019;2(9):e1912251.