Program cuts smoking among people getting cancer treatment

A new program is helping patients undergoing cancer treatment quit smoking, research shows.

When patients who smoke begin cancer treatment at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis—or at any of Siteman’s satellite locations—they also now receive advice about quitting smoking, referrals to easy-access smoking-cessation services and, if suitable, prescriptions for medications that aid in kicking the habit.

Those early-intervention steps are yielding promising results, according to the study in Translational Behavioral Medicine. When patients with cancer quit smoking, it can prolong life, and prevent recurrence and the advent of secondary cancers.

Success in quitting smoking

The program saw nearly twice as many cancer patients get assessed for their smoking status. In the five months before the program launched, doctors asked some 48% of the more than 34,000 patients getting treatment at Siteman whether they smoked. This compares with 90% of the more than 24,000 patients who doctors asked about smoking in the five months after the program began.

The percentage of patients referred to treatment also increased. In the five months before launch, only .72% of smokers were referred to behavioral counseling, and only 3% were prescribed medication to help them quit. In the months after the program began, the percentage of patients doctors referred to counseling nearly tripled to 1.91%, and the percentage of smokers prescribed medication to help them quit increased almost fivefold to 17%.

“This is a paradigm shift from the more traditional approach, in which we would refer cancer patients to specialists and hope these very sick patients would find the time, the motivation, and the transportation to get help from such a specialist,” says first author Alex T. Ramsey, assistant professor of psychiatry.

“Helping cancer patients quit smoking is one of the most important things we can do. So it’s important we provide smoking-cessation treatment in ways our patients can take advantage of.”

When the program launched in 2018, the smoking rate among adults in Missouri was 22%; in Illinois, the rate was 16%. But among patients from those two states who got treatment at Siteman, 23% were smokers.

Ramsey says it’s too early to tell how many of the smokers in the program have kicked the habit. It’s also not possible to tell yet which specific approaches to quitting work best.

“It takes most people several attempts before they quit smoking successfully,” he says. “The key now is to keep providing opportunities to quit and offering new approaches when a quit attempt fails. Our next step will be to go back and look at which types of treatment work best.”

A promising first step

The key, according to the project’s principal investigator, Li-Shiun Chen, an associate professor of psychiatry and a research member at Siteman, is to remind patients and doctors that even very sick cancer patients can improve their health if they quit or cut back on tobacco use.

“Quitting smoking ensures the best treatment outcomes for people with cancer,” says Chen. “Our idea is to find out which patients are smokers and to offer assistance to every single one of them.”

Chen and Ramsey expect that as the months and years pass, and more people get medication or counseling to help them quit, the number of ex-smokers seen at Siteman will rise, and outcomes for those patients will improve. Now, however, the program is in its infancy, Ramsey says.

“It’s very promising, but it’s only a first step,” he says. “We doubled assessment rates, and we saw five times more people taking medication to stop smoking. On the other hand, the absolute numbers are still smaller than we’d like. But this study assessed the first five months of the program, and we’re continuing to improve and extend our ability to reach more patients. I think that bringing this treatment support to clinics and hospital settings, at a time when patients are highly motivated to quit smoking, is going to pay big dividends.”

The researchers benefited from a new electronic medical records system in launching the program. Using that same system, they plan to continue expanding their efforts to assess and treat patients, and to expand their efforts to other clinics.

The National Cancer Institute’s Cancer Center Cessation Initiative funds the program. In 2018, the researchers received a grant to fund the interventional approach as part of the Cancer Moonshot Initiative. Support for the research came from the National Cancer Institute, the National Institute on Drug Abuse, and the National Center for Advancing Translational Sciences of the National Institutes of Health.

Source: Washington University in St. Louis

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