Researchers from the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis found that a patient-targeted program for smoking cessation treatment while in a cancer care clinic involves multiple cancer patients in such treatment than with previous methods. The program also helps more cancer patients to successfully quit, and its costs are lower than previous methods of sending cancer patients to specialists.
The results are published in the May issue of Journal of the Comprehensive National Cancer Network.
The same research team found that even after a cancer diagnosis, quitting smoking doubles the survival rate and reduces the risk of cancer recurrence, regardless of the stage of cancer at which a patient is able to quit smoking cigarettes.
“The key thing is that treatment is offered on-site,” said first author Alex T. Ramsey, PhD, assistant professor of psychiatry. “Past care tended to rely on referrals to specialists, requiring patients to make appointments at a different clinic. This creates obstacles involving time and transportation. When we built this program, we kept those barriers to treatment in mind, understanding that for a program like this to be sustainable and reach a large number of people, it should be fully integrated into the care patients already receive. “
The researchers used electronic health records to determine which Siteman’s patients were smokers. Then, while the patients were in the clinic to see oncologists, nurses and medical assistants offered patients help with quitting smoking. This strategy increased the percentage of patients receiving smoking cessation treatment from approximately 2% at the start of the study to nearly 30%. Additionally, the number of patients who successfully quit smoking increased from around 12% to over 17%.
Ramsey said the ultimate goal is to make evidence-based tobacco treatment available to all cancer patients who smoke. And senior researcher Li-Shiun Chen, MD, said the best way to do this is to incorporate tobacco treatment into the point of care via electronic health record support.
“We collect information before a patient arrives at the clinic so that we can maximize what is offered to them when they arrive,” said Chen, an associate professor of psychiatry. “A visit to the cancer center is very demanding for patients and providers, but by using health information and technology tools to know who smokes and to offer those patients tobacco treatment options, we are saving time, money and, above all, lives. “
The program offered through the Siteman Cancer Network is also proving less expensive than previous approaches.
“The cost of past tobacco treatment strategies averaged about $ 500 per patient in national cancer centers, but with the ability to offer treatment to patients while they are already in the clinic, we have lowered the cost per patient to about $ 70.” , Chen said.
Patients are offered access to telephone or text counseling, an app designed to help them quit, referral to a smoking cessation group, and evidence-based medication to support quit attempts. Pharmacists are available to ensure that all prescribed smoking cessation medications are safe to use alongside chemotherapy.
“Traditionally, there have been three pillars of cancer treatment,” Ramsey said. “Now, along with surgical treatment, radiotherapy and chemotherapy, we believe that smoking cessation treatment can be recognized as a fourth pillar of cancer care.”
Ramsey and Chen plan to expand their efforts, both within the Siteman Cancer Network and by sharing their strategies with providers of other cancer centers. And they are continuing to focus on personalized care recommendations, even for patients at risk for lung cancer.
Lung cancer remains the deadliest form of cancer: over 80% of lung cancers and lung cancer deaths are caused by cigarette smoking. A new $ 2.8 million grant from the National Cancer Institute will help researchers investigate whether personalized risk feedback tools, including patient-specific genetic risk results provided to patients and their primary care physicians, could lead to more frequent lung cancer screening and use of smoking cessation treatments, as well as opportunities to detect lung cancers at earlier and more treatable stages.
“We want to help more patients quit smoking, both those diagnosed with cancer and those not diagnosed with cancer,” Ramsey said. “We want to bring high-quality tobacco processing to the point of care and ensure that we have systems in place so that everyone in need of treatment has access. With that increase in scope, we think we will see smoking cessation rates rise as well and that should improve cancer outcomes going forward. “
Ramsey AT, Baker TB, Stoneking F, Smock N, Chen J, Pham G, James AS, Colditz GA, Govindan R, Bierut LJ, Chen LS. Increased reach and effectiveness with a low-load point-of-care tobacco treatment program in cancer clinics. Journal of the Comprehensive National Cancer NetworkMay 11, 2022.
This work is supported by the National Cancer Institute, the National Institute on Drug Abuse, and the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH). Grant Numbers P30 CA091842-16S2 (Moonshot Cancer Tobacco Cessation Supplement), P50 CA244431, P30 CA091842, K12 DA041449, R34 DA052928, UL1 TR002345, R01 DA038076, with additional funding from the Siteman Investment Program.
The 1,700 physicians of Washington University’s medical school are also the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is a leader in medical research, teaching and patient care and is currently the No. 4 in research funding from the National Institutes of Health (NIH). Through its affiliations with Barnes-Jewish Children’s Hospitals and St. Louis Children, the School of Medicine is linked to BJC HealthCare.
Journal of the Comprehensive National Cancer Network
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