ASPO Abstracts
Nurse-facilitated tobacco treatment in cancer patients who smoke
Category: Lifestyles Behavior, Energy Balance & Chemoprevention
Conference Year: 2020
Abstract Body:
Purpose: To determine the effectiveness of a clinic-wide intervention on the delivery of
tobacco cessation counseling and use of pharmacotherapy in patients with cancer.
Methods: We conducted a pragmatic implementation trial with a before-after design in
119 current or recently quit smokers who received care at a single NCI-designated
comprehensive cancer center (n=61 pre-intervention, n=58 post-intervention). Adult
patients (pts) with a confirmed diagnosis of cancer who smoked > 1 cigarette per day (or
who quit smoking within the past 30 days) and had a scheduled appointment with an
oncologist (index visit) were eligible, regardless of their readiness to quit. Building on the
Chronic Care Model, we used the following strategies to implement the National
Comprehensive Care Network (NCCN) guidelines for smoking cessation: 1) Training
nursing staff to provide brief cessation counseling (Ask-Advise-Refer approach), 2)
creating a best practice advisory to facilitate referral to an on-site certified tobacco
treatment specialist (TTS), 3) delivering intensive tobacco cessation counseling (with up
to 6 follow-up calls), 4) setting up quick orders for prescribing tobacco cessation
pharmacotherapy, and 5) practice facilitation by a nurse champion. We conducted exit
interviews to assess delivery of smoking cessation counseling (5 A’s, ask-advise-assess-
assist-arrange follow-up) during the index visit and interviewed pts by phone to assess
use of pharmacotherapy to quit smoking and whether they had discussed smoking
cessation with a healthcare professional during 3-mo follow-up. Performance of the 5 A’s
was compared across the pre- and post- intervention periods using logistic regression,
accounting for clustering by nursing staff. Results: More patients had received any
assistance in quitting during the intervention period compared to the pre-intervention
period (30 vs. 10%, p<.01). At 3-month follow-up, 56 and 32% of participants had
discussed smoking cessation with a healthcare professional (p=.02), and 59 and 27% of
participants had used pharmacotherapy (p<.01), respectively. Conclusions: A multi-
component tobacco treatment intervention increased the proportion of smokers who
received elements of guideline-recommended tobacco treatment during usual cancer
care.
Keywords: smoking cessation, counseling, drug therapy, practice guideline, cancer care facilities