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Matthew A Steliga
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MA 18 - Global Tobacco Control and Epidemiology II (ID 676)
- Event: WCLC 2017
- Type: Mini Oral
- Track: Epidemiology/Primary Prevention/Tobacco Control and Cessation
- Presentations: 1
- Moderators:H. Kawai, Christian Klaus Manegold
- Coordinates: 10/17/2017, 15:45 - 17:30, Room 511 + 512
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MA 18.02 - Outcomes of Integrating Smoking Cessation Counseling in a Lung Screening Program (ID 8575)
15:45 - 17:30 | Presenting Author(s): Matthew A Steliga
- Abstract
- Presentation
Background:
The National Lung Screening Trial demonstrated that lung screening reduces lung cancer mortality. In our lung screening program, the incidence of lung cancer is a small percentage (2.3% (10/440)). A more common, treatable, and potentially overlooked condition in this population is nicotine addiction (70.2% smoking (309/440) in our program). It has been widely postulated that lung cancer screening provides a “teachable moment” for smoking cessation. Smoking cessation counseling has been integrated in our lung cancer screening program since 2014. The goal is to report outcomes of integrating smoking cessation in the lung screening program.
Method:
In our lung screening program, all scheduling is done by a single coordinator who is both a Nurse Practitioner and a Certified Tobacco Treatment Specialist (CTTS). A call to schedule the scan is done and initial basic tobacco cessation intervention is integrated into every call. Further follow up as in depth face-to-face counseling is offered at the point of the scan, by the coordinator or other CTTS. Tobacco cessation follow up may be further integrated into telephone calls to give patients screening results. Patients noted to be smoking at the time of the screen (n=103) were surveyed by telephone by a researcher to determine whether they had quit smoking, reduced, or made no changes. Further chart review yielded 107 additional patients unable to be reached by the researcher, but data regarding smoking was available from medical records.
Result:
Of the patients able to be contacted by telephone, 11.7% (12/103) quit smoking, 53.4% (55/103) had reduced the amount they were smoking, and 35.0% (36/103) had made no changes. Additional chart review yielded 107 patients screened and 14.0% (15/107) had documented cessation at least one year after screening.
Conclusion:
Integration of tobacco cessation counseling into our lung screening program led to an overall quit rate of 12.9% (27/210) and of those interviewed, 60.4% (55/91) of those who did not quit, reduced the amount that they smoked. While this may sound modest, this population is heavily addicted, and unaided cessation has poor success rates, often cited as less than 4%. This supports integration of cessation counseling as a potential model for improving smoking cessation in the lung screening population. Further work with integrating pharmacotherapy and more frequent regular follow up may yield even higher success rates.
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MS 09 - Global Perspectives in Eliminating the Major Cause of Lung Cancer (ID 531)
- Event: WCLC 2017
- Type: Mini Symposium
- Track: Epidemiology/Primary Prevention/Tobacco Control and Cessation
- Presentations: 1
- Moderators:Carolyn Dresler, William Kenneth Evans
- Coordinates: 10/16/2017, 15:45 - 17:30, Room 315
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MS 09.04 - Nicotine Dependence and Cessation in Lung Cancer Patients (ID 7685)
15:45 - 17:30 | Presenting Author(s): Matthew A Steliga
- Abstract
- Presentation
Abstract:
Tobacco use is well known as a carcinogen linked to many malignacies and also linked to non-oncologic diseases such as cardiovascular disease, chronic lung disease, and respiratory infections. The majority of lung cancer patients do have a history of smoking; often many are actvely smoking at the time of diagnosis and many struggle with cessation during treatment and through survivorship. Patients may have a perception of futility and lack of perceived benefit regarding cessation, and some clinicians may view tobacco cessation with a pessimistic perspective in that "the damage is already done." One of the first steps toward cessation in lung cancer patients is to make patients, families, and physicians aware of the continued harms of smoking, the negative impact on efficacy of treatment, and for those who may be treated with curative intent, the potential for development of malignacy in the future. As the potential benefits range widely and may apply differently to different patients, the ability to individualize a message regarding relevant positive impacts of cessation is crucial. For cancer patients overall, there is survival advantage in those who are able to quit, compared to continued smoking. Nicotine and its metabolic products can promote tumor growth through increased proliferation, angiogenesis, and other pathways. Furthermore, nicotine can decrease the biologic effectiveness of conventional cancer treatments such as chemotherapy and radiotherapy. For patients undergoing surgery, smoother recovery and avoidance of perioperative complications such as respiratory infection, wound complications, and perioperative cardiovascular events is critical. For those treated with curative intent, continued smoking can clearly be a significant risk factor for metachronous lung cancer, or development of different primary tumors. Even in those with incurable disease, overall survival benefit of cessation has been demonstrated. In addition, many patients with lung cancer and a smoking history have significant burden of respiratory symptoms, including dyspnea, wheezing, exercise intolerance, cough, pneumonia, etc. From a palliative standpoint, cessation can ameliorate some of the respiratory symptoms, and improve quality of life. Physician advice is a powerful tool and should be part of every encounter. Ask-Advise-Refer is a simple standard strategy which can be integrated into even the busiest of workflows. This involves asking every patient about tobacco use, advising cessation and referral to a tobacco treatment resource. That resource may be a Certified Tobacco Treatment Specialist, a telephone counseling service (such as a 'quitline'), a group counseling setting or other specialist. A more indepth cessation strategy involves the "5 As": Ask, Advise, Assess, Assist, Arrange. In addition to asking every patient about use and advising them to stop, a physician should Assess their use, prior quit attempts, and willingness to make a quit attempt. Then a provider should Assist the patient with their quit attempt with counseling and pharmacotherapy. Motivational interviewing is a standard counseling strategy in which a process of questioning and interviewing which strengthens and engages intrinsic motivation within the patient in order to change behavior. Pharmacotherapy consists of nicotine replacement therapy, varenicline, and/or buproprion. Previous concerns regarding severe psychiatric side effects such as suicidal ideation with varenicline have made some patients and physicians wary to use it; however, a recent trial shows varenicline to be very safe with no higher incidence of psychiatric side effects than placebo. Nicotine replacement therapy (NRT) can be delivered in a slow continuous format via a nicotine patch, and/or via short acting NRT such as gum, lozenges, nasal spray, or prescription inhaler. Often times a long acting modality (nicotine patch) can be used in combination with a short acting NRT as combination therapy. Overall pharmacotherapy increases success of quit attempts, and should be integrated as a part of the patient's overall healthcare plan. Often times the choice of pharmacotherapy is guided by what has or has not worked for that patient in the past. Electronic Nicotine Delivery Systems (ENDS) or e-cigarettes have recently become widespread and commonly available in many countries. The nicotine content is widely variable, and other componenets of the vaporised liquid make comparison and quantification much more difficult than that for approved pharmacotherapy where dosing is consistent and predictable. It is true that ENDS may not contain the same level of carcinogens as cigarettes, but in reality many users of ENDS are not able to quit conventional cigarettes, but use ENDS when not able to smoke and then use conventional cigarettes when they can smoke. At current, data is lacking and does not support e-cigarettes above approved pharmacotherapy. For those patients who are using e-cigarettes, the primary goal to complete cessation of conventional cigarettes. Patients who are using e-cigarettes and unable to quit smoking should be steered toward approved pharmacotherapy. Multiple different strategies exist to support patients during cessation attempts. There is no universally applicable single way to approach cessation. Counseling and pharmacotherapy are mainstays of cessation support and best outcomes result from using them together. A concerted, consistent message combined with appropriate pharmacotherapy and counseling may help many patients with lung cancer to quit smoking and gain the benefits of cessation.
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
