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Rebecca Truscott



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    OA09 - Prevention and Cessation (ID 909)

    • Event: WCLC 2018
    • Type: Oral Abstract Session
    • Track: Prevention and Tobacco Control
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 15:15 - 16:45, Room 205 BD
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      OA09.01 - 5As to 3As: Evolution of the Systematic Approach to Smoking Cessation in Ontario’s Regional Cancer Centres (ID 14066)

      15:15 - 15:25  |  Author(s): Rebecca Truscott

      • Abstract
      • Presentation

      Background

      Smoking is responsible for approximately 30% of all cancer deaths in Canada, and more than 85% of lung cancer cases. Cancer patients who continue to smoke experience decreased treatment efficacy and safety, increased toxicities, greater risk of cancer recurrence and second primaries, poorer quality of life, and decreased survival. Evidence suggests that quitting smoking after diagnosis can significantly reduce these adverse effects. In 2012, Cancer Care Ontario (CCO) introduced a Framework for Smoking Cessation to be implemented across the province’s 14 Regional Cancer Centres (RCCs). In 2017, the Framework was revised from a 5As (Ask, Advise, Assess, Assist, Arrange) to a 3As (Ask, Advise, Act) brief intervention model.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The transition to a 3As model was based on emerging evidence, feedback from CCO’s Smoking Cessation Advisory Committee and Regional Smoking Cessation Champions, as well as learnings from a preliminary program evaluation. The revised Framework recommended an “opt-out” approach to referring smokers to cessation services. Following an environmental scan and site visit with each RCC to assess the current state, site-specific action plans were developed to promote alignment with the revised Framework. Action steps were given priority ratings in the areas of data capture, referrals, and resources. Two phone calls were held with each RCC to monitor progress on action plan implementation. Knowledge translation resources were created to support healthcare providers’ uptake of the 3As model.

      4c3880bb027f159e801041b1021e88e8 Result

      Smoking cessation interventions are often perceived by health care providers as time-consuming; the 3As model made the intervention briefer but no less effective. Over 3,000 knowledge translation resources were distributed to support healthcare providers working directly with cancer patients, including pocket cards and posters with suggested scripts. While the revised Framework officially launched in April 2018, early adopters of the 3As model and opt-out approach have seen improved performance on the Accepted a Referral indicator (proportion of smokers who accepted a referral to cessation services). In 2017, one RCC’s rate tripled from 10.1% to 30.9% in 6 months, while another improved from 13.2% to 36.9% in the same period.

      8eea62084ca7e541d918e823422bd82e Conclusion

      To improve program effectiveness, CCO’s smoking cessation initiative transitioned from a 5As to a 3As model and an opt-out referral process. Frontline staff have indicated a willingness to adopt the simplified approach, and early results show a promising increase in the number of smokers who are connected to smoking cessation services.

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      Information from this presentation has been removed upon request of the author.

      Information from this presentation has been removed upon request of the author.

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    P2.10 - Prevention and Tobacco Control (Not CME Accredited Session) (ID 959)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.10-02 - Variations in Smoking Cessation Activities at Ontario’s Regional Cancer Centres (ID 14104)

      16:45 - 18:00  |  Author(s): Rebecca Truscott

      • Abstract
      • Slides

      Background

      Tobacco use is the largest preventable cause of cancer and cancer mortality, with approximately 85% of lung cancers resulting from smoking. In 2012, Cancer Care Ontario (CCO) developed a smoking cessation (SC) initiative for cancer patients across the province’s 14 Regional Cancer Centres (RCCs). The purpose of this analysis was to examine variations in the rates of screening for tobacco use and SC referrals for lung and non-lung cancer patients in Ontario RCCs.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A descriptive analysis was conducted on data submitted to CCO from 14 RCCs on their SC activities among new ambulatory cancer patients in 2017. Data were aggregated and cleaned resulting in 64,635 patient records; two SC performance indicators (Tobacco Screening and Accepted a SC Referral) were calculated by RCC, for lung and non-lung cancer patients.

      4c3880bb027f159e801041b1021e88e8 Result

      In 2017, 67.8% of all new cancer patients in Ontario were screened for tobacco use (70.2% of lung cancer and 67.5% of non-lung patients). Screening rates for all cancer patients ranged from 51% to 96% across RCCs, with similar ranges for lung and non-lung patients. Within the RCCs, the screening rate differed by up to 12% between lung and non-lung cancer patients. Approximately 17% of all new cancer patients (15% of non-lung patients), seen at RCCs, were identified as current or recent smokers (smoked within the past 6 months), but the proportion was higher among patients with lung cancer at 37%. Overall, 21.5% of all smokers accepted a SC referral (23.7% lung cancer and 20.9% non-lung patients). Rates ranged from 9% to 43% for all cancer patients, with similar ranges observed across patient groups. Within the RCCs, differences of up to 17% were observed in SC referral acceptance rates between lung and non-lung cancer patients. For both the screening and accepted a referral metrics, the direction of the differences was inconsistent, with higher rates observed in lung cancer patients at some RCCs and lower rates at others.

      8eea62084ca7e541d918e823422bd82e Conclusion

      In Ontario, more than twice as many lung cancer patients were smokers compared to non-lung cancer patients. Although aggregate provincial Tobacco Screening and Accepted a SC Referral rates showed little difference between these patient groups, large variations in rates for both metrics were observed in RCCs between lung and non-lung patients. Further research is necessary to understand the underlying factors that might be contributing to these wide differences in screening and referral practice.

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