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Nicholas D Tingquist
OA09 - Lung Cancer: A Preventable Disease? (ID 134)
- Event: WCLC 2019
- Type: Oral Session
- Track: Prevention and Tobacco Control
- Presentations: 1
- Now Available
- Moderators:Bienvenido Barreiro, Carolyn Dresler
- Coordinates: 9/09/2019, 11:00 - 12:30, Melbourne (1991)
OA09.02 - Smoking Cessation Counseling in a Surgical Clinic Is Effective (Now Available) (ID 2772)
11:00 - 12:30 | Author(s): Nicholas D Tingquist
Many patients in a thoracic surgery oncology clinic are unable to quit despite referral for tobacco related illnesses and the knowledge that smoking is harmful. Continued smoking leads to poorer outcomes in cancer patients. We implemented individualized counseling for all patients in our ambulatory clinic as a standard part of their cancer care using an opt-out framework. All patients were surveyed for use, and cessation support consisted of individual counseling and pharmacotherapy tailored to the individual.Method
All patients in the thoracic surgery oncology clinic were surveyed for tobacco use at the intake for each visit. Any patient who was a current tobacco user met with a certified tobacco treatment specialist (CTTS) in the surgery clinic in the exam room before and/or after meeting with the surgeon. This was introduced as a standard part of the patient’s treatment plan; patients could opt-out if they chose. Less than 5% of patients who were offered the counseling declined. The cessation counseling was reinforced by the surgeon, and patients were informed about how cessation could improve outcomes. On return visits, the patients met with the CTTS for follow up counseling and feedback. Data was prospectively entered in an IRB approved database for tracking smoking cessation outcomes at our institution. Retrospectively data was harvested for the prior 17 consecutive months.Result
Over a consecutive 17 months, a total of 275 patients who were currently smoking were seen in the thoracic surgery oncology clinic by two thoracic surgeons and met with a CTTS for individualized counseling which included a cessation plan and pharmacotherapy tailored to the individual. Follow up information was available on 87% of patients 240/275. Of the 240 patients who were smoking and met with a CTTS for an individualized plan, 2.9% increased their smoking (7/240), 23.3% had no change (56/240), 29.2 decreased (70/240), and 44.6% quit (107/240) on follow up visits. Cessation was validated by a handheld exhaled breath carbon monoxide (CO) detector whenever possible, and often decreased smoking rates were validated with lower CO readings as well.Conclusion
Patients in a thoracic surgery oncology are receptive to counseling by a CTTS when provided at the point of care. Despite heavy smoking histories, many of the patients in a thoracic surgery oncology clinic can quit smoking with evidence based support including counseling, pharmacotherapy, and follow up. As cessation improves treatment outcomes in many facets of lung cancer care, cessation support should be integrated in a standard workflow for all patients.
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P2.11 - Screening and Early Detection (ID 178)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Screening and Early Detection
- Presentations: 1
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
P2.11-40 - Integration of Individualized Tobacco Cessation Counseling in a Lung Cancer Screening Program (ID 2829)
10:15 - 18:15 | Author(s): Nicholas D Tingquist
Many patients in a lung screening program are unable to quit despite the knowledge that smoking is harmful. Continued smoking leads to increased risk of poorer outcomes in all patients. Our lung cancer screening program has a high rate of patients smoking at the time of the Low Dose Computed Tomography (LDCT) (70.2% smoking; 309/440). Screening with LDCT has been considered a teachable moment and a possible time for intervention with smoking cessation resources. Providing counseling at the point of service may be a convenient and effective method to deliver smoking cessation resources to a population in need.Method
Individualized counseling was provided for all patients in our lung cancer screening program as a standard part of their care using an opt-out framework. All patients were surveyed for use, and cessation support consisted of individual counseling by a nurse practitioner and tailored to the patient. The counselor met the patient at the time of the LDCT in the radiology department for a structured tobacco cessation intervention which typically lasted 10-15 minutes. Data regarding use was entered in the electronic medical record and an IRB approved database. Exhaled breath carbon monoxide testing was used in some cases to validate cessation or reduction. The intervention consisted of counseling and referral to a quitline, a group counseling session, and/or recommendations for over-the-counter pharmacotherapy.Result
A total of 263 patients had undergone LDCT, had been smoking at the time of the LDCT, and have follow up data available. A combination of retrospective chart review, scripted telephone survey, and/or in-person follow up was used to collect data regarding tobacco use. Of those who were smoking and received a LDCT, 12.9% (34/263) of patients had quit smoking while after receiving personalized counseling. Of the 229 patients still smoking, the quantity that they were smoking was available for 156 of these patients. Of those with data available, 50.0% (78/156) who were still smoking had decreased the amount that they were using.Conclusion
Patients who undergo screening with LDCT are receptive to individualized in person counseling when provided at the point of service. This model of opt-out cessation counseling was well received and yielded a 12.9% cessation rate, with one session of counseling and referral to an outside resource. Due to the logistics of the intervention in the radiology department, the counselors did not directly provide pharmacotherapy to the patients in this intervention, but made recommendations. Cessation rates would likely increase when pharmacotherapy and further counseling is used. Even in those who do not quit, half of patients decrease the amount used on a daily basis.