A surgeon led smoking cessation intervention in a head and neck cancer centre

Abstract

BackgroundThe government has recognised the role of healthcare professionals in smoking cessation interventions with integrated care pathways for identification and referral of at-risk patients who smoke. Referral for suspected cancers has been suggested as a ‘teachable moment’, whereby individuals are motivated and more likely to adopt risk-reducing behaviours. A head and neck cancer referral clinic could therefore provide opportunities for smoking cessation intervention.This study aims to pilot a brief smoking cessation intervention during a consultation visit for patients referred with suspected head and neck cancer and evaluate its acceptability and impact.MethodsA brief script for smoking cessation intervention which included a smoking cessation referral was designed to be delivered to patients attending a rapid access clinic. Patient outcome data was collected by the stop smoking team for patients who accepted the referral. A subset of these patients was also interviewed by telephone; these findings were combined with data provided by the stop smoking services to assess the acceptability and impact of pilot smoking cessation intervention on patients.ResultsIn total, 473 new patients attended the clinic during the study period, of whom 102 (22%) were smokers. Of these, 80 (78%) accepted a referral to stop smoking services. A total of 75 (74%) patients were approached subsequently in a telephone survey. Of the 80 newly referred patients, 29 (36%) quit smoking at least temporarily. Another eight patients reduced their smoking or set a quit date (10%), so the experience of attending the clinic and the intervention impacted favourably on almost half of the patients (46%). The patient survey found the intervention to be acceptable for 94% (n = 50) of patients. Qualitative analysis of patient responses revealed five elements which support the acceptability of the intervention.ConclusionsThe findings of this pilot study suggest that discussion of smoking cessation with patients referred for suspected head and neck cancer may have an impact and facilitate the process towards quitting. A possible diagnosis of cancer appears to present a ‘teachable moment’ to encourage positive health behaviour change.

Does Quitting Smoking Make a Difference Among Newly Diagnosed Head and Neck Cancer Patients?

“…A diagnosis of cancer can be a "teachable moment" where cancer patients are highly motivated to quit smoking as the benefits of quitting are evident. 64 While several cessation interventions from brief advice/referrals to intense programs [64][65][66] as well as pharmacotherapies 66,67 have been successfully implemented to head and neck cancer patients, only few institution-wide cessation supports have been incorporated into cancer care. 60 Among covariates, age, sex, BMI levels, cancer stage, medical comorbidities, and treatment predicted both/either mortality outcomes.…”

Head and neck cancer prevention: from primary prevention to impact of clinicians on reducing burden

“…There was no significant improvement in quit attempts or cigarettes smoked per day among patients who were briefly advised by a physician, nurse, or given enhanced advice with the help of self-help booklets and booster sessions by surgeon only [40]. Another systematic review of intervention studies for cancer patients overall has supported the use of combination of pharmacologic and nonpharmacologic approaches in smoking cessation [41].…”

Pairing smoking‐cessation services with lung cancer screening: A clinical guideline from the Association for the Treatment of Tobacco Use and Dependence and the Society for Research on Nicotine and Tobacco

“…Among cancer patients (N 5 473) who received a surgeon-led, brief smoking-cessation intervention concurrent with their cancer care visit, 78% accepted a referral to stop-smoking services; among this subsample, 36% stopped smoking at least temporarily, and another 10% either reduced smoking or set a future smoking quit date. 66 Similarly, an automated tobacco-use assessment and telephone-based smoking-cessation support program for patients who had cancer identified at diagnosis/ follow-up was highly effective for engaging patients in smoking-cessation treatment. 67 For smokers who are unwilling to quit, the PHS Treating Tobacco Use and Dependence Clinical Practice Guideline recommends the specific use of evidence-based motivation techniques to increase smoking-cessation motivation, ie, the 5Rs.…”