Brief Smoking Cessation Intervention in Relation to Breast Cancer Surgery: A Randomized Controlled Trial

Thomsen, Thordis; Tønnesen, Hanne; Okholm, Mette; Kroman, Niels; Maibom, Annerikke; Sauerberg, Marie-Louise; Møller, Ann Merete

doi:10.1093/ntr/ntq158

Cited by 68 publications

(121 citation statements)

References 22 publications

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“…The two primary settings in which smoking cessation interventions were offered were during the perioperative period or within the clinic. In the perioperative setting, 15,66,68,72,73 the pooled OR was 2.31 (95% CI, 1.32-4.07; I 2 = 0%) ( Figure 6). Finally, a subgroup analysis looking at studies with only self-reported tobacco cessation 15,66,68,72,73 (Figure 8) showed a more favorable result for smoking cessation in patients who had biochemical verification of cessation.…”

Section: Tobacco Cessation Rates and Follow-upmentioning

confidence: 99%

“…Ten RCTs 5,15,16,[66][67][68][69][70][71][72] and 3 PC studies 21,73,74 met the inclusion criteria (Figure 1).…”

Section: Literature Searchmentioning

confidence: 99%

“…Published studies ( Table 1) were single-center 15,16,21,66,[68][69][70]72,73 or multicenter. 4,5,67 There were a total of 1301 patients.…”

Section: Trial Characteristicsmentioning

confidence: 99%

“…Studies were evaluated in 2 groups based on follow-up duration. The group with the shorter follow-up period (n = 6) had a mean follow-up of 5 weeks, 15,21,66,[68][69][70][71][72][73][74] and the longer follow-up group (n = 7) was followed for at least 6 months. 4,5,16,67 In the second group, pooled rates were calculated from the 6-month abstinence rates in all studies except 1, 4 which reported a 12-month rate ( Table 4).…”

Section: Tobacco Cessation Rates and Follow-upmentioning

confidence: 99%

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Smoking Cessation Interventions and Cessation Rates in the Oncology Population: An Updated Systematic Review and Meta‐Analysis

Nayan

Gupta

Strychowsky

et al. 2013

Otolaryngol.--head neck surg.

106

107

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Objectives. To evaluate tobacco smoking cessation interventions and cessation rates in the oncology population through a systematic review and meta-analysis.Data Sources. The literature was searched using PubMed, Google Scholar, Medline, EMBASE, and the Cochrane Library (inception to October 2012) by 3 independent review authors.Review Methods. Studies were included if they were randomized controlled trials (RCTs) or prospective cohort (PCs) studies evaluating tobacco smoking cessation interventions with patients assigned to a usual care or an intervention group. The primary outcome measure was smoking cessation rates. Two authors extracted data independently for each study. When applicable, disagreements were resolved by consensus.Results. The systematic review identified 10 RCTs and 3 PCs. Statistical analysis was conducted using StatsDirect software (Cheshire, UK). Pooled odds ratios (ORs) for smoking cessation interventions were calculated in 2 groups based on follow-up duration. The therapeutic interventions included counseling, nicotine replacement therapy, buproprion, and varenicline. Smoking cessation interventions had a pooled odds ratio of 1.54 (95% confidence interval [CI], 0.909-2.64) for patients in the shorter follow-up group and 1.31 (95% CI, 0.931-1.84) in the longer follow-up group. Smoking cessation interventions in the perioperative period had a pooled odds ratio of 2.31 (95% CI, 1.32-4.07). Conclusion.Our systematic review and meta-analysis demonstrate that tobacco cessation interventions in the oncology population, in both the short-term and long-term follow-up groups, do not significantly affect cessation rates. The perioperative period, though, may represent an important teachable moment with regard to smoking cessation. C igarette smoking and alcohol consumption synergistically increase the risk of developing squamous cell carcinoma of the head and neck.1,2 Tobacco carcinogens also further advance the molecular progression of squamous cell carcinomas of the head and neck.1,2 Cigarette smoking has been related to approximately 90% of diagnoses of lung cancer in countries with a high prevalence of smoking. Furthermore, the increased incidence of lung cancer from smoking is proportional to the length and intensity of smoking history.3 Smoking cessation is particularly important for patients who have smoking-related cancers, such as head and neck or lung cancer. 3,4 Persistent tobacco smoking in the oncology population has a multitude of adverse effects during the treatment of the malignancy, increases the risk of a recurrence or a second primary tumor, and reduces survival. 5,6 These risks are particularly apparent in patients with head and neck or lung cancer. Cigarette smoking also increases the perioperative risks of general anesthesia, poor wound healing, and cardiovascular events. 7-9490886O TOXXX10

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Section: Tobacco Cessation Rates and Follow-upmentioning

confidence: 99%

“…Ten RCTs 5,15,16,[66][67][68][69][70][71][72] and 3 PC studies 21,73,74 met the inclusion criteria (Figure 1).…”

Section: Literature Searchmentioning

confidence: 99%

“…Published studies ( Table 1) were single-center 15,16,21,66,[68][69][70]72,73 or multicenter. 4,5,67 There were a total of 1301 patients.…”

Section: Trial Characteristicsmentioning

confidence: 99%

Section: Tobacco Cessation Rates and Follow-upmentioning

confidence: 99%

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Smoking Cessation Interventions and Cessation Rates in the Oncology Population: An Updated Systematic Review and Meta‐Analysis

Nayan

Gupta

Strychowsky

et al. 2013

Otolaryngol.--head neck surg.

106

107

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“…Similar work has already been pursued among anesthesiologists to promote long-term risk-factor reduction in the case of smoking cessation. 54-58 Specifically, regarding elevated blood pressure, several multidisciplinary cooperative efforts among nurses, pharmacists and other physician specialists, including surgeons, have demonstrated the potential feasibility of this idea for addressing the urgent and persistent public health need of improving the longitudinal control of elevated outpatient blood pressure. 59-62 …”

Section: Discussionmentioning

confidence: 99%

Balancing Model Performance and Simplicity to Predict Postoperative Primary Care Blood Pressure Elevation

Schonberger

Dai²,

Brandt

et al. 2015

Anesthesia &Amp; Analgesia

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Background Because of uncertainty regarding the reliability of perioperative blood pressures and traditional notions downplaying the role of anesthesiologists in longitudinal patient care, there is no consensus for anesthesiologists to recommend postoperative primary care blood pressure follow-up for patients presenting for surgery with an elevated blood pressure. The decision of whom to refer should ideally be based on a predictive model that balances performance with ease-of-use. If an acceptable decision-rule were developed, a new practice paradigm integrating the surgical encounter into broader public health efforts could be tested, with the goal of reducing long-term morbidity from hypertension among surgical patients. Methods Using national data from United States veterans receiving surgical care, we determined the prevalence of poorly controlled outpatient clinic blood pressures ≥ 140/90mmHg, based on the mean of up to four readings in the year after surgery. Four increasingly complex logistic regression models were assessed to predict this outcome. The first included the mean of two preoperative blood pressure readings; other models progressively added a broad array of demographic and clinical data. After internal validation, the C-statistics and the Net Reclassification Index between the simplest and most complex models were assessed. The performance characteristics of several simple blood pressure referral thresholds were then calculated. Results Among 215,621 patients, poorly controlled outpatient clinic blood pressure was present postoperatively in 25.7% (95%CI 25.5%-25.9%) including 14.2% (95%CI 13.9%-14.6%) of patients lacking a prior hypertension history. The most complex prediction model demonstrated statistically significant, but clinically marginal, improvement in discrimination over a model based on preoperative blood pressure alone (C-statistic 0.736 (95% CI 0.734-0.739) vs 0.721 (95% CI 0.718-0.723); p for difference <0.0001). The Net Reclassification Index was 0.088 (95%CI 0.082-0.093), p < 0.0001. A preoperative blood pressure threshold ≥ 150/95mmHg, calculated as the mean of two readings, identified patients more likely than not to demonstrate outpatient clinic blood pressures in the hypertensive range. Four of five patients not meeting this criterion were indeed found to be normotensive during outpatient clinic follow-up (Positive Predictive Value 51.5%, 95% CI 51.0-52.0; Negative Predictive Value 79.6%, 95% CI 79.4-79.7). Conclusions In a national cohort of surgical patients, poorly controlled postoperative clinic blood pressure was present in more than 1 of 4 patients (95%CI 25.5%-25.9%). Predictive modeling based on the mean of two preoperative blood pressure measurements performed nearly as well as more complicated models and may provide acceptable predictive performance to guide postoperative referral decisions. Future studies of the feasibility and efficacy of such referrals are needed to assess possible beneficial effects on long-term cardiovascular morbidity.

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Implementing Smoking Cessation Interventions for Tobacco Users Within Oncology Settings

et al. 2023

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ImportancePatients with cancer who continue to smoke tobacco experience greater treatment-related complications, higher risk of secondary cancers, and greater mortality. Despite research to improve smoking cessation care within clinical oncology, implementation of proposed interventions within routine care remains challenging.ObjectiveTo identify and recommend implementation strategies for smoking cessation interventions associated with improved screening, advice-giving, and referral for tobacco users recently diagnosed with cancer, as well as shifting smoking behaviors and attitudes in this patient population.Evidence ReviewMEDLINE, CINAHL, Embase, and PsycINFO databases, as well as Google Scholar, were searched for articles published before September 7, 2020, using terms related to cancer, smoking cessation, and implementation science. Outcomes of interest were study characteristics, implementation strategies, and outcome measures (screening, advice, referral, abstinence rates, and attitudes). The Cochrane Risk of Bias Tool for randomized and nonrandomized studies was used to assess bias. The review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline and Synthesis Without Meta-analysis (SWiM) guideline. Implementation strategies were categorized according to Expert Recommendations for Implementing Change (ERIC) study taxonomy. A systematic analysis was conducted focusing on studies with low or moderate risk of bias due to high heterogeneity in outcome measurement.FindingsIn total, 6047 records were screened, yielding 43 articles (10 randomized clinical trials and 33 nonrandomized studies). Four strategies were associated with improved screening, advice-giving, and referral: (1) supporting clinicians, (2) training implementation stakeholders (including clinicians), (3) changing the infrastructure, and (4) developing stakeholder interrelationships.Conclusions and RelevanceIn this systematic review, supporting clinicians by providing cessation care through a trained tobacco specialist was identified as important for achieving short-term abstinence and changing attitudes among patients with cancer. Combined with a theoretical framework and stakeholder involvement, these strategies provide the basis for successful implementation of cessation support; this systematic review serves as an illustration of the methodological application and synthesis of implementation studies and other medical conditions more generally.

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Brief Smoking Cessation Intervention in Relation to Breast Cancer Surgery: A Randomized Controlled Trial

Cited by 68 publications

References 22 publications

Smoking Cessation Interventions and Cessation Rates in the Oncology Population: An Updated Systematic Review and Meta‐Analysis

Smoking Cessation Interventions and Cessation Rates in the Oncology Population: An Updated Systematic Review and Meta‐Analysis

Balancing Model Performance and Simplicity to Predict Postoperative Primary Care Blood Pressure Elevation

Implementing Smoking Cessation Interventions for Tobacco Users Within Oncology Settings

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