Implementing Smoking Cessation Interventions for Tobacco Users Within Oncology Settings

Abstract

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.

Effectiveness of a computer-facilitated intervention on improving provider delivery of tobacco treatment in a thoracic surgery and oncology outpatient setting: A pilot study

“…We used multiple implementation strategies to adapt and integrate the CEASE intervention into the practice setting. The strategies that we used are consistent with recent recommendations for implementing tobacco treatment in oncology settings which included: training stakeholders who can facilitate implementation in the clinical setting, changing the infrastructure to integrate the intervention into the workflow, supporting clinicians through use of educational resources, and developing key stakeholder relationships 16 . The benefit of leadership support, especially identifying a clinical champion to facilitate integration of the intervention into the workflow and providing support for prescribing cessation medication, is essential for enabling implementation of tobacco treatment 17 .…”

Resectable non-stage IV nonsmall cell lung cancer: the surgical perspective

“…Those who quit smoking ∼4 weeks before surgery have a reduced risk of post-surgical complications [ 39 – 41 ].…”