Physician Support of Smoking Cessation After Diagnosis of Lung, Bladder, or Upper Aerodigestive Tract Cancer

Abstract

PURPOSE Smoking cessation after a diagnosis of lung, bladder, and upper aerodigestive tract cancer appears to improve survival, and support to quit would improve cessation. The aims of this study were to assess how often general practitioners provide active smoking cessation support for these patients and whether physician behavior is influenced by incentive payments. METHODSUsing electronic primary care records from the UK Clinical Practice Research Datalink, 12,393 patients with incident cases of cancer diagnosed between 1999 and 2013 were matched 1 to 1 to patients with incident cases of coronary heart disease (CHD) diagnosed during the same time. We assessed differences in the proportion for whom physicians updated smoking status, advised quitting, and prescribed cessation medications, as well as the proportion of patients who stopped smoking within a year of diagnosis. We further examined whether any differences arose because the physicians were offered incentives to address smoking in patients with CHD and not cancer. RESULTSAt diagnosis, 32.0% of patients with cancer and 18.2% of patients with CHD smoked tobacco. Patients with cancer were less likely than patients with CHD to have their general practitioners update smoking status (OR = 0.18; 95% CI, 0.17-0.19), advise quitting (OR = 0.38; 95% CI, 0.36-0.40), or prescribe medication (OR = 0.67; 95% CI, 0.63-0.73), and they were less likely to have stopped smoking (OR = 0.76; 95% CI, 0.69-0.84). One year later 61.7% of patients with cancer and 55.4% with CHD who were smoking at diagnosis were still smoking. Introducing incentive payments was associated with more frequent interventions, but not for patients with CHD specifically.CONCLUSIONS General practitioners were less likely to support smoking cessation in patients with cancer than with CHD, and patients with cancer were less likely to stop smoking. This finding is not due to the difference in incentive payments. 2017;15:443-450. https://doi Ann Fam Med

Smoking Cessation after Bladder Cancer Diagnosis

“…27,[45][46][47] Os urologistas e os médicos de família, pressionados pelos constrangimentos do tempo de consulta, sentem que a promoção de cessação é pouco eficiente e desapontante, o que pode justificar o pouco investimento na prática clínica diária. [46][47][48][49] Este estudo apresenta algumas limitações, para além das referidas anteriormente, que deverão ser tidas em conta na apreciação das conclusões: 1) o desenho transversal do estudo prejudica a atribuição de causalidade dos dados 2) os doentes não participantes eram mais velhos e do sexo feminino, duas características associadas à ausência de tabagismo -este facto poderá ter condicionado uma sobrevalorização da taxa de fumadores 3) os dados da história tabágica foram baseados nas entrevistas, sem a confirmação bioquímica da abstinência, existindo o risco da subestimação do número de fumadores ativos 50,51 4) o tempo entre o diagnóstico e a entrevista não foi homogéneo, o que acarreta um risco inerente de viés de memória.…”

Smoking cessation after long-term sick leave due to cancer in comparison with cardiovascular disease: Japan Epidemiology Collaboration on Occupational Health Study

“…for promoting smoking cessation. 9) However, a recent study showed that after diagnosis, physicians provide less smoking cessation support to cancer patients than to patients with CVD, 10) resulting in a lower smoking cessation rate among cancer patients (36.7% vs.…”

“…10) After receiving a diagnosis or being hospitalized for CVD, approximately 50% of smokers quit smoking according to a systematic review, 11) whereas nearly 30 to 40% of smokers quit smoking after cancer diagnosis in large-scale studies. 10,12,13) However, these studies focusing on cancer diagnosis 10,12,13) may have included participants with an early stage of cancer who might therefore have been less motivated to quit smoking. 9) If cancer treatment takes a longer time, resulting in long-term hospitalization or sick leave, patients may take smoking cessation more seriously and be more motivated to quit smoking.…”

“…More importantly, existing studies on this topic used data mainly in 1990s to 2000s. [10][11][12][13] Given the rapid advancement in treatment, especially for cancer, smoking cessation rate needs to be estimated from updated data. Therefore, we investigated the smoking cessation rate of Japanese workers after long-term sick leave due to cancer in comparisons with CVD using data in 2010s.…”

In This Issue: Tools to Help Focus on What is Valuable

“…General practitioners are less likely to support smoking cessation in patients with lung, bladder, and upper aerodigestive tract cancer than coronary heart disease, and patients with cancer are less likely to stop smoking. 43 In a study of 870,319 community health center patients, Holderness et al find a very interesting pattern of large and unequal reductions in the rate of uninsurance in 10 states that expanded Medicaid and 6 states that did not. 44 This issue continues the new Annals feature on Innovations in Primary Care.…”