Rates of Smoking Cessation at 6 and 12 Months after a Clinical Tobacco Smoking Cessation Intervention in Head and Neck Cancer Patients in Northern Ontario, Canada

Abstract

Smoking during cancer treatment is associated with reduced treatment response and cancer recurrence in patients with tobacco-related cancers. The purpose of this study was to examine smoking characteristics in head and neck cancer patients (n = 503) with a history of smoking and examine the impact of an intensive clinical tobacco intervention to patients who were currently smoking. All participants completed an interviewer-administered questionnaire at study enrollment which examined smoking behaviours, motivations to quit, and strategies used to cessate smoking. Follow-up assessments were completed at 6- and 12-months which monitored whether patients had quit smoking, remained cessated, or continued to smoke since study recruitment. For those who were currently smoking (n = 186, 37.0%), an intensive clinical tobacco intervention that utilized the 3A’s—Ask, Advise, Arrange—and the Opt-Out approach was offered to assist with smoking cessation at their new patient visit and followed-up weekly during their head and neck radiation therapy for 7 weeks. At 6 months, 23.7% (n = 41) of those who were smoking successfully quit; 51.2% quit ‘cold turkey’ (defined as using no smoking cessation assistance, aids or pharmacotherapy to quit), while 34.9% used pharmacotherapy (varenicline (Champix)) to quit. On average, it took those who were smoking 1–5 attempts to quit, but once they quit they remained cessated for the duration of the study. Although the head and neck cancer patients in this study reported high levels of nicotine dependence, many were able to successfully cessate.

Systematic Review of Smoking Cessation Interventions for Smokers Diagnosed with Cancer

“…In this review, evidence identified significant barriers for healthcare professionals supporting smokers with cancer due to a lack of confidence and perceptions [ 39 ]. The findings in this review are consistent with Feuer’s [ 55 ] review of 29 studies that examined smoking relapse for a population who are cancer survivors. They suggest that smoking cessation after a cancer diagnosis is understudied, and that interpretation of interventions is challenging due to heterogeneity (p. 102237).…”

“…It is crucial to consider the longevity of support that may be needed beyond the usual eight or 12-week programme. Santi et al [ 55 ] confirm the challenges for those quitting and the potential for additional support beyond six months, as noted in the updated National Institute for Health and Care Excellence (NICE) guidelines [ 57 ]. Evidence indicates the importance of married/partnered patients for social support when quitting [ 53 ].…”

Association between Smoking Status and the Risk of Hip Fracture in Patients with Type 2 Diabetes: A Nationwide Population-Based Study

“…This is a similar conclusion to that of our study ( Table 3 ), in which the risk of hip fracture did not significantly decrease even among smokers within 2 years. Another study found that approximately 60% of quitters resumed smoking within 6 to 12 months [ 41 ]. It is possible that some of the short-term quitters in our study resumed smoking during the follow-up period, diluting the positive effects of 2 years of abstinence on hip fracture risk.…”

Evolution of a Systematic Approach to Smoking Cessation in Ontario’s Regional Cancer Centres

“…Another example is the Northeast Cancer Centre, which offers an intensive clinical tobacco intervention involving multiple follow-up appointments and pharmacotherapy. A study of head and neck cancer patients found that, although these patients reported high levels of nicotine dependence, many were able to successfully quit [ 11 ].…”