Smoking cessation treatment outcomes among people with and without mental and substance use disorders: An observational real-world study

Castaldelli-Maia, João Maurício; Loreto, Aline Rodrigues; Guimarães-Pereira, Bruna Beatriz Sales; Carvalho, Carlos Felipe Cavalcanti; Gil, Felipe G.; Frallonardo, Fernanda Piotto; Ismael, Flávia; Andrade, Arthur Guerra de; Ventriglio, Antonio; Richter, Kimber P.; Bhugra, Dinesh

doi:10.1016/j.eurpsy.2018.02.005

Cited by 23 publications

(37 citation statements)

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“…Another important topic is the reduction of smoking, which is frequent in patients with severe mental disorders ( 72 – 74 ). The reduction in smoking habit is not the primary outcome of the study, and for this reason we did not propose to patients specific pharmacological (e.g., nicotine patches, nicotine gum, bupropion, or nortriptyline) or non-pharmacological strategies (e.g., cognitive-behavioral therapy group targeted on substance abuse) for supporting smoking cessations, as already done in previous studies ( 26 ). Nevertheless, we expect a reduction in the number of cigarettes smoked per day, as a consequence of the global lifestyle improvement.…”

Section: Discussionmentioning

confidence: 99%

“…On these premises, several psychosocial interventions—including behavioral, educational, and psychological components—have been developed worldwide for addressing these needs ( 20 – 25 ). In particular, some interventions have been specifically focused on improving dietary patterns [e.g., ( 24 )] or smoking habits [e.g., ( 26 )] or on physical inactivity, unhealthy dietary habits, and smoking [e.g., ( 22 , 23 )]. These lifestyle psychosocial interventions—that are different in format, setting, duration, and involved professionals—have been found to be effective in improving patients' physical health.…”

Section: Introductionmentioning

confidence: 99%

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A Randomized Controlled Trial on the Efficacy of a Psychosocial Behavioral Intervention to Improve the Lifestyle of Patients With Severe Mental Disorders: Study Protocol

et al. 2018

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Patients with severe mental disorders die on average 20 years prior to the general population. This mortality gap is mainly due to the higher prevalence of physical diseases and the adoption of unhealthy lifestyle behaviors.The LIFESTYLE trial aims to evaluate the efficacy of a new psychosocial group intervention (including psychoeducational, motivational, and problem-solving techniques) focused on healthy lifestyle behavior compared to a brief educational group intervention in a community sample of patients with severe mental disorders. The trial is a national-funded, multicentric, randomized controlled trial with blinded outcome assessments, which is carried out in six outpatient units of the Universities of Campania “Luigi Vanvitelli” in Naples, Bari, Genova, L'Aquila, Pisa, and Rome—Tor Vergata. All patients are assessed at the following time points: baseline (T0); 2 months post-randomization (T1); 4 months post-randomization (T2); 6 months post-randomization (T3); 12 months post-randomization (T4); and 24 months post-randomization (T5). T1 and T2 assessments include only anthropometric tests. The BMI, a reliable and feasible anthropometric parameter, has been selected as primary outcome. In particular, the mean value of BMI at 6 months from baseline (T3) will be evaluated through a Generalized Estimated Equation model. The work hypothesis is that the LIFESTYLE psychosocial group intervention will be more effective than the brief educational group intervention in reducing the BMI. We expect a mean difference between the two groups of at least one point (and standard deviation of two points) at BMI. Secondary outcomes are: the improvement in dietary patterns, in smoking habits, in sleeping habits, physical activity, personal and social functioning, severity of physical comorbidities, and adherence to medications. The expected sample size consists of 420 patients (70 patients for each of the six participating centers), and they are allocated with a 1:1 ratio randomization, stratified according to center, age, gender, and educational level. Heavy smoking, sedentary behavior, and unhealthy diet pattern are very frequent and are associated with a reduced life expectancy and higher levels of physical comorbidities in people with severe mental disorders. New interventions are needed and we hope that the LIFESTYLE protocol will help to fill this gap.Trial registration number: 2015C7374S.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Randomized Controlled Trial on the Efficacy of a Psychosocial Behavioral Intervention to Improve the Lifestyle of Patients With Severe Mental Disorders: Study Protocol

et al. 2018

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“…We did not have information on smoking or smoking cessation interventions, but it is possible that high rates of smoking contributed to the excess mortality in patients with SMI. Smoking cessation interventions are effective and well tolerated in patients with SMI [34][35][36], and they should be an integral component of lung cancer treatment.…”

Section: Overview Of Main Findingsmentioning

confidence: 99%

The impact of severe mental illness on lung cancer mortality of patients with lung cancer in Finland in 1990–2013: a register-based cohort study

Arffman

Manderbacka

Suvisaari

et al. 2019

European Journal of Cancer

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Background While the link between severe mental illness (SMI) and elevated cancer mortality is well established, few studies have examined lung cancer survival and SMI in detail. Our study compared cancer-specific mortality in lung cancer patients with and without a history of SMI, and whether mortality differences could be explained by cancer stage at presentation, comorbidity or differences in cancer treatment. Methods We identified patients with their first lung cancer diagnosis in 1990-2013 from the Finnish Cancer Registry, their preceding hospital admissions due to SMI from the Hospital Discharge Register and deaths from the Causes of Death statistics. Competing risk analyses were used to estimate hazard ratios (HR) for the impact of SMI on mortality. Results Out of the 37,852 lung cancer cases, 12% had a history of SMI. Cancer-specific mortality differences were found between patient groups in some cancer types after controlling for stage at representation and treatment. Men with history of psychosis had excess mortality risk (HR 1.24, 1.06-1.45) in squamous cell carcinoma. Similar excess risk was found among women with psychosis in small-cell carcinoma (HR=1.76, 1.41-2.19) and in squamous cell carcinoma (HR=1.67, 1.26-2.20) and among women with mood disorders in adenocarcinoma (HR=1.37, 1.08-1.74). Patient group differences in HRs in five-year mortality did not markedly change from the 1990s. Conclusions We found elevated cancer-specific mortality among persons with a history of SMI. Collaboration between patients, mental health care professionals, and oncological teams is needed to reduce the mortality gap between cancer patients with and without SMI.

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“…However, an RCT evaluating the efficacy of initiating smoking cessation treatment in patients admitted to a psychiatry ward has reported promising results 154 , as has an observational study on depressive smokers that used routinely collected data from a smoking cessation clinic in the Czech Republic and showed quit-rates of 25-33%, depending on the severity of depression when entering into the SCI, as well as improvements in the depression level in abstinent patients 155 . In addition, a recent real-world study on clinical practice showed no significant difference in abstinence rates between smokers with or without a mental disorder at the end of the 6-week treatment 156 . Unfortunately, the study only included a short-term followup, and, therefore, it is not possible to determine whether the results would be maintained in the long term 156 .…”

Section: Vulnerable and Disadvantaged Groupsmentioning

confidence: 95%

“…In addition, a recent real-world study on clinical practice showed no significant difference in abstinence rates between smokers with or without a mental disorder at the end of the 6-week treatment 156 . Unfortunately, the study only included a short-term followup, and, therefore, it is not possible to determine whether the results would be maintained in the long term 156 .…”

Section: Vulnerable and Disadvantaged Groupsmentioning

confidence: 95%

Intensive Smoking Cessation Interventions in Denmark - Based on data from the Danish Smoking Cessation Database

Rasmussen¹

2018

clinhp

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Background Tobacco smoking is by far the most deadly and preventable lifestyle factor for public health, both globally and nationally. Nevertheless, it is estimated that worldwide, more than 1.1 billion adults are smokers. Today, 16% (0.8 million) of the adult population in Denmark are daily smokers, while 23% (1.1 million) consider themselves smokers, and one in four deaths are smoking related. The most effective method of reducing smoking prevalence is by employing a two-tier strategy to 1) prevent adolescents from initiating smoking and 2) offer effective help to smokers to quit. The aim of this thesis was to evaluate the effect of intensive smoking cessation interventions (ISCI) on successful quitting through different study designs, synthesised from cohort studies and a review of randomised controlled trials. The aim was fulfilled through 4 scientific studies, each with their own objective. Studies A systematic review with meta-analysis (I) was set up to compare ISCI and shorter interventions in randomised controlled trials (RCT). Initially, 9,569 unique papers were identified, and, after screening for relevant studies, 18 RCTs were included, investigating a total of 10,131 smokers. The studies were primarily conducted in Western Europa and the USA. The body of evidence for three of four outcomes were graded moderate, and the last outcome was graded low. A random effect meta-analysis revealed that smokers randomised to ISCI were significantly more likely to be successful quitters compared to shorter interventions for all four outcomes. The primary outcome (continuous abstinence in the short and long term) increased the chance of success 3-fold. A methodological study (II) of the Danish National Smoking Cessation Database (SCDB) was undertaken. The development of the SCDB and the most commonly registered smoking cessation interventions (SCI) were described, as were the data collection and validity. Two cohort studies based on the data from the SCDB were conducted to evaluate the effectiveness of SCI in real life. One study investigated the effectiveness of five different SCIs (III) and found that the intensive Gold Standard Programme’ (GSP - Standard SCI in Denmark) was the only intervention that was effective for both men and women. The other cohort study was set up to investigate the effectiveness of the GSP in a vulnerable subgroup of smokers diagnosed with severe mental disorder (SMD) (IV). The study showed that smokers with SMD were significantly less likely to become successful quitters compared to smokers without mental disorders. However, one in every four smokers with SMD managed to stay continuously smoke-free for at least 6 months compared to one in three in the comparison group. The data were analysed using a mixed-effect logistic regression model. In both cohort studies, compliance was identified as the strongest predictor of a successful outcome. Conclusion This thesis adds to the evidence on intensive smoking cessation interventions (ISCI) through different study designs. The results from both study designs favoured ISCI, although the GSP was significantly less effective in smokers with SMD compared to smokers without mental illness. To develop effective SCI in the future, it is important to evaluate the effects in an RCT and to follow-up the post-implementation effects in real life (e.g., through a national SCDB).

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Smoking cessation treatment outcomes among people with and without mental and substance use disorders: An observational real-world study

Cited by 23 publications

References 37 publications

A Randomized Controlled Trial on the Efficacy of a Psychosocial Behavioral Intervention to Improve the Lifestyle of Patients With Severe Mental Disorders: Study Protocol

A Randomized Controlled Trial on the Efficacy of a Psychosocial Behavioral Intervention to Improve the Lifestyle of Patients With Severe Mental Disorders: Study Protocol

The impact of severe mental illness on lung cancer mortality of patients with lung cancer in Finland in 1990–2013: a register-based cohort study

Intensive Smoking Cessation Interventions in Denmark - Based on data from the Danish Smoking Cessation Database

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