Tobacco Use Assessment and Treatment in Cancer Patients: A Scoping Review of Oncology Care Clinician Adherence to Clinical Practice Guidelines in the U.S.

Abstract

Background Smoking after a cancer diagnosis negatively impacts health outcomes; smoking cessation improves symptoms, side effects, and overall prognosis. The Public Health Service and major oncology organizations have established guidelines for tobacco use treatment among cancer patients, including clinician assessment of tobacco use at each visit. Oncology care clinicians (OCCs) play important roles in this process (noted as the 5As: Asking about tobacco use, Advising users to quit, Assessing willingness to quit, Assisting in quit attempts, and Arranging follow‐up contact). However, OCCs may not be using the “teachable moments” related to cancer diagnosis, treatment, and survivorship to provide cessation interventions. Materials and Methods In this scoping literature review of articles from 2006 to 2017, we discuss (1) frequency and quality of OCCs' tobacco use assessments with cancer patients and survivors; (2) barriers to providing tobacco treatment for cancer patients; and (3) the efficacy and future of provider‐level interventions to facilitate adherence to tobacco treatment guidelines. Results OCCs are not adequately addressing smoking cessation with their patients. The reviewed studies indicate that although >75% assess tobacco use during an intake visit and >60% typically advise patients to quit, a substantially lower percentage recommend or arrange smoking cessation treatment or follow‐up after a quit attempt. Less than 30% of OCCs report adequate training in cessation interventions. Conclusion Intervention trials focused on provider‐ and system‐level change are needed to promote integration of evidence‐based tobacco treatment into the oncology setting. Attention should be given to the barriers faced by OCCs when targeting interventions for the oncologic context. Implications for Practice This article reviews the existing literature on the gap between best and current practices for tobacco use assessment and treatment in the oncologic context. It also identifies clinician‐ and system‐level barriers that should be addressed in order to lessen this gap and provides suggestions that could be applied across different oncology practice settings to connect patients with tobacco use treatments that may improve overall survival and quality of life.

Leveraging Patient Reported Outcomes Measurement via the Electronic Health Record to Connect Patients with Cancer to Smoking Cessation Treatment

“…By supplementing the "Ask Assess, Refer" approach in the clinic setting, the PRO system may maximize the likelihood of identifying all smokers and referring them for treatment. In practice, only 40% of providers actively assist their patients with quitting or refer them to treatment, creating a critical missed opportunity [9,10]. This gap in cancer care is being addressed by Lurie Cancer Center and 41 other cancer centers under the NCI Cancer Moonshot Cancer Center Cessation Initiative (C3I).…”

“…One commonly accepted model of tobacco assessment and treatment is the "Ask, Advise, Refer" method, in which all patients are asked about tobacco use, advised to quit, and referred to evidence-based treatment [8]. Although many providers ask and advise, only 42% of providers report providing treatment or referring patients to treatment [9,10]. Barriers to consistently providing tobacco cessation support include time constraints and low confidence in ability to adequately treat patients [11].…”

A Qualitative Study of Smoking‐Related Causal Attributions and Risk Perceptions in Cervical Cancer Survivors

“…Based on the extant literature, CCS have high unmet need with respect to health information . Unfortunately, healthcare providers often fail to educate their patients about the robust benefits of health behavior change or provide smoking cessation treatment after cancer diagnosis . This missed opportunity undercuts efforts at evidence‐based cancer control and does not meet current standards for “best practices” in cancer care .…”

An Evaluation of the Process and Quality Improvement Measures of the University of Virginia Cancer Center Tobacco Treatment Program

“…To that end, the American Society for Clinical Oncology recommends assessing tobacco use status at every clinic visit given the likelihood in changes motivation and relapse [10]. Even with the known benefits of cessation and national recommendations supporting cessation in oncology care, consistent cessation is not always provided [11]. Specifically, less than half of oncology clinicians actively treat or refer their patients to cessation services [12].…”