ASCO Quality Oncology Practice Initiative (QOPI) quality measures for smoking cessation and survival in metastatic NSCLC.

Abstract

6074 Background: According to the ASCO Quality Oncology Practice Initiative (QOPI) quality measures, smoking status should be documented and smoking cessation counseling should be done by the second oncology office visit. Although smoking during NSCLC treatment is associated with treatment complications, it is unknown whether meeting these quality standards impact cancer outcomes. We analyzed the association of adherence to smoking treatment recommendations with survival in this cohort of patients with metastatic NSCLC. Methods: This retrospective cohort study includes 68 deceased patients with metastatic NSCLC enrolled in a longitudinal survey study at Massachusetts General Hospital between 2007-2010 and received all of their cancer care at MGH from initial visit to death. Smoking history and pack years were obtained independently by patient reported smoking status and full chart review. QOPI Core quality measures were assessed including 1) documentation of smoking status by the second office visit and 2) smoking cessation counseling recommended to cigarette smokers by the second office visit. The defect-free composite measure of smoking cessation administered appropriately (combined measure 1 and 2) was the indicator for receiving high quality smoking care. Univariate differences between groups were tested using Chi-square and t-tests. Median survival was estimated using Kaplan-Meier method and survival differences were tested with Cox proportional hazards models. Results: By the second office visit 94% (64/68) patients had smoking status documented; 10 subjects (15%) smoked at enrollment; 50% had smoking cessation counseling documented. Of the total cohort 87% (59/68) had smoking cessation administered appropriately. There were no differences in pack years smoked, age, sex, performance status (PS), and race between groups. Controlling for age, sex, race, PS and pack/years smoked, patients who received high quality smoking care had significantly longer survival (7.2 months vs. 4.3 months; HR 0.33, p=0.009). Conclusions: Meeting QOPI standards for documentation of recommended quality smoking care was associated with longer survival in patients with metastatic NSCLC.