ES20.04 Tobacco Control Integration in Cancer Care: The Jordan Experience

Abstract

Tobacco Control Integration in Cancer Care: The Jordan Experience Tobacco control is an integral component of any action plan that aims to reduce cancer incidence and mortality. Efforts at King Hussein Cancer Center, the only comprehensive cancer center in Jordan and the region, started 10 years ago. We sought to address the tobacco epidemic in Jordan on multiple fronts. In Jordan, tobacco prevalence exceeds 60%. About 50% of patients presenting with a cancer diagnosis are smokers. Integrating tobacco control in general and tobacco dependence treatment in patients suffering from cancer is pivotal. Smoking in patients with cancer has been shown to impact cancer treatment, increase complications from cancer treatment, increase cancer recurrence, increase the odds of development of secondary malignancies and eventually decrease overall long-term survival. Throughout the last 10 years our tobacco dependence treatment program grew in services and scope. The program addressed three major components required for tobacco control in cancer patients: First, patient-centered clinical tobacco dependence treatment service. Second, tobacco dependence treatment training and education for health-care providers. Third, research that addresses tobacco dependence in cancer patients. Our program provides 6 smoking cessation clinics every week dedicated mainly to our cancer patients. We have managed to address training needs for our staff by establishing a tobacco treatment specialist training program, the first ever to be accredited by The Council for Tobacco Treatment Training Programs outside the USA. We studied outcomes of our treatment program and developed means to improve referral to smoking cessation clinics as well as improve the abstinence of our patients. In addition, we studied knowledge, attitude and perception of our health care providers working at our institution; a step especially important in a country where significant numbers of health care providers are smokers. Finally, we studied the impact of our tobacco dependence treatment program on the survival of our patients. Understanding the impact of smoking cessation on short-term survival of patients with cancer (2 years) highlights the importance of integrating such programs as part of the acute treatment phase of these patients. Cancer registry and smoking cessation clinic data for cancer patients diagnosed between 2012 and 2016 were analyzed. Approximately 19% of cancer patients were seen at the smoking cessation clinic. In a sub-sample of 2,387 patients, a significant two-year survival advantage was observed for smokers who had visited the smoking cessation clinic and confirmed that they had not smoked on at least two of their 3, 6 or 12-month follow-up visits (HR 2.8, 95% confidence interval [CI] = 1.7–4.5) relative to those who never went to the smoking cessation clinic. Those at the smoking cessation clinic who were abstinent at only one follow-up point also exhibited a survival advantage (non-abstainers at the smoking cessation had comparable survival to those who were not seen at the clinic). In conclusion, tobacco control in patients with cancer has an important role in the outcome and survival of these patients and must be integrated in their short and long-term plan of care. Cessation, cancer, Tobacco