Smoking Cessation Interventions During Chemoradiotherapy for Locally Advanced Cervical Cancer: A Missed Opportunity?

Abstract

Smoking cessation education and intervention have been well-studied in patients with cervical dysplasia or smoking-related malignancies in efforts to improve health outcomes. Though smoking is associated with worse outcomes after chemoradiotherapy (CRT) for local advanced cervical cancer (LACC), the utilization and impact of smoking cessation interventions on patients with LACC during CRT and follow-up is unknown. We hypothesize that tobacco cessation interventions are under-utilized during CRT for LACC.Patients with LACC treated with definitive CRT from 2009 -2019 were identified from an IRB-approved retrospective institutional database. Smoking cessation education encounters with the institutional tobacco treatment program (TTP) during CRT and follow-up were identified within the electronic medical record. TTP encounters included counseling with or without pharmacologic therapy/nicotine replacement. Overall survival (OS) calculated with the Kaplan-Meier method. Fisher's exact and Wilcoxon rank sum tests were performed to identify differences in patients who quit smoking versus those who continued to smoke.Of 220 patients with LACC treated with CRT, 61 (28%) were smoking at time of diagnosis. Median follow-up from date of LACC diagnosis was 25 months. Smoking cessation education was provided to 39 patients (63.9%); however only 9 patients (15%) received these services during CRT. At last follow-up, 18 patients (29.5%) had quit smoking; nearly half of these patients (8/18, 44%) attempted cessation during CRT, while some patients (5/18, 27%) quit over one year after cancer diagnosis. The overall rate of smoking cessation was 23.1% (9/39) for patients who underwent counseling and 40.9% (9/22) for those who did not. After LACC diagnosis, the median time to first cessation attempt was 61 days, while median time to the first TTP interaction was 196 days. No significant difference in 3-year OS was found between patients who quit smoking compared to those who continued smoking (73% vs 56%, P = 0.7). There was also no difference in FIGO stage (P = 0.34), nodal status (P = 0.78), age (P = 0.50), or pack years smoking (P = 0.25) between patients who quit smoking and those who continued smoking.Most patients continued smoking after CRT for LACC, though cessation rates are higher than the national average (< 10%). Patients can successfully quit smoking during CRT, though few patients receive formal tobacco cessation counseling during treatment. Smoking cessation interventions should be maximized during CRT; however, interventions should also continue as part of a longitudinal, person-centered survivorship plan. Future work will attempt to ensure the success of smoking cessation attempts in patients with LACC by early referral to the TTP to augment cancer treatment and improve overall patient health and outcomes.E.S. Hollis: None. E. Ruebush: None. E. Davies: None. S. Paraghamian: None. A.A. Weiner: None.