Abstract
Studies evaluating smoking cessation treatment outcomes in cancer patients are scarce, despite smoking cessation importance in cancer care. We sought to add to the literature by evaluating smoking cessation in a challenging group of cancer patients (medium-to-heavy smokers) visiting an out-patient smoking cessation clinic (SCC) in a cancer center in Amman, Jordan. Patients smoking >9 cigarettes per day (CPD) and referred to the SCC between June 2009 and May 2012 were studied. Clinic records were reviewed to measure demographic and baseline clinical characteristics, and longitudinal (3-, 6- and 12- month) follow- up by phone/clinic visit was conducted. At each follow-up, patients were asked if they experienced medication side-effects, if they had returned to smoking, and reasons for failing to abstain. Descriptive and multivariable logistic regression analyses were performed. A total of 201 smokers were included in the analysis. The 3-month abstinence was 23.4% and significantly associated with older age, being married, and presenting with lower (≤ 10 ppm) baseline carbon monoxide (CO) levels. On a multivariable level, lower CO levels, a higher income (relative to the lowest income group), being older, and reporting severe dependence (relative to dependence reported as 'somewhat' or 'not') were significant predictors of higher odds of abstinence at three months. Reasons for failing to quit included not being able to handle withdrawal and seeing no value in quitting. Long- term ARs did not reach 7%. In a sample of Jordanian smokers (>9CPD) with cancer and receiving smoking cessation treatment, ARs were low and further declined with time. Results underscore the need for more aggressive patient management and rigorous follow-up during and after smoking cessation treatment, particularly when this takes place in challenging settings. Observed reasons for failure to abstain should be used to tailor counseling practices.
Highlights
IntroductionContinued tobacco use after a cancer diagnosis has been associated with various detrimental clinical outcomes such as shorter survival (Videtic et al, 2003; Fox et al, 2004; Sardari Nia et al, 2005; Zhou et al, 2006; Nguyenet al., 2010; Parsonset al., 2010; Kenfield, et al, 2011); increased risk of tumor recurrence or development of secondary malignancies (Do et al, 2003; Kawaguchi et al, 2006; Garces et al, 2007; Kaufman et al, 2008; Li et al, 2009; Joshu et al, 2011); poorer response to treatment and an increased risk of treatment toxicities (Monson et al, 1998; Dresler, 2003; O’Sullivan et al, 2003; van der Bol et al, 2007; de Jong et al, 2008; Waller et al, 2011; Petros et al, 2012); an increased risk of surgical complications (Moller et al, 2002; Barrera et al, 2005; Selber et al, 2006; Liu et al, 2011); and inferior bone marrow transplantation outcomes (Marks et al, 2009; Ehlers et al, 2011 ; Tran et al, 2011)
It is not surprising that tobacco cessation measures are included in the evaluation of healthcare quality (Fiore et al, 2012), and the integration of tobacco dependence treatment (TDT) is emphasized as an important service to establish within oncology practice settings (Mazza et al, 2010; 2011; Goldstein et al, 2012)
Given the importance of evaluating TDT outcomes, we previously reported one-year abstinence rates (ARs) in cancer patients that had visited the clinic in the period shortly after its inception (Hawari et al, 2012)
Summary
Continued tobacco use after a cancer diagnosis has been associated with various detrimental clinical outcomes such as shorter survival (Videtic et al, 2003; Fox et al, 2004; Sardari Nia et al, 2005; Zhou et al, 2006; Nguyenet al., 2010; Parsonset al., 2010; Kenfield, et al, 2011); increased risk of tumor recurrence or development of secondary malignancies (Do et al, 2003; Kawaguchi et al, 2006; Garces et al, 2007; Kaufman et al, 2008; Li et al, 2009; Joshu et al, 2011); poorer response to treatment and an increased risk of treatment toxicities (Monson et al, 1998; Dresler, 2003; O’Sullivan et al, 2003; van der Bol et al, 2007; de Jong et al, 2008; Waller et al, 2011; Petros et al, 2012); an increased risk of surgical complications (Moller et al, 2002; Barrera et al, 2005; Selber et al, 2006; Liu et al, 2011); and inferior bone marrow transplantation outcomes (Marks et al, 2009; Ehlers et al, 2011 ; Tran et al, 2011). It is not surprising that tobacco cessation measures are included in the evaluation of healthcare quality (Fiore et al, 2012), and the integration of tobacco dependence treatment (TDT) is emphasized as an important service to establish within oncology practice settings (Mazza et al, 2010; 2011; Goldstein et al, 2012). Studies evaluating smoking cessation treatment outcomes in cancer patients are scarce, despite smoking cessation importance in cancer care. We sought to add to the literature by evaluating smoking cessation in a challenging group of cancer patients (medium-to-heavy smokers) visiting an out-patient smoking cessation clinic (SCC) in a cancer center in Amman, Jordan. Conclusions: In a sample of Jordanian smokers (>9CPD) with cancer and receiving smoking cessation treatment, ARs were low and further declined with time. Results underscore the need for more aggressive patient management and rigorous follow-up during and after smoking cessation treatment, when this takes place in challenging settings. Observed reasons for failure to abstain should be used to tailor counseling practices
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