Abstract
Most people who smoke and develop cancer are unable to quit smoking. To address this, many cancer centers have now opened smoking cessation programs specifically designed to help cancer patients to quit. An important question has now emerged—what is the most effective approach for engaging smokers within a cancer center in these smoking cessation programs? We report outcomes from a retrospective observational study comparing three referral methods—traditional referral, best practice advisory (BPA), and direct outreach—on utilization of the Duke Cancer Center Smoking Cessation Program. We found that program utilization rate was higher for direct outreach (5.4%) than traditional referral (0.8%), p < 0.001, and BPA (0.2%); p < 0.001. Program utilization was 6.4% for all methods combined. Inferring a causal relationship between referral method and program utilization was not possible because the study did not use a randomized design. Innovation is needed to generate higher utilization rates for cancer center smoking cessation programs.
Highlights
Patients who attended an appointment with the Duke Cancer Center Smoking Cessation Program had a mean age of 53.8 (SD 10.1); 43.7% were female, 28.1% were African American, 65.6% were Caucasian, and 6.3% were other/unknown/not reported race
The referral rate over this 30-day period was defined as the total number of patients who were referred to the Duke Cancer Center Smoking Cessation Program divided by 503—the total number of current smokers seen for any reason at the Duke Cancer Center
A comparison of the three referral methods showed that direct outreach led to higher rates of of program referral and program utilization than traditional referral, and that traditional referral program referral and program utilization than traditional referral, and that traditional referral was was associated with higher rates of program utilization than best practice advisory (BPA)
Summary
Treatment of tobacco dependence is uniquely important in people with cancer. States, smoking causes approximately 28.6% of all cancer deaths [1] and causes multiple types of cancer, including lung, laryngeal, pharyngeal, esophageal, pancreatic, bladder, stomach, colorectal, liver, cervical, renal, and acute myeloid leukemia [2]. Smoking cessation after a cancer diagnosis is associated with increased survival in lung cancer [4] and head and neck cancers [5]. Smoking cessation leads to a reduced risk of cancer recurrence in lung cancer [6], breast cancer [7], bladder cancer [8], and gastric cancer [9]
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