Importance Of Smoking Cessation Research Articles

Impact of smoking and nicotine addiction on HbA1c levels and diabetic microvascular complications

Introduction. In this study we aimed to determine whether a difference in complications between smok­ers and non-smokers exists in type 2 diabetes mellitus (T2DM) and to evaluate if there is a correlation between microvascular complications and Fagerstrom test score. Material and methods. Patients with T2DM who at­tended the family medicine outpatient clinics were enrolled in the study. Smokers and non-smokers were compared according to their metabolic outcomes and presence of microvasculer complications. The level of smoking addiction was determined by Fagerstrom Test for Nicotine Dependence. Results. Fasting blood glucose (FBG), low-density lipoprotein, systolic and diastolic blood pressures were found to be higher in smokers. The presence of neuropathy was significantly higher in smokers. The presence of retinopathy rate increased with increasing level of smoking addiction. The nicotine dependence test score were found to be positively correlated with HbA1c and FBG levels whereas, negatively correlated with body mass index among smokers. Conclusions. Assessing the cigarette smoking status of diabetic patients at the initial clinic visit and indicating the importance of smoking cessation should be the essential part of diabetes follow up program.

Presentation and outcomes of carotid endarterectomy in active smokers

ObjectiveSmoking is a significant modifiable risk factor in the pathogenesis of carotid artery disease and has been shown to be a predictor of worse outcomes after vascular surgery. However, the effect of active smoking on outcomes of patients undergoing carotid endarterectomy is unknown. This study analyzed the outcomes of carotid endarterectomy by smoking status in a large national database. MethodsThe American College of Surgeons National Surgical Quality Improvement Program targeted carotid endarterectomy files (2011-2017) were reviewed. Patients were stratified according to smoking status, and outcomes were compared using propensity score matching (1:1) based on preoperative characteristics. ResultsDuring the study period, 26,293 patients underwent carotid endarterectomy, with 19,282 (73.34%) nonsmokers and 7011 (26.66%) smokers. Smokers were more likely to be younger, to have chronic obstructive pulmonary disease, to have a symptomatic presentation, and to have higher anatomic risk (P < .05). Smokers were also more likely to have emergent surgery, to have general anesthesia, and to be reintubated (P < .05). After propensity matching, 5354 nonsmokers were matched with 5354 smokers who underwent carotid endarterectomy. Smokers were at significantly higher risk for death, with an odds ratio of 1.93 (confidence interval, 1.18-3.13). ConclusionsSmokers are at increased risk for death after carotid endarterectomy compared with matched counterparts. Smoking should be considered an important risk factor for worse outcomes, and patients should be strongly counseled on the importance of smoking cessation before undergoing carotid endarterectomy.

Abstract TP440: Effect of Smoking Habit on and Cardiovascular Disease Among Patients With Newly Diagnosed Dyslipidemia Patients in Korea

Introduction: This study aimed to investigate the effects of smoking habit pattern on the risks of all-cause mortality and cardiovascular diseases (CVDs) among patients with newly diagnosed dyslipidemia using the Korean National Sample Cohort data. Methods: The study population consisted of 32,639 newly diagnosed dyslipidemia male patients from the Korean National Health Insurance Service – Health Screening Cohort during 2003-2012. Afterwards, the participants were followed-up until 31 December 2015 for cardiovascular disease event (CVD). Dyslipidemia was defined as those who were prescribed statin medication under the International Classification of Disease, Tenth Revision (ICD-10) codes for dyslipidemia (E78). CVD was composed to coronary heart disease (CHD, ICD-10 codes I20-25) and total stroke (ICD-10 codes I60-69). Cox proportional hazards regression analysis was used to determine the risk of developing CVD according to smoking habit change before and after diagnosis of dyslipidemia. Results: Quitters (adjusted hazard ratio [aHR], 0.82; 95% confidence interval [CI], 0.68–0.99) , sustained ex-smokers (aHR 0.71, 95% CI 0.62-0.82) and never smokers (aHR 0.70, 95% CI 0.62-0.80) showed reduced risk of CVD compared with continual smokers. Quitters also tended to have reduced risk for CHD (aHR 0.83, 95% CI 0.66-1.05) and acute myocardial infarction (aHR 0.68, 95% CI 0.44-1.05) compared to continual smokers. Finally, compared to continual smokers, those who quit after dyslipidemia diagnosis tended to have reduced risk for total stroke (aHR 0.84, 95% CI 0.64-1.11).Our study suggested smoking reduction after dyslipidemia diagnosis may have potential positive effects and have definite benefits on the health outcomes. Conclusion: Smoking cessation after dyslipidemia diagnosis could reduce the risks of cardiovascular disease among patients with newly diagnosed dyslipidemia. Therefore, physicians should advice patients with newly diagnosed dyslipidemia on the importance of smoking cessation in order to reducing risk for CVD.

I.9 Importance of Smoking Cessation in the Treatment of Lung Cancer Patients

I.9 Importance of Smoking Cessation in the Treatment of Lung Cancer Patients

1908P - Tobacco smoking is associated with the immune suppressive microenvironment in head and neck squamous cell carcinoma (HNSCC)

BackgroundHead and neck squamous cell carcinoma (HNSCC) patients with a significant tobacco smoking history have a poor prognosis compared to never smokers. We hypothesize the poor prognosis in tobacco smokers with HNSCC is, at least in part, due to ongoing suppression of immune response and that understanding of deregulated signals in each step may provide insights to improve clinical outcomes of HNSCC patients. MethodsWe characterized the tumor immune microenvironment (TIM) of HNSCC in a retrospective cohort of 177 current, former, and never smokers. Tumors were subjected to analysis of CD3, CD8, FOXP3, PD-1, PD-L1, and pan-cytokeratin by multiplex immunofluorescence, whole exome sequencing, and RNA sequencing. The immune markers were measured in the tumor core (TC), tumor margin (TM), and stroma (S). ResultsOur data indicate that current smokers have significantly lower numbers of CD8+ cytotoxic T-cells and PD-L1+ cells compared to never- and former-smokers. While tumor mutation burden and mutant-allele tumor heterogeneity score do not associate with smoking status, gene-set enrichment analyses reveal significant suppression of IFN-α and IFN-γ response pathways in current smokers. Gene expression of canonical IFN-response chemokines of the CXCL9, CXCL10, CXCL11/CXCR3 axis are lower in current smokers than in former smokers suggesting decreased immune cell migration to the tumor site. ConclusionsThese results indicate that active tobacco use in HNSCC has an immunosuppressive effect through inhibition of tumor infiltration of cytotoxic T-cells likely as a result of suppression of IFN response pathways. Our study highlights the importance of understanding the interaction between smoking and TIM in light of emerging immune modulators for cancer management and the importance of smoking cessation during treatment with immunotherapy. Legal entity responsible for the studyThe authors. FundingThe James and Esther King Biomedical Research Grant. DisclosureC.H. Chung: Honoraria (self): bristol myers squibb; Honoraria (self): astrazeneca; Honoraria (self): Lilly; Honoraria (self): CUE Biopharma. J. Conejo-Garcia: Honoraria (self): Compass Therapeutics; Honoraria (self): Anixa Biosciences. R. Slebos: Spouse / Financial dependant: Bristol Myers Squibb; Spouse / Financial dependant: AstraZeneca ; Spouse / Financial dependant: CUE Biopharma; Spouse / Financial dependant: Lilly Oncology. All other authors have declared no conflicts of interest.

44. Buerger’s disease with severe eosinophilia and acute critical ischemia

IntroductionBuerger’s disease usually presents with normal blood tests. We present a case with significant eosinophilia, a phenomenon rarely reported. Eosinophilia with acute onset Raynaud’s and critical ischemia can be atypical early manifestation of Buerger’s disease (thromboangiitis obliterans).Case descriptionA case report of a 24-year-old male, smoker, with no other history, presented acutely, complaining of cool, painful hands with tricolour changes with worsening for 48 hours. On examination, apart from features of Raynaud’s and tender fingers, he had good perfusion, as shown by Doppler testing. Blood tests showed eosinophilia; 13x10*9 (Normal 0.04-0.40 x10*9) and mild raised C-reactive protein 24 (normal range <10.0 mg/L). Chest radiograph, ECG, and echocardiography showed no abnormalities. The results of initial screening including Immunoglobulins, complements, ANA, ANCA, RF, APLA and CCP were all negative. As there were no critical features of ischemia, we considered the patient for discharge from the hospital with a plan for close review. We strongly advised him not to smoke. He re-admitted within a week with worsening of Raynaud’s and features of critical ischemia with bluish nail and fingertip and some early features of mild digital necrosis. We began treatment with intravenous heparin, aspirin, and iloprost (prostacyclin) infusion for 10 days. The patient’s digital ischemia and intermittent claudication showed some improvement after 1 week, but eosinophilia persisted at 11x10*9 with ruminant pain in digits. The importance of smoking cessation was re-emphasised. Magnetic resonance angiography showed no occlusion of the distal arteries of the upper and lower extremities. Capillaroscopy showed micro haemorrhages (no connective tissue disease/scleroderma pattern abnormality). Investigations for parasitic infections and malignancy were negative. HIV / Hepatitis B/C CMV/EBV/Parvovirus IGM was all undetected. Schistosoma testing was negative. Haematology investigated him for the rare possibility of the genetic mutation for hypereosinophilic syndrome (PDGFRA and FIP1L1 genes) which was negative and underwent bone marrow biopsy which was also normal.We started him on oral prednisolone 1 mg/kg body weight with complete resolution of eosinophilia and ischemic symptoms plus Raynaud’s. Smoking stopped with help.DiscussionBuerger’s disease is a rare disease of exclusion and recognised as one form of vasculitis with a strong association with smoking and nicotine. There has been no consensus or any significant data for any specific therapies proven a benefit in this condition, more than in alone stopping smoking or even oral tobacco products. The main characteristic features of this form are present in young smokers with no systemic disease manifestation, normal inflammatory response, and negative immunology.Eosinophilia has only rarely been a feature of the presentation of Buerger’s disease. Its presence does not imply a systemic vasculitis or a related syndrome. Although there is limited evidence for the use of steroids in this condition, inflammatory features such as eosinophilia could strengthen the rationale for using steroids in certain cases by halting the ongoing immune driven inflammatory cascade. The presence of eosinophilia might suggest alternative pathogenic mechanisms in certain cases of Buerger’s.Key learning pointsTo recognise eosinophilia as a marker in atypical Buerger’s disease presentation. Being a disease of exclusion we have to rule out all other possibilities including some rare ones as was done in this case by seeking advice from infectious disease and haematology team.Conflicts of interestThe authors have declared no conflicts of interest.

1707-P: Maternal Smoking Around Birth, Offspring Genetic Susceptibility to Adiposity, and Risk of Type 2 Diabetes

Prenatal exposure to maternal smoking (MS) and genetic predisposition to obesity have been related to an increased risk of developing type 2 diabetes (T2D), individually; however, little is known about whether these risk factors may interact with each other. This study included 394867 European participants in UK Biobank. Three types of adiposity polygenetic score (PGS) were created based on 97, 66, and 12 genetic loci associated with BMI, waist-to-hip ratio adjusted for BMI (WHRadjBMI), and percentage of body fat (PBF). The adjusted odds ratio (OR) of MS for T2D was 1.25 (95% CI: 1.21-1.28), and ORs for T2D were 1.09 (1.08-1.11), 1.07 (1.05-1.08), and 1.02 (1.01-1.04) per one SD increment of BMI-, WHRadjBMI-, and PBF- PGS. The joint associations of MS and a higher adiposity genetic susceptibility for T2D were 1.52 (1.45-1.60), 1.43 (1.36-1.50), and 1.35 (1.28-1.41), respectively. The estimated proportions of the joint association were 45.1% for MS alone, 28.4% for genetic susceptibility to obesity alone, and 26.5% for their additive interaction. Our results indicate that the increased risk of T2D due to the joint association of MS and adiposity genetic predisposition was greater than each factor. Our findings extend our knowledge on the synergistic contribution of prenatal factors and genetic make-up to adiposity on T2D risk, and re-emphasize the importance of smoking cessation around pregnancy in women. Disclosure D. Sun: None. T. Zhou: None. X. Li: None. Y. Heianza: None. L. Qi: None. Funding National Heart, Lung, and Blood Institute (HL0791981, HL034594, HL126024); National Institute of Diabetes and Digestive and Kidney Diseases (DK091718, DK100383, DK078616); Boston Nutrition Obesity Research Center (DK46200); United States-Israel Binational Science Foundation (2011036)

Exploring mental health professionals\u2019 practice in relation to smoke-free policy within a mental health trust: a qualitative study using the COM-B model of behaviour

BackgroundSmoking has played a significant role in the historical culture of mental healthcare settings. Mental health professionals (MHPs) often hold dismissive attitudes regarding the importance of smoking cessation in the context of mental healthcare. In 2007, English mental health inpatient buildings were required by law to become smoke-free, and healthcare trusts have more recently begun to implement comprehensive policies (i.e. smoke-free grounds and buildings) and staff training in response to national guidance. It is therefore important to explore MHPs practice around smoking, smoking cessation, and smoke-free policy adherence. This study aimed to explore these issues by using the COM-B (capability, opportunity, motivation, behaviour) model to systematically identify barriers to, and facilitators for, MHPs addressing smoking with their patients.MethodsFive focus groups with a total of 36 MHPs were conducted between March and August 2017. MHPs were recruited from one of the largest mental health trusts in Europe. Discussions were guided by a semi-structured guide. Responses were audio recorded, transcribed and coded using thematic analysis and the COM-B framework.ResultsAddressing smoking with patients was undermined by MHPs’ 1) psychological capability to recall training content, misunderstand the potential benefits of addressing patient smoking and harm reduction approaches; 2) physical opportunity in terms of time constraints, and easy accessibility of tobacco in the community; 3) social opportunity in terms of increased cultural value of tobacco following inpatient smoke-free policy implementation, and lack of support from colleagues to enforce the smoke-free policy; 4) automatic motivation, including intrinsic biases regarding patients abilities and motivations to quit, and 5) reflective motivation, including perceived job role and decision making processes related to addressing behaviours deemed more important than smoking. The main facilitating factors identified were MHPs’ having opportunity in the form of patients asking directly for support, and MHPs having access to resources such as stop smoking services and spirometers.ConclusionMultiple barriers were identified across all key domains of the COM-B framework that undermine MHPs’ practice regarding smoking cessation. Few facilitators were identified which may have implications for future smoke-free policy and clinical practice.

Invited Commentary

Invited Commentary

Importance of Smoking Cessation on Surgical Outcome in Primary Lung Cancer

Smoking cessation is important in the management of patients who require pulmonary resection. However, the impact of short-term smoking cessation on the surgical outcome remains unclear. A retrospective study was conducted on patients with stage I to III primary lung cancer who underwent resection between 2012 and 2016. The rate of operative mortality and morbidity were evaluated according to smoking status. The relationship between the preoperative interval of smoking cessation and pulmonary complications after surgery was also examined. This study included 666 patients, of whom 256 (38.4%) were never smokers and 410 (61.6%) were smokers. Significant differences were found between the smokers and never smokers regarding the 90-day mortality rate (2.0% versus 0%, p= 0.025) and respiratory complications (22.3% versus 3.5%, p < 0.001). A multivariate analysis indicated that smoking (odds ratio [OR] 2.8, p= 0.017), forced expiratory volume in 1 second/forced vital capacity less than 0.7 (OR 2.6, p= 0.001), percentage of diffusing capacity of the lung for carbon monoxide less than 40% (OR 4.2, p= < 0.001), and clinical stage of lung cancer (OR 2.3, p= 0.005) were predictors of pulmonary complications after pulmonary resection. In comparison with never smokers, the ORs for pulmonary complications at each cessation interval (current smoker/cessation for <1month, 1 to 3 months, 3 to 6 months, 6 to 12 months, and >12 months) were 12.9 (p < 0.001), 10.3 (p < 0.001), 8.5 (p < 0.001), 6.3 (p= 0.011), 6.0 (p= 0.003), and 5.0 (p < 0.001), respectively. A longer period of cessation might be more effective for reducing the risk of pulmonary complications. Smoking cessation at any time is valuable for lung cancer surgery.

Nursing Care of Patients With Carotid Artery Stenosis Who Receive Carotid Artery Stent

Atherosclerosis, a major cause of carotid artery stenosis, has a high correlation to stroke, which may induce transient ischemic attack (TIA) and/or permanent brain damage. The main treatment of carotid artery stenosis includes medication, carotid endarterectomy (CEA), and carotid artery stenting (CAS). However, when artery stenosis becomes severe, CEA or CAS is the most-often recommended intervention. CAS, a type of revascularization, is considered less invasive than CEA and is associated with a higher successful rate. CAS not only treats carotid stenosis effectively and reduces the incidence of stroke and myocardial infarction but also may increase the survival rate. Because CAS may lead to in-stent restenosis, an eluting stent has been developed to prevent this adverse event. However, the effectiveness of the eluting stent has yet to be adequately verified. As patients who receive CAS remain at risk of recurrent stroke, intravascular restenosis, TIA, and mortality, post-procedure medical and nursing care for this population must be appropriately applied in order to maximize the rate of long-term success. Therefore, we recommend that clinical physicians and nurses regularly evaluate and monitor post-CAS patients in order to prevent complications. Moreover, they should educate patients before discharge on post-CAS wound care and medicine-taking regimens as well as on the importance of smoking cessation, controlling blood sugar and blood pressure, exercising regularly, reducing body weight, maintaining a healthy diet, and controlling the risk factors of atherosclerosis in order to prevent the recurrence of complications.

BPCO et sevrage tabagique : attentes des patients et réponses des professionnels de santé

The importance of smoking cessation in the management of COPD is well-established: the benefit of quitting smoking as regards morbidity and mortality outcomes in patients, is unquestioned. The smoking cessation in COPD patients is difficult: high levels of consumption, the duration of smoking, high dependence level, psychological co-morbidities such as anxiety and depression, lower socio-economic and intellectual level, constitute barriers. Studies have shown that patients often minimize the risks of smoking, that others do not believe in the benefits of quitting or doubt their ability to quit smoking. The patients' experience, and expectations with regard to smoking cessation are incompletely satisfied: are considered, the smoking characteristics of these patients, the understanding of the tobacco dependence, the beliefs and ideas of smokers, the knowledge of smoking cessation methods, the role of validated aids and alternative treatments, failure management. The answers of the health professionals can be in several directions: establishment of a better communication patient-doctor (empathy), more centered on the needs of the smoker, the role of the motivation and the place of the motivational interview, the understanding of the mechanisms of addiction, a better individualisation of therapeutics, the necessity of a extended follow-up, the contribution of modern technologies, the electronic cigarette, the smoking cessation in respiratory rehabilitation, guidelines that address smoking cessation treatment.

Effects of smoking habit change on all-cause mortality and cardiovascular diseases among patients with newly diagnosed diabetes in Korea

This study aimed to investigate the effects of smoking habit change on the risks of all-cause mortality and cardiovascular diseases (CVDs) among patients with newly diagnosed diabetes using the Korean National Sample Cohort data. Survival regression analyses for the risks of all-cause mortality and CVDs were performed. Quitters without body mass index (BMI) change (adjusted hazard ratio [aHR], 0.68; 95% confidence interval [CI], 0.46–1.00) and quitters with BMI loss (aHR, 1.76; 95% CI, 1.13–2.73) showed significantly reduced and substantially the increased risk of all-cause mortality, respectively, compared with sustained smokers. Smoking reduction after diabetes diagnosis may have potential positive effects. However, definite benefits on the health outcomes were not identified in this study. Participants who started smoking after diabetes diagnosis had higher risks of all-cause mortality and CVDs than those who were never smokers or ex-smokers, although not statistically significant. In conclusion, smoking cessation after diabetes diagnosis could reduce the risks of all-cause mortality and cardiovascular events among patients with newly diagnosed diabetes when accompanied by proper weight management. Therefore, physicians should advice patients with newly diagnosed type 2 diabetes on the importance of smoking cessation in combination with long-term weight management to maximize the benefits of smoking cessation.

Effect of training program regarding smoking cessation counseling for primary health care physicians in Port Said City, Egypt

Smoking is a major risk factor for death-related diseases. Not all healthcare professionals are following evidence-based guidelines for smoking cessation counseling in primary care settings. The WHO, Framework Convention on Tobacco Control (FCTC), and United States Public Health Service (USPHS) guidelines recommend that all healthcare professionals, including students in healthcare training programs, receive education in the management of tobacco use and dependence. To evaluate the effect of training programs for primary healthcare physicians on the knowledge, attitude, and practice of smoking cessation counseling. This was a pre-post intervention study. The study included 74 primary care physicians working in primary healthcare centers affiliated with the Ministry of Health and Suez Canal University Hospitals in Port Said City. The study was conducted between June 2015 and March 2016 using a structured questionnaire and observation checklist to assess counseling of patients willing to quit smoking. There were highly statistically significant improvements in the physicians’ median scores of knowledge (30%–80%), attitude (65% -100%), and practice (20%–70%) (p < 0.001) pre-post intervention. The most frequent correct knowledge was consequences of smoking (73%–87.3%) (p < 0.001) pre-post intervention. The most favorable attitude was the importance of smoking cessation (70.3%–100%) (p < 0.001) pre-post intervention. The best observed correct practice was asking about smoking (70.3%–100%) (p < 0.001) pre-post intervention. Knowledge, attitude, and practice skills regarding smoking cessation counseling among primary healthcare physicians were markedly improved after implementation of the education program.

High Rate of Late Toxicity in Patients Treated with MRI-Guided HDR Brachytherapy for Locally Advanced Cervix Cancer: The Importance of Smoking Cessation

Magnetic resonance imaging (MRI)-guided high-dose-rate (HDR) brachytherapy for locally advanced cervical cancer is used to improve target coverage and limit dose to critical structures. Here we evaluate disease control and toxicity rates utilizing this technique. This is a retrospective review of patients with FIGO stage I-IV cervical cancer who underwent MRI -guided HDR tandem and ring (T&R) brachytherapy between January 2010 and January 2015 at a single institution. All patients received pelvic external beam radiotherapy (EBRT) to a median dose of 45 Gy followed by T&R HDR brachytherapy. All patients received an MRI with at least the first brachytherapy insertion (CT was performed for non-MRI insertions) and completed at least 4 fractions of brachytherapy. Gross tumor volume, high-risk clinical target volume (HR-CTV), and organs at risk were all contoured according to GEC-ESTRO guidelines. Forty-three patients underwent 214 HDR T&R brachytherapy insertions between 2010 and 2015. The mean age was 50 years (range: 29-74). Sixty-three percent of patients were smokers. Histopathology was predominantly squamous cell carcinoma (79%). Average tumor size was 5.5cm, and 56% were FIGO stage IIB. Fifty-one percent had positive lymph nodes at diagnosis. Median total (EBRT + brachytherapy) equivalent dose in 2Gy fractions (EQD2) to 90% of the HR-CTV was 79.97Gy, and median total EQD2 dose to Point A was 77.04Gy. Median follow up was 48 months. At 5 years, the local control rate was 98%, the regional control rate was 84%, the freedom from distant metastases rate was 90%, the disease-free survival rate was 73%, the cause-specific survival rate was 78%, and the overall survival rate was 57%. Late grade 3 and higher toxicities were experienced in 14% of patients, and 28% experienced a late grade 2 or higher toxicity. We evaluated the risk of developing a late grade 2 or higher bladder, vaginal, sigmoid or rectal complication based on the total dose to 2cc of each of these structures being greater than or less than the median dose to these structures and found no correlation. The 5 year rate of developing a grade 2 or higher late toxicity was 11% for non-smokers, compared with 60% for smokers (p=0.0035). With a median follow up of 4 years, this study demonstrates excellent local control. However, late toxicity continues to be clinically significant, even with MRI guidance and volume based dosimetry, and smoking is a significant predictive factor for late toxicity. This data supports using aggressive smoking cessation strategies in patients receiving radiotherapy for cervix cancer.

The awareness of patients with non - muscle invasive bladder cancer regarding the importance of smoking cessation and their access to smoking cessation programs.

ABSTRACTObjectives Smoking is the most important risk factor for bladder cancer and smoking cessation is associated with reduced risk of tumor recurrence and progression. The aim of this study is to assess the awareness of non-muscle invasive bladder cancer (NMIBC) patients regarding the importance of smoking cessation, determine their access to smoking cessation programs and the effects of smoking cessation on recurrence rates of NMIBC.Materials and Methods NMIBC patients who were followed with cystoscopy were included in the study. Their demographic properties were recorded, along with their smoking habits, awareness regarding the effects of smoking on bladder cancer and previous attempts for smoking cessation. Moreover, the patients were asked whether they applied for a smoking cessation program. Recurrence of bladder cancer during the follow-up period was also noted.Results A total of 187 patients were included in the study. The mean age was 64.68±12.05 (range: 15-90) and the male to female ratio was 167/20. At the time of diagnosis, 114 patients (61.0%) were active smokers, 35 patients (18.7%) were ex-smokers and 38 patients (20.3%) had never smoked before. After the diagnosis, 83.3% of the actively smoking patients were advised to quit smoking and 57.9% of them quit smoking. At the time of the study, 46.52% of the NMIBC patients were aware of the link between smoking and bladder cancer, whereas only 4.1% of the smoking patients were referred to smoking cessation programs. After a mean follow-up of 32.28±11.42 months, 84 patients (44.91%) had recurrence; however, current smoking status or awareness of the causative role of smoking on NMIBC did not affect the recurrence.Conclusion In our study group, the majority of the NMIBC patients were not aware of the association between smoking and bladder cancer. Although most of the physicians advised patients to quit smoking, a significant amount of the patients were still active smokers during follow-up. Only a small proportion of patients were referred to smoking cessation programs. Urologists should take a more active role in the battle against smoking and refer those patients to smoking cessation programs. Larger study populations with longer follow-up periods are needed to better demonstrate the beneficial effects of smoking cessation on recurrence rates.

Abstract P4-17-02: Design, implementation and evaluation of a smoking cessation intervention for patients undergoing breast cancer surgery

Abstract Introduction: Smoking is a risk factor for poor outcomes following breast reconstructive surgery, including wound dehiscence and infection. Women who would choose to have reconstructive surgery after mastectomy for breast cancer are unable to do so if they have not quit smoking. The specific aims of this project are to 1) design and implement an intervention to assist these patients in quitting and 2) evaluate its efficacy. Methods: Baseline data regarding current practices was collected via a chart review of 75 smoking breast cancer surgery patients from 1/1/2012-12/31/13. Charts were analyzed for documentation of smoking status, quit advice, resources provided and used, and smoking status at follow-up. Formative research informed the design of an Ask-Advise-Refer intervention for all new breast cancer patients seen at Mayo Clinic. Intervention Design: Smoking patients were identified prior to their initial Breast Cancer evaluation at Mayo Clinic, Rochester, during a standard intake call. Smoking status was documented by the rooming assistant to alert the physicians of smoking status, and physicians asked these patients about their smoking behavior, discussed the risks of smoking both for surgical procedures and breast cancer, and offered a Nicotine Dependence Consultation with a tobacco treatment specialist in an “opt-out” strategy that emphasized the importance of smoking cessation as part of the breast cancer treatment process. The advice and referral was documented in the medical record. Evaluation of the intervention was performed via a chart review of patients seen after one year of implementation. Intervention Evaluation Results: Breast clinic physicians documented smoking status in all patients seen after implementation. Referral to the Nicotine Dependence Center for cessation counseling increased from 29% (22/75) to 74% (20/27). Among those referred, attendance at the consultation increased from 41% (9/22) to 75% (15/20), suggesting stronger provider encouragement of cessation services. 30-day abstinence rates for those who attended a consult prior to 5/1/16 were 46% (6/13), which is consistent with baseline data. Conclusions: An Ask-Advise-Refer intervention for new breast cancer patients seen at Mayo Clinic, Rochester, who report current smoking, has been associated with higher rates of provider counseling on tobacco dependence, referral to available services, and patient attendance at referrals. Attending a referral greatly increases a patient's chances of quitting smoking for at least 30 days compared to average spontaneous quit rates in this population. This model is low-cost, time-efficient for providers, and applicable to most practice settings. Finding ways to make this intervention self-sustaining and applicable to multiple other practices could greatly improve our patient's health outcomes. Citation Format: Nolan M, Ghosh K, Warner DO. Design, implementation and evaluation of a smoking cessation intervention for patients undergoing breast cancer surgery [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-17-02.

An epidemiological profile of chronic obstructive pulmonary disease

Background:Different definitions used for chronic obstructive pulmonary disease (COPD) preclude getting reliable prevalence estimates. Study objective was to find the prevalence of COPD as per standard Global Initiative for Chronic Obstructive Lung Disease definition, risk factors associated, and treatment seeking in adults >30 years.Methodology:Community-based cross-sectional study was conducted in Delhi, among 1200 adults, selected by systematic random sampling. Pretested questionnaire was used to interview all subjects and screen for symptoms of COPD. Postbronchodilator spirometry was done to confirm COPD.Statistical Analysis:Adjusted odds ratio (aOR) was calculated by multivariable analysis to examine the association of risk factors with COPD. Receiver operating characteristic (ROC) curve was developed to assess predictability. Results: The prevalence of COPD was 10.1% (95% confidence interval [CI] 8.5, 11.9%). Tobacco smoking was the strongest risk factor associated (aOR 9.48; 95% CI 4.22, 14.13) followed by environmental tobacco smoke (ETS), occupational exposure, age, and biomass fuel. Each pack-year of smoking increased 15% risk of COPD. Ex-smokers had 63% lesser risk compared to current smokers. Clinical allergy seems to preclude COPD (aOR 0.06; 95% CI 0.02, 0.37). ROC analysis showed 94.38% of the COPD variability can be assessed by this model (sensitivity 57.4%; positive predictive value 93.3%). Only 48% patients were on treatment. Treatment continuation was impeded by its cost.Conclusion:COPD prevalence in the region of Delhi, India, is high, and our case-finding population study identified a high rate of patients who were not on any treatment. Our study adds to creating awareness on the importance of smoking cessation, early diagnosis of COPD, and the need for regular treatment.

The Importance of Smoking Cessation in Improving Disease Course in Crohn's Disease.

The Importance of Smoking Cessation in Improving Disease Course in Crohn's Disease.

Attitudes and Perceptions About Smoking Cessation in the Context of Lung Cancer Screening.

Broad adoption of lung cancer screening may inadvertently lead to negative population health outcomes if it is perceived as a substitute for smoking cessation. To understand views on smoking cessation from current smokers in the context of being offered lung cancer screening as a routine service in primary care. As an ancillary study to the launch of a lung cancer screening program at 7 sites in the Veterans Health Administration, 45 in-depth semi-structured qualitative interviews about health beliefs related to smoking and lung cancer screening were administered from May 29 to September 22, 2014, by telephone to 37 current smokers offered lung cancer screening by their primary care physician. Analysis was conducted from June 15, 2014, to March 29, 2015. Attitudes and perceptions about the importance of smoking cessation in the context of lung cancer screening. Lung cancer screening prompted most current smokers to reflect for the first time on what smoking means for their current and future health. However, 17 of 35 (49%) participants described mechanisms whereby screening lowered their motivation for cessation, including the perception that undergoing an imaging test yields the same health benefits as smoking cessation. Other misperceptions include the belief that everyone who participates in screening will benefit; the belief that screening and being able to return for additional screening offers protection from lung cancer; the perception by some individuals that findings from screenings have saved their lives by catching their cancer early when indeterminate findings are identified that can be monitored rather than immediately treated; and a reinforced belief in some individuals that a cancer-free screening test result indicates that they are among the lucky ones who will avoid the harms of smoking. In this qualitative, lung cancer screening prompted many current smokers to reflect on their health and may serve as a potential opportunity to engage patients in discussions about smoking cessation. However, several concerning pathways were identified in which screening, when offered as part of routine care and described as having proven efficacy, may negatively influence smoking cessation. Health care professionals should be aware that the opportunity for early detection of lung cancer may be interpreted as a way of avoiding the harms of smoking. To promote cessation, discussions should focus on the emotional response to screening rather than clinical details (eg, nodule size) and address misperceptions about the value of early detection so that screening does not lower motivation to quit smoking.