Association of a Comprehensive Smoking Cessation Program With Smoking Abstinence Among Patients With Cancer
Association of a Comprehensive Smoking Cessation Program With Smoking Abstinence Among Patients With Cancer
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DOI：
10.1001/jamanetworkopen.2019.12251
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发表时间：
2019-09-01
影响因子：
13.8
通讯作者：
Blalock, Janice A.
中科院分区：
文献类型：
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作者：
Cinciripini, Paul M.;Karam-Hage, Maher;Blalock, Janice A.
重要的是，确诊后吸烟的癌症患者有可能降低治疗效果、生存率和生活质量，并增加并发症、癌症复发和第二原发癌的风险。戒烟可以显著影响这些结果，但到目前为止，综合治疗还没有在肿瘤环境中广泛实施。目的描述在癌症环境中实施的潜在模式烟草治疗计划(TTP)，报告其长期结果，并强调其对高质量患者护理的重要性。设计、设置和参与者2006年1月1日至2015年8月31日，在一个综合性癌症中心的TTP中接受了一组预期的吸烟者的治疗。数据分析从2017年11月至2018年12月进行。参与者包括3245名患者(2343名当前癌症患者；309名既往癌症患者；593名无癌症病史)，这些患者来自TTP转介治疗的5061名吸烟者。排除的原因包括非癌症疾病的随访、没有就诊、每天吸烟不到1支；或者在9个月的随访之前死亡。EXPOSURES治疗包括面对面的医疗咨询、6到8次面对面和电话的跟踪咨询会议，以及10到12周的药物治疗。主要结果和测量主要结果是使用特定时间(3、6和9个月的随访)和纵向变量调整和未调整的回归模型评估9个月、7天、9个月的特定时间(3、6和9个月的随访)的戒烟情况和纵向变量调整和未调整的回归模型，其中包括多次输入、治疗意向和仅针对缺失数据的回答方法。结果在3245名吸烟者中，男性1588人(48.9%)，黑人322人(9.9%)，西班牙裔172人(5.3%)，白人2498人(76.0%)。平均年龄为54岁(11.4岁)；Fagerstrom香烟依赖评分为4.41(2.2)分；每天吸烟次数为17.1(10.7)支；吸烟年限为33(13.2)岁；1393名患者(42.9%)至少有一种精神疾病。在多重归因样本中，总体自我报告戒烟率在3个月时为451%，6个月时为45.8%，9个月时为43.7%。所有模型的结果都是一致的，这表明，与没有癌症病史的吸烟者相比，这个TTP项目中的戒烟率没有明显的差异，无论吸烟者是否患有当前癌症、癌症幸存者或与吸烟相关的癌症，头颈癌患者除外；9个月时的戒烟率(相对风险，1.31；95%可信区间，1.11-1.56；P=.001)和纵向模型中的戒烟率(相对风险，1.24；95%可信区间，1.08-1.42；结论：在这项研究中，癌症患者和非癌症患者之间的平均戒烟率没有显著差异。这些发现表明，在肿瘤学环境中提供全面的烟草治疗可以导致所有癌症患者和幸存者持续的高戒烟率，应该被纳入标准护理，以确保尽可能好的癌症治疗结果。
IMPORTANCE Patients with cancer who smoke after diagnosis risk experiencing reductions in treatment effectiveness, survival rates, and quality of life, and increases in complications, cancer recurrence, and second primary cancers. Smoking cessation can significantly affect these outcomes, but to date comprehensive treatment is not widely implemented in the oncologic setting.OBJECTIVES To describe a potential model tobacco treatment program (TTP) implemented in a cancer setting, report on its long-term outcomes, and highlight its importance to quality patient care.DESIGN, SETTING, AND PARTICIPANTS A prospective cohort of smokers was treated in the TTP at a comprehensive cancer center from January 1, 2006, to August 31, 2015. Data analysis was performed from November 2017 to December 2018. Participants included 3245 patients (2343 with current cancer; 309 with previous cancer; 593 with no cancer history) drawn from a population of 5061 smokers referred for treatment in the TTP. Reasons for exclusion included follow-up for a noncancerous disease, no medical consultation, smoked less than 1 cigarette per day; or died before the 9-month follow-up.EXPOSURES Treatment consisted of an in-person medical consultation, 6 to 8 in-person and telephone follow-up counseling sessions, and 10 to 12 weeks of pharmacotherapy.MAIN OUTCOMES AND MEASURES Primary outcome was 9-month 7-day point-prevalence abstinence evaluated using time-specific (3-, 6-, and 9-month follow-ups) and longitudinal covariateadjusted and unadjusted regression models with multiple imputation, intention-to-treat, and respondent-only approaches to missing data. The Fagerstrom Test for Cigarette Dependence was used as a measure of dependence (possible range, 0-10; higher numbers indicate greater dependence).RESULTS Of the 3245 smokers, 1588 (48.9%) were men, 322 (9.9%) were of black race/ethnicity, 172 (5.3%) were of Hispanic race/ethnicity, and 2498 (76.0%) were of white race/ethnicity. Mean (SD) age was 54 (11.4) years; Fagerstrom Test for Cigarette Dependence score, 4.41 (2.2), number of cigarettes smoked per day, 17.1 (10.7); years smoked, 33 (13.2); and 1393 patients (42.9%) had at least 1 psychiatric comorbidity. Overall self-reported abstinence was 45.1% at 3 months, 45.8% at 6 months, and 43.7% at 9 months in the multiply imputed sample. Results across all models were consistent, suggesting that, in comparison with smokers with no cancer history, abstinence rates within this TTP program did not differ appreciably whether smokers had current cancer, were a cancer survivor, or had smoking-related cancers, with the exception of patients with head and neck cancer; the rates were higher at 9 months (relative risk, 1.31; 95% CI, 1.11-1.56; P =.001) and in longitudinal models (relative risk, 1.24; 95% CI, 1.08-1.42; P =.002).CONCLUSIONS AND RELEVANCE In this study, mean smoking abstinence rates did not differ significantly between patients with cancer and those without cancer. These findings suggest that providing comprehensive tobacco treatment in the oncologic setting can result in sustained high abstinence rates for all patients with cancer and survivors and should be included as standard of care to ensure the best possible cancer treatment outcomes.