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Sustained, intensive smoking cessation program: benefits in patients with cancer

By Nicole MacKee
Patients with newly diagnosed cancer are more likely to quit smoking when provided intensive smoking cessation counselling and free smoking cessation medication than if provided standard support alone, US researchers say.

In research reported in the Journal of the American Medical Association, 303 patients were randomised to receive intensive or standard smoking cessation counselling.

The patients (mean age 58 years) had been recently diagnosed with breast, gastro­intestinal, genitourinary, gynaecological, head and neck, or lung cancer; lymphoma; or melanoma and had smoked one or more cigarettes in the previous month.

Both groups received four weekly telephone counselling sessions and medication advice. The intensive group also received additional telephone counselling sessions (four biweekly and three monthly) and a choice of cessation medication (nicotine replacement therapy, bupropion or varenicline).

Cessation medication was used by 77% of participants in the intensive counselling program and 59% in the standard program.

The researchers found that after six months patients participating in the intensive program had a higher rate of quitting (confirmed biochemically) than those in the standard program (34.5% vs 21.5%, respectively; odds ratio, 1.92).

Dr Fiona Day, Medical Oncologist at Calvary Mater Newcastle and Conjoint Senior Lecturer at the University of Newcastle, said the most striking finding was the patient­ reported outcome of satisfaction with the support program provided.

‘A positive response was significantly more likely among the patients randomised to the intensive treatment arm,’ she said. ‘This is important information for health workers who may doubt patient willing­ness to thoroughly engage with smoking cessation care.’

She said although guidelines recom­mended that patients be supported with both cessation counselling and pharmaco­therapy, action was often not taken to arrange one or both.

‘We know that smoking cessation care for Australian patients with cancer needs improvement. While it was not possible to tease out the respective contributions of pharmacotherapy and sustained counsel­ling in this study, the message for Australian clinicians is to recommend both to patients,’ she said.

‘Encouragement from their treating doctor to trial medication, and to remain engaged with counselling, such as via the Quitline, may make the difference between continued smoking and a successful quit attempt in a person with cancer.’

Dr Day said next year the NHMRC­ funded Care to Quit stepped wedge randomised trial would test whether increased staff training led by a local multidisciplinary ‘champion team’ would improve patient support and, ultimately, smoking abstinence at six months.
JAMA 2020; 324: 1406-1418.