Cancer Patients Interest and Preferences for an Inpatient Smoking Cessation Program (SCP)

Transcription

1 Cancer Patients Interest and Preferences for an Inpatient Smoking Cessation Program (SCP) Lawson Eng, Devon Alton, Yuyao Song, Jie Su, Delaram Farzanfar, Rahul Mohan, Olivia Krys, Tom Yoannidis, Robin Milne, M Catherine Brown, Ashlee Vennettilli, Andrew J Hope, Doris Howell, Jennifer M Jones, Peter Selby, Wei Xu, David P Goldstein, Meredith E Giuliani, Geoffrey Liu Lawson.eng@utoronto.ca Princess Margaret Cancer Centre, University of Toronto June 5, 2016

2 Introduction Continued smoking after a cancer diagnosis leads to decreased treatment efficacy, increased number of adverse events, reduced survival and reduced overall quality of life and psychosocial function With improvements in both the early detection of cancer and the development of new therapies, secondary prevention including smoking cessation is becoming an increasingly important issue Although smoking cessation programs are being developed for cancer survivorship, little is known about patient s interest and preferences with respect to the delivery of a smoking cessation program Study Aims: 1) To determine patient interest rates with respect to joining an smoking cessation program and predictors for patient interest 2) To assess cancer patient perceptions of the benefits of a smoking cessation program and whether it should be integrated into routine cancer care 3) To determine patient preferences with respect to the delivery of a smoking cessation program

3 Methods Patient Recruitment with Single Questionnaire ( ) Identified all patients with a known histological diagnosis of cancer Questionnaire assessed: Socio-demographics, Smoking History, Functional Status Patient awareness and perceptions of the harms of continued smoking Patient interest and preferences for a smoking cessation program (Current smokers at diagnosis) Chart Review Chart review for clinico-pathological data: Stage, Disease site, Treatments to date and intent Validated smoking history SAS 9.2 Logistic Regression Analysis and Qualitative Analysis Univariate analysis of co-variates and primary predictor variables with patient interest in a smoking cessation program Multivariate analysis of significant primary predictor variables in univariate analysis with each outcome adjusted for confounding covariates (P< 0.10) Qualitative thematic analysis to help supplement survey responses

4 Results Patient Population Completed One Time Questionnaire n = 985 Current Smokers n = 230 (23%) Ex-Smokers n = 337 (34%) Never Smokers n = 418 (42%) Follow Up Continued Smoking n = 102 Quit Smoking n = 128 Relapsers n = 0 Continued Quitters n = 337 Started Smoking n = 0 Remained Abstinent n = 418

5 Results Patient Population Variable Subgroup All Patients Current Smokers Ex- Smokers Never Smokers N Socio-Demographic Variables Gender Male 55% 66% 65% 42% Race Caucasian 76% 88% 83% 64% Age at Dx Average (range) in yr 60 (15-91) 60 (28-88) 63 (15-90) 56 (15-91) Martial Status Married or Equivalent 70% 58% 72% 74% Education Level Completed HS/Univ 62% 46% 61% 71% ECOG % 76% 87% 86% Self-Rated Health Excellent/Very Good 28% 21% 29% 31% Income Greater than 80K 43% 29% 47% 47% Pack Years Average (range) in yr 5 (0-214) 44 (2-214) 20 (1-102) - Clinico-Pathological Variables Stage of Disease Metastatic 15% 15% 16% 14% Surgery 57% 48% 58% 61% Rad Therapy Received 58% 67% 61% 50% Chemotherapy 58% 51% 58% 63% Tx Intent at Dx Curative 86% 87% 84% 86% Tx Intent at F/U Curative 77% 80% 79% 74% Prior Cancer Dx Yes 15% 13% 19% 12% Recent Rx Within Last 3 Mos 42% 40% 39% 46% Disease Site Lung/Head and Neck 25%/30% 37%/40% 29%/28% 15%/26%

6 Results Patient Interest Rates Cancer patients preferred an in-patient smoking cessation program Variable Interest Rate Ambulatory Smoking Cessation Program 35% In-patient Smoking Cessation Program 51% Higher income and being on palliative therapy were each found significantly associated with interest in an in-patient smoking cessation program Variable Age at Dx Education Income Smoking Status Recent Rx Rx Intent Comparison Per 1 year increase Post-Secondary vs No Post- Sec > 80k vs < 80k Quit vs Continued to Smoking Within 3 mo vs > 3 mo Palliative vs Curative Univariate Analysis Multivariate Analysis OR (95% CI) P Value aor (95% CI) P Value 0.97 ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) 0.03

7 Results Benefits/Routine Care Questions on Smoking Cessation Integration Agree Neutral Disagree Smoking Cessation Program is Beneficial 60% 20% 18% Among Current Smokers 51% 33% 15% Smoking Cessation Should be Routine Cancer 75% 19% 6% Care Among Current Smokers 64% 27% 10% Most cancer patients felt that a smoking cessation program is beneficial and should be a part of routine cancer care Variable Smoking Cessation Program Is Beneficial Smoking Cessation Should Be Routine Cancer Care Comparison Agree vs Neutral/Disagree Multivariate Analysis aor (95% CI) P Value 4.65 ( ) < ( ) < Believing that smoking cessation is beneficial and should be routine care were strongly associated with interest in an in-patient smoking cessation program

8 Results Awareness and Perceptions Most cancer patients self report being unaware that smoking is harmful on cancer outcomes Question on Harms of Continued Smoking Agree Don t Know Disagree Smoking Increases Surgical Complications 35% 49% 16% Smoking Increases Radiation Side Effects 26% 56% 17% Smoking Reduces Quality of Life After Chemotherapy 36% 45% 19% Smoking Reduces Efficacy of Chemotherapy/Radiation 30% 51% 19% Smoking Increases Risk of Death 46% 35% 20% Smoking Increases Risk of Second Primary Cancers 48% 31% 21% However, Perception most cancer Variable patients perceive smoking Worsens to be harmful No Effect on Improves survivorship outcomes Smoking Impacts Quality of Life 83% 10% 7% Smoking Impacts Fatigue 84% 12% 5% Smoking Impacts Survival 85% 9% 5% Neither cancer patient awareness nor perceptions of smoking being harmful were found associated with cancer patient interest in an inpatient smoking cessation program (P > 0.05)

9 Results Perceptions and Belief Perception Variable Comparison aor (95% CI) P Value Smoking Impacts Quality of 4.06 (2.08- <0.001 Life 7.92) Smoking Impacts Fatigue Worsens vs No 3.07 (1.58- Effect/Improves < ) Smoking Impacts Survival 4.35 (2.09- <0.001 Perceiving that continued smoking is harmful 9.02) was associated with patient perception that a smoking cessation program would be beneficial Cancer patient perceptions and awareness of the harms of continued smoking were not directly associated with their interest in a smoking cessation program

10 Results Other Preferences Other Modalities of Smoking Cessation Web Apps (24%) Phone Counselling (15%) Health Care Provider Discussing Smoking Cessation Smoking Cessation Counsellor (49%) Physician (44%) Nurse (7%) When to Initiate Smoking Cessation Discussions At the First Visit (50%) Only if patient initiates discussion (29%) Subsequent Follow-Up visit to first visit (5%) After treatments have finished (5%)

11 Results Qualitative Data Reasons for lack of interest in joining a program Quit prior to first oncologist visit (26%) Wishing to quit independently (23%) Enjoys smoking (23%) Lack of interest in a program/unaware smoking is harmful (16%) Reasons for not discussing at first visit Feeling overwhelmed (50%) Patients wanting to control discussions regarding smoking (31%) Not interested in a program regardless (13%)

12 Conclusions Cancer patients preferred an in-patient versus ambulatory smoking cessation program Patient interest in a smoking cessation program was associated with Believing that a smoking cessation program is beneficial Believing that it should be a part of routine cancer care And not associated directly with awareness of smoking harms or smoking perceptions About half of patients preferred discussing smoking cessation at their first visit, others mainly wanted to control timing of discussion Clinicians should initiate discussions both during initial care planning and at follow-up In-patient smoking cessation programs should be explored as another option for smoking cessation