Continuing to smoke after cancer diagnosis has serious negative consequences for patients including reduced treatment effectiveness, decreased survival, and greater risk of cancer returning. A large portion of cancer patients, however, continue to smoke and among those who quit, 40-50% relapse usually within a few months. Tobacco cessation has not been provided in the outpatient cancer care setting, despite findings that tobacco interventions are most effective within 3 months of diagnosis.
Few studies have examined tobacco cessation among cancer patients. Of these, only one study found an intervention effect, with low quit rates (14-30%) across studies. This and other research suggests that most cancer patients do not understand the risk of continued smoking on their prognosis and treatment outcomes. No studies have explored whether more clearly communicating the risks and consequences of tobacco use to patients improves quit rates over current cessation treatment. Therefore, this study is working to achieve two main objectives: 1) Develop a risk communication tool to enhance clinical cessation interventions and educate cancer patients about risks associated with continued tobacco use and 2) Conduct a randomized pilot study (best practices vs. best practices + targeted risk communication) among tobacco-dependent Veterans receiving outpatient cancer care. Primary outcomes will be use of quitline services and tobacco cessation.
The research is being conducted in two phases. During the first developmental phase, we developed a risk communication tool and refined it using cognitive interviews with patients. In the second phase we will conduct a RCT of the risk communication tool. Oncology nurses will provide N=118 VA cancer patients with best-practices cessation treatment (advice, medications, and referral to the state Quitline) alone or in addition to reviewing the decision aid with patients. Patient reactions and quitting outcomes will be surveyed at 2-weeks post-encounter and at 6-months. We will evaluate motivation to quit, 7-day abstinence, and moderators of cessation, as well as gather data related to costs.
In early 2015 we completed Phase 1, having conducted two rounds of cognitive interviews with our target population of Veteran cancer patients who use tobacco (N=20). We have analyzed these data and made changes to the decision aids accordingly. In brief our findings were: 90% rated the aids as very easy to read, that they somewhat or very much kept patients' attention (90%), looked professional (85%), found them very (55%) or moderately (25%) relevant, and were the right length (90%). 100% noted they found nothing offensive or problematic with the content and 95% said they had no discomfort with the information provided. 80% said the decision aids gave them enough information to quit smoking.
Findings for the pilot remain blinded as study is still recruiting.
The goal of this project is to create a feasible, acceptable, and effective tool for helping providers educate Veterans with cancer about the consequences of continued smoking. It is clear from formative evaluations conducted in Phase I that the intervention is highly promising and that cancer patients hold misconceptions about the role of tobacco use in cancer treatment, as expected.
This innovative project has implications for improving the design of theory-based tobacco cessation programs and the quality of cancer care within VA. Nursing and oncology staff has been highly receptive to learning about tobacco cessation and implementing the intervention.
In addition to the current project, knowledge and materials from the formative evaluation phase have been integrated into Dr. Krebs' CDC study and in a VA pilot and subsequent IIR on which Dr. Krebs has been consulting with Dr. Steve Zeliadt (PI) regarding communicating risk information about smoking to Veterans receiving lung cancer screening.
- Krebs P. Tobacco Risk Communication Intervention for Veterans Receiving Cancer Care: Current Findings. Paper presented at: VA New York Harbor Research Day; 2015 May 20; New York, NY.