Researchers at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis have found that a program that targets patients for smoking-cessation treatment while they’re visiting a clinic for cancer care gets more cancer patients into such treatment than previous methods. The program also helps more cancer patients quit successfully, and its costs are lower than prior methods that involved referring cancer patients to specialists.
The findings are published in the May issue of the Journal of the National Comprehensive Cancer Network.
The same research team has found that even after a cancer diagnosis, quitting smoking doubles the survival rate and lowers the risk of cancer recurrence, no matter the stage of the cancer when a patient is able to stop smoking cigarettes.
“The key thing is that treatment is offered on site,” said first author Alex T. Ramsey, PhD, an assistant professor of psychiatry. “Past care has tended to rely on referrals to specialists, requiring patients to make appointments in a different clinic. That creates hurdles involving time and transportation. When we built this program, we kept those barriers to treatment in mind, understanding that for a program like this to be sustainable, and to reach large numbers of people, it would need to be fully embedded in the care patients already receive.”
The researchers used electronic health records to determine which patients at Siteman were smokers. Then, while the patients were in the clinic to see oncologists, nurses and medical assistants offered the patients help to quit smoking. This strategy has increased the percentage of patients receiving smoking-cessation treatment from about 2% at the start of the study to nearly 30%. Further, the number of patients who successfully quit smoking increased from about 12% to more than 17%.
Ramsey said the eventual goal is to make evidence-based tobacco treatment available to every cancer patient who smokes. And senior investigator Li-Shiun Chen, MD, said the best way to make that happen is to incorporate tobacco treatment into the point of care via electronic health record support.
“We gather information before a patient gets to the clinic so that we can maximize what they’re offered when they arrive,” said Chen, an associate professor of psychiatry. “A cancer center visit is very busy for patients and for providers, but by using health informatics and technology tools to learn who smokes and to offer those patients tobacco treatment options, we’re saving time, money, and, most importantly, lives.”
The program offered through the Siteman Cancer Network also is proving to be less expensive than prior approaches.
“The cost of past tobacco-treatment strategies averaged about $500 per patient across national cancer centers, but with the ability to offer treatment to patients while they already are in the clinic, we’ve lowered the per patient cost to about $70,” Chen said.
Patients are offered access to phone- or text-based counseling, an app designed to help them quit, referral to a smoking-cessation group, and evidence-based medications to support attempts to quit. Pharmacists are available to ensure that any smoking-cessation drugs prescribed will be safe to use in conjunction with chemotherapy.
“Traditionally, there have been three pillars of cancer treatment,” Ramsey said. “Now, along with surgical treatment, radiation therapy and chemotherapy, we believe smoking-cessation treatment can be recognized as a fourth pillar of cancer care.”
Ramsey and Chen plan to expand their efforts, both within the Siteman Cancer Network and by sharing their strategies with providers at other cancer centers. And they’re continuing to home in on personalized care recommendations, including for patients at risk for lung cancer.
Lung cancer remains the deadliest form of cancer: More than 80% of lung cancers and lung cancer deaths are caused by cigarette smoking. A new $2.8 million grant from the National Cancer Institute will assist the researchers as they investigate whether personalized risk feedback tools — including patient-specific genetic risk results delivered to patients and to their primary care physicians — may lead to more frequent lung cancer screening and use of smoking-cessation treatments, as well as opportunities to detect lung cancers at earlier, more treatable stages.
“We want to help more patients stop smoking, both those who have and who have not been diagnosed with cancer,” Ramsey said. “We want to bring high-quality tobacco treatment to the point of care and ensure that we have systems in place so that everyone who needs treatment has access. With that increase in reach, we think we’ll see smoking-cessation rates increase, too, and that should improve cancer outcomes moving forward.”
Ramsey AT, Baker TB, Stoneking F, Smock N, Chen J, Pham G, James AS, Colditz GA, Govindan R, Bierut LJ, Chen LS. Increased reach and effectiveness with a low-burden point-of-care tobacco treatment program in cancer clinics. Journal of the National Comprehensive Cancer Network, May 11, 2022.
This work is supported by the National Cancer Institute, the National Institute on Drug Abuse and the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH). Grant numbers P30 CA091842-16S2 (Cancer Moonshot Tobacco Cessation Supplement), P50 CA244431, P30 CA091842, K12 DA041449, R34 DA052928, UL1 TR002345, R01 DA038076, with additional funding from the Siteman Investment Program.
Washington University School of Medicine’s 1,700 faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is a leader in medical research, teaching and patient care, and currently is No. 4 in research funding from the National Institutes of Health (NIH). Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.