Department of Psychology, University of Arizona, Tucson, Arizona, USA
Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA.
Oncologist. 2019 Feb;24(2):229-238. doi: 10.1634/theoncologist.2018-0246. Epub 2018 Nov 16.
Smoking after a cancer diagnosis negatively impacts health outcomes; smoking cessation improves symptoms, side effects, and overall prognosis. The Public Health Service and major oncology organizations have established guidelines for tobacco use treatment among cancer patients, including clinician assessment of tobacco use at each visit. Oncology care clinicians (OCCs) play important roles in this process (noted as the 5As: Asking about tobacco use, Advising users to quit, Assessing willingness to quit, Assisting in quit attempts, and Arranging follow-up contact). However, OCCs may not be using the "teachable moments" related to cancer diagnosis, treatment, and survivorship to provide cessation interventions.
In this scoping literature review of articles from 2006 to 2017, we discuss (1) frequency and quality of OCCs' tobacco use assessments with cancer patients and survivors; (2) barriers to providing tobacco treatment for cancer patients; and (3) the efficacy and future of provider-level interventions to facilitate adherence to tobacco treatment guidelines.
OCCs are not adequately addressing smoking cessation with their patients. The reviewed studies indicate that although >75% assess tobacco use during an intake visit and >60% typically advise patients to quit, a substantially lower percentage recommend or arrange smoking cessation treatment or follow-up after a quit attempt. Less than 30% of OCCs report adequate training in cessation interventions.
Intervention trials focused on provider- and system-level change are needed to promote integration of evidence-based tobacco treatment into the oncology setting. Attention should be given to the barriers faced by OCCs when targeting interventions for the oncologic context.
This article reviews the existing literature on the gap between best and current practices for tobacco use assessment and treatment in the oncologic context. It also identifies clinician- and system-level barriers that should be addressed in order to lessen this gap and provides suggestions that could be applied across different oncology practice settings to connect patients with tobacco use treatments that may improve overall survival and quality of life.
癌症诊断后的吸烟行为会对健康结果产生负面影响；戒烟可改善症状、副作用和总体预后。公共卫生服务机构和主要肿瘤组织已经为癌症患者的烟草使用治疗制定了指南，包括临床医生在每次就诊时评估烟草使用情况。肿瘤护理临床医生（OCC）在这一过程中发挥着重要作用（被称为 5A：询问烟草使用情况、建议使用者戒烟、评估戒烟意愿、协助戒烟尝试和安排随访联系）。然而，OCC 可能没有利用与癌症诊断、治疗和生存相关的“可教时刻”来提供戒烟干预。
在本次对 2006 年至 2017 年文献的范围综述中，我们讨论了（1）OCC 对癌症患者和幸存者进行烟草使用评估的频率和质量；（2）为癌症患者提供烟草治疗的障碍；（3）促进遵守烟草治疗指南的提供者层面干预措施的有效性和未来。
OCC 未能充分解决患者的戒烟问题。综述研究表明，尽管超过 75%的医生在就诊时评估烟草使用情况，超过 60%的医生通常建议患者戒烟，但只有较少比例的医生推荐或安排戒烟治疗或在戒烟尝试后进行随访。不到 30%的 OCC 报告接受过充足的戒烟干预培训。
需要开展以提供者和系统层面改变为重点的干预试验，以促进将基于证据的烟草治疗纳入肿瘤治疗环境。在针对肿瘤学环境的干预措施时，应关注 OCC 面临的障碍。
本文综述了癌症环境中烟草使用评估和治疗最佳实践与当前实践之间差距的现有文献。它还确定了临床医生和系统层面的障碍，需要加以解决，以缩小这一差距，并提供可应用于不同肿瘤学实践环境的建议，以将患者与可能改善总体生存和生活质量的烟草使用治疗联系起来。
