Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
Fralin Biomedical Research Institute at VTC, Roanoke, VA 24016, USA.
Int J Environ Res Public Health. 2020 May 31;17(11):3907. doi: 10.3390/ijerph17113907.
Despite the importance of smoking cessation to cancer care treatment, historically, few cancer centers have provided treatment for tobacco dependence. To address this gap, the National Cancer Institute (NCI) launched the Cancer Center Cessation Initiative (C3i). As part of this effort, this study examined implementation outcomes in a cohort of cancer survivors (CSs) who smoked cigarettes in the first year of an ongoing process to develop and implement a robust Tobacco Treatment Service at Roswell Park Comprehensive Cancer Center. We provide a comprehensive description of the new tobacco use assessment and referral process, and of the characteristics of cancer survivors who agreed to treatment including traditional tobacco-related psychosocial and cancer treatment-related characteristics and novel characteristics such as delay discounting rates. We also examine characteristic differences among those who agreed to treatment between those who attended and those who did not attend treatment. As the new tobacco assessment was implemented, the number of referrals increased dramatically. The mean number of treatment sessions attended was 4.45 (SD = 2.98) and the six-month point prevalence intention to treat abstinence rate among those who attended was 22.7%. However, only 6.4% agreed to treatment and 4% attended at least one treatment session. A large proportion of cancer survivors who agreed to treatment were women, of older age, of lower socioeconomic status (SES), and who had high levels of depressive symptomology. The findings demonstrate that the implementation of system changes can significantly improve the identification of cancer survivors who use tobacco and are referred to tobacco use treatment. Among those who attend, treatment is effective. However, the findings also suggest that a systematic assessment of barriers to engagement is needed and that cancer survivors may benefit from additional treatment tailoring. We present plans to address these implementation challenges. Systematic electronic medical record (EMR)-sourced referral to tobacco treatment is a powerful tool for reaching cancer survivors who smoke, but more research is needed to determine how to enhance engagement and tailor treatment processes.
尽管戒烟对于癌症治疗至关重要，但历史上很少有癌症中心提供烟草依赖治疗。为了解决这一差距，美国国家癌症研究所（NCI）启动了癌症中心戒烟倡议（C3i）。作为这项工作的一部分，本研究检查了在罗切斯特大学帕克综合癌症中心正在进行的开发和实施强大的烟草治疗服务的过程中，一组吸烟的癌症幸存者（CSs）在第一年的实施结果。我们提供了新的烟草使用评估和转介流程的全面描述，以及同意接受治疗的癌症幸存者的特征，包括传统的与烟草相关的心理社会特征和与癌症治疗相关的特征以及新颖的特征，例如延迟折扣率。我们还检查了同意治疗的人与未接受治疗的人之间在治疗方面的特征差异。随着新的烟草评估的实施，转介数量急剧增加。参加治疗的患者平均治疗次数为 4.45（SD=2.98），参加治疗的患者在 6 个月时的意图治疗禁欲率为 22.7%。然而，只有 6.4%的人同意接受治疗，只有 4%的人参加了至少一次治疗。同意治疗的癌症幸存者中，很大一部分是女性，年龄较大，社会经济地位（SES）较低，且抑郁症状较高。研究结果表明，系统变化的实施可以显著提高识别使用烟草并转介到烟草使用治疗的癌症幸存者的能力。在参加治疗的人中，治疗是有效的。然而，研究结果还表明，需要对参与障碍进行系统评估，并且癌症幸存者可能受益于额外的治疗定制。我们提出了应对这些实施挑战的计划。系统的电子病历（EMR）来源的转介到烟草治疗是接触吸烟的癌症幸存者的有力工具，但需要进一步研究如何增强参与度并定制治疗过程。
