Ramey Stephen J, Silver Benjamin, Diaz Dayssy A, Munjal Akul, Mehta Shahil, Rich Benjamin, Yechieli Raphael, Takita Cristiane
Department of Radiation Oncology, Jackson Memorial Hospital and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida.
Department of Radiation Oncology, Georgia Cancer Center, Augusta University, Augusta, Georgia.
Adv Radiat Oncol. 2020 Jun 11;5(5):1061-1065. doi: 10.1016/j.adro.2020.05.013. eCollection 2020 Sep-Oct.
Continued smoking among patients with cancer has been associated with increased toxicities, resistance to treatment, and recurrence. This resident-led quality improvement study attempted to increase smoking cessation by providing free smoking cessation medications in the radiation oncology clinic.
Twenty currently smoking patients with nonmetastatic cancer were prospectively enrolled. First line treatment was protocol-standardized combined nicotine replacement therapy (patches and lozenges). Therapy was initiated before radiation therapy and given for 12 weeks. Patient self-reported tobacco use was assessed at midtreatment, end of 12-week treatment, 3-month follow-up, 6-month follow-up, and 12-month follow-up.
Within the initial cohort of 20 patients, average years smoked was 36.3 years (median = 37.5). In addition, 85% had attempted to quit previously. Among patients initially enrolled, 3 did not initiate radiation therapy, and 4 were removed from the study by midtreatment due to noncompliance. Midway through treatment, patients had cut self-reported cigarette use to 31% of baseline. However, 75% or more of patients had smoked within the last week at all timepoints assessed. With further follow-up, the number of cigarettes smoked daily continued to rise, reaching 61% of baseline by the 12-month follow-up.
Patients reduced cigarette consumption, but all patients eventually resumed smoking during the 12-month follow-up. Although it is unfortunate that this study did not result in long-term smoking cessation, the results demonstrate the difficulties faced in helping patients with cancer quit, particularly patients seen at a safety-net hospital. Future efforts could be directed at intensified smoking cessation programs, likely incorporating a more standardized counseling component.
癌症患者持续吸烟与毒性增加、治疗抵抗及复发相关。这项由住院医师主导的质量改进研究试图通过在放射肿瘤诊所提供免费戒烟药物来提高戒烟率。
前瞻性纳入20名目前正在吸烟的非转移性癌症患者。一线治疗采用方案标准化的联合尼古丁替代疗法（贴片和含片）。治疗在放疗前开始，持续12周。在治疗中期、12周治疗结束时、3个月随访、6个月随访和12个月随访时评估患者自我报告的烟草使用情况。
在最初的20名患者队列中，平均吸烟年限为36.3年（中位数 = 37.5）。此外，85%的患者此前曾尝试戒烟。在最初纳入的患者中，3人未开始放疗，4人在治疗中期因不依从被排除在研究之外。治疗中期，患者自我报告的香烟使用量降至基线的31%。然而，在所有评估的时间点，75%或更多的患者在过去一周内吸烟。随着进一步随访，每日吸烟量持续上升，到12个月随访时达到基线的61%。
患者减少了香烟消费，但在12个月的随访期间所有患者最终都恢复了吸烟。尽管这项研究未能实现长期戒烟令人遗憾，但结果表明帮助癌症患者戒烟面临困难，尤其是在安全网医院就诊的患者。未来的努力可以针对强化戒烟项目，可能需要纳入更标准化的咨询部分。
