Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.
Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri.
J Natl Compr Canc Netw. 2022 May;20(5):488-495.e4. doi: 10.6004/jnccn.2021.7333.
Tobacco cessation after a cancer diagnosis can extend patient survival by improving outcomes for primary cancer and preventing secondary cancers. However, smoking is often unaddressed in cancer care, highlighting the need for strategies to increase treatment reach and cessation. This study examined a low-burden, point-of-care tobacco treatment program (ELEVATE) featuring an electronic health record-enabled smoking module and decision support tools to increase the reach and effectiveness of evidence-based smoking cessation treatment.
This study included adult outpatient tobacco smokers (n=13,651) in medical oncology, internal medicine, and surgical oncology clinics from a large midwestern healthcare system. We examined reach and effectiveness of ELEVATE with 2 comparisons: (1) preimplementation versus postimplementation of ELEVATE and (2) ELEVATE versus usual care. Data were evaluated during 2 time periods: preimplementation (January through May 2018) and postimplementation (June through December 2018), with smoking cessation assessed at the last follow-up outpatient encounter during the 6 months after these periods.
The proportion of current tobacco smokers receiving cessation treatment increased from pre-ELEVATE to post-ELEVATE (1.6%-27.9%; difference, 26.3%; relative risk, 16.9 [95% CI, 9.8-29.2]; P<.001). Compared with 27.9% treatment reach with ELEVATE in the postimplementation time period, reach within usual care clinics ranged from 11.8% to 12.0% during this same period. The proportion of tobacco smokers who subsequently achieved cessation increased significantly from pre-ELEVATE to post-ELEVATE (12.0% vs 17.2%; difference, 5.2%; relative risk, 1.3 [95% CI, 1.1-1.5]; P=.002). Compared with 17.2% smoking cessation with ELEVATE in the postimplementation time period, achievement of cessation within usual care clinics ranged from 8.2% to 9.9% during this same period.
A low-burden, point-of-care tobacco treatment strategy increased tobacco treatment and cessation, thereby improving access to and the impact of evidence-based cessation treatment. Using implementation strategies to embed tobacco treatment in every healthcare encounter promises to engage more smokers in evidence-based treatment and facilitate smoking cessation, thereby improving care cancer for patients who smoke.
癌症诊断后的戒烟可以通过改善原发性癌症的结果并预防继发性癌症来延长患者的生存时间。然而，在癌症治疗中经常不解决吸烟问题，这突出了需要增加治疗范围和戒烟的策略。这项研究检查了一种低负担，即时护理的烟草治疗计划（ELEVATE），该计划具有电子病历支持的吸烟模块和决策支持工具，以提高基于证据的戒烟治疗的范围和效果。
这项研究包括来自一家大型中西部医疗保健系统的医学肿瘤学，内科和外科肿瘤学诊所的成年门诊烟草吸烟者（n = 13651）。我们通过以下两种比较来检查 ELEVATE 的范围和效果：（1）在实施 ELEVATE 之前和之后，（2）ELEVATE 与常规护理。在两个时期评估数据：实施前（2018 年 1 月至 5 月）和实施后（2018 年 6 月至 12 月），并在这些时期之后的 6 个月内的最后一次门诊随访时评估吸烟状况。
在接受戒烟治疗的当前烟草吸烟者的比例从 ELEVATE 实施前增加到实施后（1.6％-27.9％；差异，26.3％；相对风险，16.9 [95％CI，9.8-29.2]；P<.001）。与实施后期间 ELEVATE 达到的 27.9％的治疗范围相比，在同一时期，常规护理诊所的治疗范围在 11.8％至 12.0％之间。从 ELEVATE 实施前到实施后的烟草吸烟者随后戒烟的比例显着增加（12.0％与 17.2％；差异，5.2％；相对风险，1.3 [95％CI，1.1-1.5]；P =.002）。与实施后期间 ELEVATE 戒烟率为 17.2％相比，在同一时期，常规护理诊所的戒烟率在 8.2％至 9.9％之间。
一种低负担，即时护理的烟草治疗策略增加了烟草治疗和戒烟，从而改善了对基于证据的戒烟治疗的获取和影响。使用实施策略将烟草治疗纳入每个医疗保健接触点有望使更多的吸烟者参与基于证据的治疗并促进戒烟，从而改善吸烟患者的护理。
