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Let's Discuss: Helping Cancer Survivors to End Tobacco Use and Improve Health Outcomes

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I am so very fortunate to be part of the Comprehensive Cancer Control National Partnership’s Workgroup on Tobacco Cessation and Cancer Survivorship.  The workgroup members --- in our organizational and collective efforts --- work to draw needed attention to this issue and support the work necessary to address this cancer control priority.  Today’s R2R cyber-seminar was co-sponsored by the CCCNP and we were all excited by the robust response.

Dr. Diana Stewart Hoover and Dr. Jennifer Vidrine presented the lessons they are learning as they adapt a tobacco cessation intervention, “Motivation And Problem-Solving” (MAPS), for cervical cancer survivors. Diana and Jennifer have identified several themes from a preliminary analysis of their study and will discuss how they are using these results to tailor interventions to reach a vulnerable and underserved population of young women.   

And we shared the excitement of Dr. Elisa Tong and Shauntay Davis, MPH as they shared the newly-issued Call to Action for California Cancer Centers. Indeed, comprehensive cancer control programs play a vital role in facilitating the systemic changes necessary to support tobacco cessation initiatives.  

And now we would like to invite you to join the discussion!

 Do you have any questions for our speakers?

 Please share your thoughts:

  • What is your organization and coalition doing to “shine a light” on the issue of tobacco use amongst cancer survivors?
  • Do you have resources the address the needs of survivors?
  • What systematic changes need to be made to better support tobacco cessation in this group?
  • What partnerships does one need to develop in order to better address the needs of cancer survivors?
  • How have you made the case for needed resources?
  • How can we engage researchers and practitioners in this important conversation?
  • Can R2R help facilitate those discussions?

We look forward to hearing your stories!


Posts/Comments

How can we engage researchers

  • How can we engage researchers and practitioners in this important conversation?

We know cigarettes contain known cancer causing substances. Smoking goes against every cancer treatment and management goal, and cessation would realistically be the first step in treating cancer patients. 

Smoking even one cigarette causes changes in the body that go against everything cancer treatment efforts work to accomplish. There is no safe amount of cigarettes to smoke. Stress = smoking is a common behavioral attachment. A cancer diagnosis and the treatments that follow will be stressful. What new activities, behaviors, and thought patterns can the patient commit to learning to help manage stress?  

Smoking reduces immunity, degrades the body's own natural health defenses, changes how the body responds to medication, slows or interferes with healing, and takes up neuropathways in the brain that block the efficacy of many medications. Smoking undermines everything the doctors, nurses, chemo & radiation treatments, and patients are fighting so hard to accomplish. How can the patient be motivated to decide for themselves that quitting is an important part of their treatment process?  

Combined with practitioner awareness of the importance of quitting smoking as part of treatment, there needs be the engagement skills required to inspire an interest in smoking cessation. I think the latter is the biggest barrier to practitioner involvement. In the normal clinical setting, the provider quickly discloses some smoking scare tactics and a quit now lecture which results in some eye rolling or floor staring and a list of reasons why the patient 'needs' to smoke. Frustrated and busy, the provider says "But you really need to stop." and patient says " I know" and that is the end of it. Uncomfortable for everyone; where does the provider go from there? The good news is, motivational interviewing skills are actually faster to and easier for the provider, make the patient 'do the work' AND elicit change talk. These skills encourage behavior change, reduce resistance, and open a dialog with the patient. Once the provider gets a 'green light', then s(he) can provide patient with a quit guide/toll free quit line/ site link/ local program that is more likely to be utilized. 

 

Thank you very much for your

Thank you very much for your post, Vikki! I think you reinforce a good point--if smokers aren't truly engaged in these conversations, only "talked at", there's going to be little motivation to quit smoking. Do you have any specific motivational interviewing skills that you think are the most important, or any best practices to share? Thanks again for your post!

Some suggests include opening

Some suggests include opening the door by asking things like "Tell me a bit about your smoking" or "How do you feel about smoking" Chances are, the patient will list their own pros and cons.

Patient: "I know I should quit, but it really helps with the stress. Now is not a good time to quit!"

Listen, normalize, and reflect back what patient said using their own words, noting the change talk "I know I should quit."  Ask an open ended question, aimed at eliciting more change talk: 

Provider: "That is understandable; stress is a common smoking trigger. On the one hand, it sounds like you feel smoking helps you cope with stress, but on the other, you know you should quit. What are some of the good things that could come from quit smoking if you were to quit?

Patient: "It would probably be better for my health, save money of course, and the hassle...tired of being a slave to it. My kids would be happy; they hate that I smoke."

It is a different flow when the Provider guides rather than commands while letting the patient find their own motivation. Plus, listening and reflecting is much less energy than dragging the patient along, arguing, or overcoming objections.  Let's continue...

Provider: "'Those are all great reasons to enjoy being a nonsmoker! (note adding the enjoyment and reinforcement of how nonsmoking will be a great choice for her) Your kids will be happy, you'll be free to focus on your health - which is perfect timing as we move forward with your treatments. (note adding that now is a perfect time to quit overcomes her objection that now is not a good time) Extra money is always nice. What would you buy as a reward with the extra money you'll save?

By putting the important but potentialy stressful health/treatment benefit before the end, so last thing she hears is a fun quit related benefit, but still hears the health aspect while visualizing a reward that money can buy (note the  'you will save' is purposefully added as if she has already decided to quit):

Patient: "I have no idea, maybe save up for something for the kids."  

Provider: "That is wonderful! They will sure look forward to that." You sound ready to quit. We can put together some ideas to help you cope with stress, and  discusss medication options that will help you quit. How does that sound? (open ended question) 

Patient: "Great, let's do it. What medications work?" 

This is a perfect time to discuss quit medications, and set a quit date. Provide quit guide and resources. Since stress is her biggest barrier, she will need help and support around stress management in order to keep her quit.Also provide an easy to read but very userful stress management pamplet that talks about stress, a long list of ideas, how stress is unavoidable, how to sit with it and let it pass, and so forth plus a work book area to write down answers to guided questions, and so forth, and toll free support lines to call if feeling stressed. More MI can be done around the stress issue and her quit progress at next appointment. Patient will be more committed knowing provider is going to support their quit process at each appointment.

Thank you for this, Vikki! I

Thank you for this, Vikki! I like the road map you provided, as well as more general information about provider/patient interactions! It makes for a useful resource, as well as discussion.

I was cleaning out my inbox

I was cleaning out my inbox this morning and came across this announcement from my colleagues down the hall that is relevant to this discussion.

NCI awarded six grants to support research on the design and implementation of smoking cessation interventions in lung cancer screening settings (RFA-CA-15-011). NCI plans to provide a total of $18.4 million to support the projects for five years. 

Smoking cessation treatment during LDCT screening offers great potential to reduce tobacco use rates and smoking-related morbidity and mortality. Smoking and exposure to tobacco smoke cause more than 440,000 premature deaths from cancer, heart disease, stroke, and lung disease in the United States each year.

Awardees Are:

The newly funded grants will advance scientific understanding of the components and characteristics of effective smoking cessation interventions in the lung cancer screening setting, and will provide models for the implementation of evidence-based cessation interventions in screening settings across the nation.

We will be following this project and no doubt featuring some of these researchers as their projects unfold.

In Michigan, the Michigan

In Michigan, the Michigan Department of Health and Human Services has partnered with the Michigan Cancer Consortium (our statewide cancer coalition) and the Michigan Oncology Quality Consortium to implement a standard process within participating oncology practices and cancer centers to automatically refer cancer patients who use tobacco to the free Michigan Tobacco Quitline, which is run by National Jewish Health.

Through this collaborative systems change project the staff at oncology practices are trained to systematically use Ask, Advise, Refer to address tobacco use among people undergoing cancer treatment. Providers use a fax referral process to refer patients, so that the patient then receives a call from the Quitline. By the end of 2015 more than 2,700 people had been referred to the Quitline from the oncology practices.

The post-treatment survivorship phase is another opportunity to encourage tobacco cessation. Building on the success of the project, educational materials with messages about the importance of quitting tobacco while undergoing treatment were adapted to include messages for people who have completed cancer treatment.

More information is available at http://www.michigancancer.org/AboutTheMCC/CurrentProjects-Tobacco.html and an archived Research to Reality Cyber-Seminar from June 2015 that included a presentation on the project is available at https://researchtoreality.cancer.gov/cyber-seminars/tobacco-control-and-....

I was intrigued to read an

I was intrigued to read an article this week by Ramzi Salloum and colleagues on the Use of Electronic Cigarettes Among Cancer Survivors in the U.S. (http://dx.doi.org/10.1016/j.amepre.2016.04.015)   The study aimed to look at the prevalence and predictors of e-cigarette use amoung cancer survivors.  

The study prevalence of current and ever e-cigarette use is lower among cancer survivors compared with the general population. In general, current cigarette smokers and young adults are more likely to use e-cigarettes.  Among cancer survivors, current cigarette smoking is also associated with e-cigarette experimentation and use. Hence, the authors suggest that it is plausible that cancer survivors who smoke cigarettes are attracted to e-cigarettes because of perceived harm reduction. 

As noted in the R2R cyber-seminar, e-cigarettes are not part of current evidence-based smoking-cessation strategies. However, the finding that cancer survivors who currently smoke cigarettes are more likely to use e-cigarettes highlights the importance of addressing e-cigarette use in patient–provider communications around tobacco cessation.

I would be interested in continuing to hear your thoughts about this topic.

Use of Electronic Cigarettes Among Cancer Survivors in the U.S.: https://www.ncbi.nlm.nih.gov/pubmed/27242079

I was sorry to miss this

I was sorry to miss this presentation, but so delighted to add to the discussion that NCI, in collaboration with the American Cancer Society (ACS) has launched an online tool for cancer survivors.

Springboard Beyond Cancer (https://smokefree.gov/springboard) is designed to make it easy for those in treatment and post-treatment to access essential information to help them manage ongoing cancer-related symptoms, deal with stress, improve healthy behaviors, communicate better with healthcare teams, and seek support from friends and family.

With Springboard Beyond Cancer, we want to empower cancer survivors by giving them the information they need to help identify issues, set goals, and create a plan to more smoothly navigate the cancer journey and take control of their health.

We hope that Springboard Beyond Cancer, along with the close collaboration of their medical team, can help cancer survivors reduce their disease burden and improve their overall well-being. Certainly, we designed Springboard Beyond Cancer to be an easy-to-use resource that helps cancer survivors address their unique medical, psychosocial, and wellness needs during and after treatment.

Please let us know if you use this resource and any suggestions you have about it.