Whether obtaining a routine mammogram or receiving chemotherapy, smokers and other tobacco users seeking care at the University of Arizona Cancer Center soon will have access to a robust, comprehensive tobacco-cessation program.
“When patients walk through our doors, they can expect to get a consistent message that if they smoke, they need to stop,” said Cynthia Thomson, professor at the UA Mel and Enid Zuckerman College of Public Health, co-leader of the UA Cancer Center Cancer Prevention and Control Program, and member of the UA BIO5 Institute. “We want anyone spending time with patients to value tobacco cessation and send that message consistently to our patients.”
Fueled by a grant from the National Cancer Institute Cancer Moonshot Initiative, a UA Cancer Center team is building a long-term, sustainable program from the ground up. More than 40 other comprehensive cancer centers across the nation are rolling out similar projects as part of a larger effort that aims to address a critical gap in care.
The project will roll out in two phases. First, Banner – University Medicine IT experts will standardize how patients’ tobacco use is captured in electronic health records. U.S. comprehensive cancer centers report difficulties recording patients’ tobacco status, which hinders the ability to consistently offer them support in quitting.
“It’s not that we’re not asking about tobacco usage, it’s that it’s not easy to find that information,” said the project’s lead investigator Tracy Crane, assistant professor at the UA College of Nursing. “It’s difficult to find tobacco-use history, as it may be documented in different places in a patient’s record. We need to standardize how and when we ask, and refer to tobacco-cessation services when a patient reports tobacco use.”
The UA Cancer Center will collaborate with other comprehensive cancer centers that use the same electronic health record system to identify ways to streamline the process.
“It’s shocking that something with such a clear evidence base is not integrated into care. If I went out on the street and asked the average person, ‘Do you think cancer centers provide patients who smoke support to quit?’ Most of us would say, ‘Absolutely! That’s a no-brainer!’” Thomson said. “We have commitment from both the UA as well as Banner to support this new programming and make sure we are in a very different place a year from now.”
The project’s second phase will involve training staff and building a team of tobacco-treatment specialists. Patients hoping to quit will have access to the full range of options, including counseling and cessation medications that could include patches, which contain decreasing doses of nicotine that allow users to wean themselves off the substance, and prescription drugs, which reduce cravings by blocking certain receptors in the brain.
“A combination approach with medication plus behavioral counseling is optimal to help people quit and stay quit,” Crane said. “But not everybody wants to take medication, and not everyone is ready for counseling. We have to honor where a person is in their journey. Having a menu of options for people, regardless of their readiness to quit, is imperative to the success of this program.”
Tobacco is well-known for increasing cancer risk, but it also continues to wreak havoc after a cancer diagnosis. Though about 17 percent of U.S. adults are smokers, about 30 percent of people diagnosed with cancer are smokers. Patients who continue to use tobacco have poorer responses to treatment and are more likely to die from their cancer. Survivors who continue to smoke also face a greater chance of their cancers returning or developing other types of cancer.
“Cancer patients who smoke need to know that if they continue to smoke, exposure will interfere with their treatment. That’s different from saying smoking is a bad habit,” Thomson said. “Tobacco cessation is a part of their treatment plan.”
The team started work in September. When the $767,500 grant expires in two years, they aim to have a fully formed, comprehensive tobacco-cessation program that will be a permanent part of the way the UA Cancer Center offers care to patients.
“We have two years to establish this program; we need to take off vertically and accelerate,” Crane said. “We’re looking forward to partnering with Banner and are excited about this opportunity to advance the health of patients treated for cancer.”
Key members of the team are the clinic leaders and staff at Banner – University Medicine North, including nurses Jill Mausert and Lois Lattimore and patient services navigator Kristen Bloom. Other study investigators include: Dr. Linda Garland and Dr. Amit Algotar, of the UA Cancer Center and UA College of Medicine – Tucson, Judith Gordon, of the UA Cancer Center and UA College of Nursing, Dr. Yves Lussier, of the UA Cancer Center and UA BIO5 Institute, and project coordinator Samantha Slack. This research is supported by a National Cancer Institute Cancer Center Support Grant (P30CA023074).
A version of this article originally appeared on the UA Health Sciences website: opa.uahs.arizona.edu/newsroom/news/2018/ua-support-smokers-their-journey-quit