Integration of a smoking cessation program in the treatment protocol for patients with head and neck and lung cancer

J. C. de Bruin-Visser 0 1 2 3 A. H. Ackerstaff 0 1 2 3 H. Rehorst 0 1 2 3 V. P. Rete`l 0 1 2 3 F. J. M. Hilgers 0 1 2 3 0 V. P. Rete`l Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital , Amsterdam, The Netherlands 1 H. Rehorst Biometrics Department, The Netherlands Cancer Institute- Antoni van Leeuwenhoek Hospital , Amsterdam, The Netherlands 2 J. C. de Bruin-Visser A. H. Ackerstaff F. J. M. Hilgers (&) Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital , Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands 3 F. J. M. Hilgers Institute of Phonetic Sciences/ACLC and Academic Medical Center, University of Amsterdam , Amsterdam, The Netherlands Smoking is the main causative factor for development of head and neck and lung cancer. In addition, other malignancies such as bladder, stomach, colorectal, kidney and pancreatic cancer have a causative relation with smoking. Continued smoking after having been diagnosed with cancer has many negative consequences: effectiveness of radiotherapy is diminished, survival time is shortened and risks of recurrence, second primary malignancies and treatment complications are increased. In view of the significant health consequences of continued smoking, therefore, additional support for patients to stop smoking seems a logical extension of the present treatment protocols for smoking-related cancers. For prospectively examining the effect of nursing-delivered smoking cessation programme for patients with head and neck or lung cancer, 145 patients with head and neck or lung cancer enrolled into this programme over a 2-year period. Information on smoking behaviour, using a structured, programme specific questionnaire, was collected at baseline, and after 6 and 12 months. At 6 months, 58 patients (40%) had stopped smoking and at 12 months, 48 patients (33%) still had refrained from smoking. There were no differences in smoking cessation results between patients with head and neck and lung cancer. The only significant factor predicting success was whether the patient had made earlier attempts to quit smoking. A nurse-managed smoking cessation programme for patients with head and neck or lung cancer shows favourable long-term success rates. It seems logical, therefore, to integrate such a programme in treatment protocols for smoking-related cancers. - Tobacco use in the form of cigarette, pipe or cigar smoking is associated with 5 million deaths per year worldwide. The estimation for 2025 is that this number will increase to 10 million deaths annually [1]. Furthermore, there appears to be a synergistic effect between smoking and alcohol intake. The relative risk of developing, for example, supraglottic laryngeal cancer is increased by 50% from what would be predicted by the simple additive effect of tobacco and alcohol abuse combined [2]. Smoking is the main causative factor for the development of head and neck and lung cancer. In addition, other malignancies, such as bladder, stomach, colorectal, kidney and pancreas cancer, have a causative relation with smoking [1, 35]. In the Netherlands, although a decline Table 1 Probabilities of recurrence, secondary tumours and mortality, as derived from the Dutch study by Fadharspour, comprising 2012 patients with head-and-neck cancer [6] has been observed over the last decades, almost 30% of the population is still smoking. To continue smoking after having been diagnosed with cancer has many negative consequences: the effectiveness of radiotherapy is diminished, survival time is shortened, and the risks of recurrence, second primary malignancies and treatment complications are increased. In a recent study from the Netherlands comprising 2012 patients, the effects of continued smoking on recurrence rate, secondary cancers, and on mortality was clearly shown (see Table 1) and the authors rightfully emphasise the importance of substance abuse cessation [6]. In a casecontrol study in 202 patients, Chen et al. [7] confirmed that tobacco smoking during radiation therapy for head-and-neck cancer was associated with unfavourable outcomes. Obviously, these complications and side effects also have a negative impact on the patients quality of life. Nevertheless, many patients, who were smoking prior to their illness, continue after diagnosis and treatment [8]. Although clinicians often warn about these smokingrelated consequences and already at the time of diagnosis recommend their cancer patients to quit smoking, reports indicate that still 3572% of patients continue smoking during and after treatment [9, 10]. Positively interpreted, these data indicate that fortunately, many smokers are able to stop without help and physicians and other health-care professionals apparently to some extent still have a positive influence on smoking cessation. This approach has reported threefold to fivefold increased cessation rates [1113]. Furthermore, research has shown that patients suffering from serious disease may be more open for smoking cessation advice than smokers without serious health problems [14]. This means that patients receiving the diagnosis cancer probably are more receptive for such advise by their physician, and if that does not work, for an additional counselling programme. Better than in an initial patientphysician contact, such a counselling programme more comprehensively can and should be targeted towards dealing with the physical addiction to nicotine, the psychological reliance on the effects of nicotine, and the behavioural aspects of tobacco use [11]. In view of these significant health consequences of continued smoking, we considered that additional support for patients to stop smoking should become an integral part of the treatment protocol for those cancers that are clearly smoking related. For this reason, a stop smoking clinic was initiated in the Netherlands Cancer Institute. In this paper, we assess whether such a clinic can contribute to smoking cessation in the patient population, who did not succeed in stopping solely on the basis of counselling by the health-care providers before the onset of their oncologic treatment. We will present the outcomes of this initiative with emphasis on the 12-month follow-up results and provide some data on the costs of the programme. Patients and methods The project started as a so-called Care-renewal project endorsed and funded by the health-care authorities and the study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. From November 2003 to December 2005, 185 patients visiting the hospital were referred to the stop smoking clinic. There were 16 patients who were excluded from the programme as they did not have cancer, and 24 patients, after having been informed about the programme, decided they did not (yet) want to participate, resulting in 145 patients for fur (...truncated)