Doctors Fail to Counsel Lung Cancer Patients to Quit Smoking

Fran Lowry

April 08, 2013

Physicians who care for patients with lung cancer often fail to provide help with smoking cessation, despite knowing the importance of quitting, according to research published online March 22 in the Journal of Thoracic Oncology.

A survey of members of the International Association for the Study of Lung Cancer (IASLC) found that most of the lung cancer specialists who responded agreed that current smoking affects disease outcome and that quitting should be part of clinical care.

However, although most respondents report that they advise patients to quit, less than half say they actually provide cessation assistance.

"Over 90% of respondents felt that tobacco use affected outcome and that tobacco cessation should be a standard part of cancer care, so this was a very motivated group of practitioners," lead author Graham W. Warren, MD, PhD, from the Medical University of South Carolina in Charleston, told Medscape Medical News.

"But even with such a motivated group, only about 40% actually provide assistance to quit. This shows that people who are very motivated about tobacco cessation still may not provide cessation support," Dr. Warren said.

The online survey, conducted in 2012, was designed to determine the practices, perceptions, and potential barriers to tobacco assessment and cessation in cancer patients.

The response rate was excellent, Dr. Warren noted, with 1507 IASLC members, representing 40.5% of the organization's membership, completing the survey. "Most respondents were from countries other than the United State, so it was a truly international survey."

The IASLC is a global organization dedicated to the study and treatment of lung cancer. It was founded in 1974 and its membership includes more than 3500 multidisciplinary lung cancer specialists from 80 countries.

Specifically, 90% of respondents reported that they ask about tobacco use at the initial patient visit, 79% ask smokers whether they intend to quit, and 81% advise the smoker to quit.

However, only 40% reported discussing medication options for smoking cessation, and 39% reported that they actively treat patients for smoking cessation. Even fewer respondents reported addressing tobacco use or cessation at follow-up visits.

"The inference from this is that we have very well-trained clinicians who take care of lung cancer patients but who do not provide tobacco-cessation assistance that could improve cancer treatment outcomes for their patients," Dr. Warren noted.

Shock of Cancer Diagnosis Puts Counseling Out of Mind

"Perhaps clinicians or patients do not place enough emphasis on the fact that it's never too late to quit smoking. Even after such a diagnosis, you could still have the benefits of smoking cessation," Dr. Warren said.

However, "the emphasis on stopping smoking may be overwhelmed by the new cancer diagnosis and the complicated management of the disease itself. Simple tobacco-cessation efforts may not appear to be as important, even though they can benefit all cancer patients," he said.

Dr. Warren said he would like to see special services set up in hospitals and clinics to help patients quit smoking.

"If you have a group of specialists who just emphasize tobacco cessation, it can help cancer patients stop smoking with less distraction from other cancer-related treatment issues. This is not to diminish the role of cancer treatment, but it may be one way to emphasize the importance of smoking cessation without distracting from the day-to-day management of cancer treatment," he said.

The survey respondents also reported feeling pessimistic about their own abilities to help a patient quit smoking, and consider that a barrier to bringing up the topic.

In addition, some respondents reported being concerned that patients would be resistant to efforts to help them quit or would find quitting too difficult, especially at such a stressful time.

Having a place to refer cancer patients to that would help them quit smoking could be an effective way to increase cessation support, Dr. Warren noted.

"Considerable work needs to be done to find the best way to centralize tobacco-cessation support," which could significantly enhance the ability to provide support and emphasize why cessation is so important, he said.

The study was supported by the American Cancer Society, the National Cancer Institute, and the IASLC. Dr. Warren has disclosed no relevant financial relationships.

J Thorac Oncol. Published online March 22, 2013. Abstract


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