[Helping smoking cessation in COPD, asthma, lung cancer, operated smokers]

[Smoking cessation: two complementary practices of nurses trained in tabacology]

Smoking is considered a chronic disease and is a public health issue. Support for smoking cessation is well defined within healthcare establishments. Nurses and other paramedical professionals must also make their contribution, whatever their practice. At the University Hospital of Caen Normandie, the renal transplant nurse coordinator in the nephrology-dialysis-transplantation department, who holds a university diploma, works with patients with chronic kidney disease, alongside the nurse tobaccologist in the tobacco coordination unit.

[Smoking cessation treatment for smokers with COPD: The importance of therapeutic education]

Smoking is a major risk factor for chronic obstructive pulmonary disease (COPD). The diagnosis of tobacco addiction and management of tobacco dependence are part and parcel of COPD treatment, especially in respiratory rehabilitation. Management encompasses psychological support, validated treatments and therapeutic education. The objective of this review is to briefly recall the guiding principles of therapeutic patient education (TPE) as it applies to smokers wishing to quit and, more specifically, to present the tools conducive to shared educational assessment and treatment according to the Prochaska's stages of change model. We are also proposing an action plan and a questionnaire through which TPE sessions can be assessed. Finally, culturally adapted interventions and new communication technologies are taken into consideration insofar as they constructively contribute to TPE.

[The interest of a nurse and dietician pair in smoking cessation]

The Tobacco Coordination Unit of the Caen Normandy University Hospital assists smokers in their efforts to quit or reduce their tobacco consumption. In addition to the usual individual consultations, a consultation with a nurse-dietician pair is offered to patients for whom individual work on smoking and eating behaviors has reached an impasse. This unconventional approach allows for a more effective consultation method that is better adapted to certain types of patients treated in tobaccoology.

A global burden assessment of lung cancer attributed to residential radon exposure during 1990-2019

This study aimed to explore the spatial and temporal trends of lung cancer burden attributable to residential radon exposure at the global, regional, and national levels. Based on the Global Burden of Disease Study (GBD) 2019, we collected the age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life rate (ASDR) of lung cancer attributable to residential radon exposure from 1990 to 2019. The Joinpoint model was used to calculate the annual average percentage change (AAPC) to evaluate the trend of ASMR and ASDR from 1990 to 2019. The locally weighted regression (LOESS) was used to estimate the relationship of the socio-demographic index (SDI) with ASMR and ASDR. In 2019, the global ASMR and ASDR for lung cancer attributable to residential radon exposure were 1.03 (95% CI: 0.20, 2.00) and 22.66 (95% CI: 4.49, 43.94) per 100 000 population, which were 15.6% and 23.0% lower than in 1990, respectively. According to the estimation, we found the lung cancer burden attributable to residential radon exposure declined significantly in high and high-middle SDI regions, but substantially increased in middle and low-middle SDI regions from 1990 to 2019. Across age and sex, the highest burden of lung cancer attributable to residential radon exposure was found in males and elderly groups. In conclusion, the global burden of lung cancer attributable to residential radon exposure showed a declining trend from 1990 to 2019, but a relatively large increase was found in the middle SDI regions. In 2019, the burden of lung cancer attributable to residential radon exposure remained high, particularly in males, the elderly, and high-middle SDI regions compared with other groups.

Managing unresolved issues of addiction during cancer treatment: A qualitative study about cancer care providers' representations

OBJECTIVE

Five French oncology institutions had participated in a funded study aiming at implementing an Evidence-Based Practice tool (PAM-13), which allowed nurses to measure the level of activation of the patient to support his or her own empowerment in the cancer care pathway. The purpose of this ancillary study is to (i) describe the caregivers' perceptions of addictions and their management concurrently with cancer treatment, (ii) explore the role that Motivational Interviewing techniques can play.

METHODS

15 individual semi-structured interviews of caregivers were performed, using the Theoretical Domains Framework for the interview guide. Qualitative data were analyzed inductively, in a thematic analysis. The COREQ guided the reporting of this qualitative study.

RESULTS

Views on addictions influence the way caregivers manage patients suffering from unresolved issues of addiction. Care is mainly focused on the pathology (cancer-centered) and strictly curative. When practiced, Motivational Interviewing is patient-centered, fostering the patient's empowerment on the cancer care pathway.

CONCLUSIONS

The dissemination of Motivational Interviewing techniques in current practices in oncology, both in terms of doctors and nursing teams, would enable improvement to the management of addictions on the cancer care pathway, by deploying a patient-centered approach. This new paradigm of care would support the empowerment of patients enrolled in the cancer care pathway and promote better communication between caregivers and patients. Hence, a paradigm shift is essential. Motivational Interviewing techniques could provide a caring approach that promotes communication between the patient and the caregiver and also supports the former's empowerment. This research suggests the need to adapt the cancer care pathway in order to integrate the necessary care for patients who concomitantly suffer from unresolved addictive disorders.

TRIAL REGISTRATION

NCT03706937.

[Smoking cessation and lung cancer screening]

Several studies have shown that lung cancer screening, using annual low-dose computed tomography (CT) scan in a targeted population of smokers and ex-smokers reduces overall and lung cancer specific mortality rates. This form of screening strategy is not currently established for use in France by the French High Authority for Health. Quitting smoking is the most important measure in reducing mortality from lung cancer. The maximum benefit in reducing mortality from lung cancer should be seen through an effective combination of smoking cessation intervention and chest CT screening to identify early, curable disease. However, current data to guide clinicians in the choice of smoking cessation interventions in this specific context are limited due to the small number of randomized studies that have been carried out. The optimal approach to smoking cessation during lung cancer screening needs to be clarified by new studies comparing different motivation strategies, establishing the ideal moment to propose stopping smoking and the most effective therapies to use.

Complementary therapeutic approaches in asthma

Asthma is defined by The Initiative for Asthma (GINA 2018) as a heterogeneous disease, which include chronic airway inflammation and a history of respiratory symptoms. In the last decades asthma had a rise in prevalence, becoming one of the most frequent diagnosed diseases in the world. The main goals of asthma management are to achieve good symptom control, minimize the risks of exacerbations, decrease rescue medication intake, improve the quality of life by decreasing respiratory system inflammation and ameliorating the patient’s lung function. Beside effective medications, asthma continues to impair quality of life for most patients. Due to the difficulty of controlling symptoms and exacerbations, the need of developing complementary options of treatment is increasing in order to achieve an optimum control and a lower risk of acute episodes or fatal events. Pulmonary rehabilitation is suggested for asthma patients when adequate medical therapy poorly control the symptoms and mental, physical or social consequences of illness persist during the daily life. The following non-drug therapy components are included in the rehabilitation program: physical training, comprehensive smoking cessation program, comprehensive patient education, respiratory physiotherapy, psychosocial support and comprehensive nutritional counseling. These complementary therapies have been proven to improve muscle strength, exercise capacity and symptomatology. Also, it has been associated to fewer exacerbations and a lower use of rescue medication, leading to a better quality of life. Key words: asthma, quality of life, symptomatology, rehabilitation, physiotherapy,

[COPD and smoking cessation: Patients' expectations and responses of health professionals]

The importance of smoking cessation in the management of COPD is well-established: the benefit of quitting smoking as regards morbidity and mortality outcomes in patients, is unquestioned. The smoking cessation in COPD patients is difficult: high levels of consumption, the duration of smoking, high dependence level, psychological co-morbidities such as anxiety and depression, lower socio-economic and intellectual level, constitute barriers. Studies have shown that patients often minimize the risks of smoking, that others do not believe in the benefits of quitting or doubt their ability to quit smoking. The patients' experience, and expectations with regard to smoking cessation are incompletely satisfied: are considered, the smoking characteristics of these patients, the understanding of the tobacco dependence, the beliefs and ideas of smokers, the knowledge of smoking cessation methods, the role of validated aids and alternative treatments, failure management. The answers of the health professionals can be in several directions: establishment of a better communication patient-doctor (empathy), more centered on the needs of the smoker, the role of the motivation and the place of the motivational interview, the understanding of the mechanisms of addiction, a better individualisation of therapeutics, the necessity of a extended follow-up, the contribution of modern technologies, the electronic cigarette, the smoking cessation in respiratory rehabilitation, guidelines that address smoking cessation treatment.