Systematic Review of Smoking Cessation Interventions for Smokers Diagnosed with Cancer

Free Flap Enhanced Recovery Protocols in Head and Neck Surgery

Enhanced recovery after surgery (ERAS) protocols facilitates a standardized patient care regimen with a goal of reducing the metabolic stress of surgery. Adapted to head and neck free flap reconstructive surgery in 2017, these protocols focused on several key domains such as perioperative nutritional optimization, multimodal pain control, and early mobilization. Studies have shown that in addition to ERAS implementation, the maintenance and improvement of ERAS protocol compliance rates improve perioperative outcomes such as hospital length of stay and decrease major postoperative complications.

A Qualitative Study to Understand the Barriers and Facilitators in Smoking Cessation Practices Among Oncology Health Care Practitioners in One Health System

INTRODUCTION

Despite the benefits of quitting smoking for those who have cancer, including improved health outcomes and reduced therapeutic toxicities, it is unclear how many people are supported in quit attempts during this time. Variations in the availability and provision of smoking cessation (SC) services are reported, with little understanding of the challenges and solutions. This codesigned study aimed to understand the perspectives of health care professionals (HCPs) working in oncology settings to engage in SC practices and identify recommendations for developing a SC pathway.

AIMS AND METHODS

This was a qualitative study. Eighteen HCPs participated in semi-structured interviews from July 2021 to May 2022. We used thematic analysis approaches to code data and present four themes and SC strategies at micro, meso, and organizational levels.

RESULTS

Four themes are reported specifically: (1) timing and knowledge, (2) building a relationship, (3) frequent asking with infrequent action, and (4) removing the barriers and tailoring the system. While HCPs discuss SC, there are variations in documentation and when conversations occur. Primarily, HCPs value the time to build therapeutic relationships with patients and thus may limit SC discussions in preference to treatment in clinical interactions. The role of structural barriers, including prescriptive authority for nurses, hinders active SC processes, as it is the lack of continuity and embedding of services supported by a clinical champion for SC.

CONCLUSIONS

The study suggests reevaluating the status quo in SC service, highlighting service gaps, and suggesting opportunities at organizational levels to reduce structural barriers.

IMPLICATIONS

Variations in SC services exist in designated cancer centers. The data from this study can be used to inform a real-time health systems approach for SC services in oncology settings. Developing tailored SC services and interventions that are patient-centered and informed by their experiences is required. The data in this study suggest developing specialist education and training to upskill HCPs for equitable engagement if we are to meet EU and Cancer Moonshot goals for cancer reduction.

Effectiveness of a self-determination theory-based smoking cessation intervention plus instant messaging via mobile application for smokers with cancer: Protocol for a pragmatic randomized controlled trial

BACKGROUND AND AIMS

Despite evidence that patients living with cancer who continue to smoke after diagnosis are at higher risk for all-cause mortality and reduced treatment efficacy, many cancer patients continue to smoke. This protocol is for a study to test the effectiveness of a self-determination theory-based intervention (quit immediately or progressively) plus instant messaging (WhatsApp or WeChat) to help smokers with cancer to quit smoking.

DESIGN

This will be a multi-centre, two-arm (1:1), single-blind, pragmatic, individually randomized controlled trial.

SETTING

Taking part will be specialist outpatient clinics in five major hospitals in different location-based clusters in Hong Kong.

PARTICIPANTS

The sample will include 1448 Chinese smokers living with cancer attending medical follow-ups at outpatient clinics.

INTERVENTIONS

The intervention group will receive brief advice (approximately 5-8 minutes) from research nurses in the outpatient clinics and then be invited to choose their own quit schedules (immediate or progressive). During the first 6-month follow-up period they will receive instant messaging with smoking cessation advice once per week for the first 3 months, and thereafter approximately once per month. They will also receive four videos, and those opting to quit progressively will receive a smoking reduction leaflet. The control group will also receive brief advice but be advised to quit immediately, and instant messaging with general health advice during the first 6-month follow-up period using the same schedule as the intervention group. Participants in both groups will receive smoking cessation leaflets.

MEASUREMENTS

The primary outcome is biochemically validated smoking abstinence at 6 months, as confirmed by saliva cotinine level and carbon monoxide level in expired air. Secondary outcomes include biochemically validated smoking abstinence at 12 months, self-reported 7-day point prevalence of smoking abstinence at 6 and 12 months, self-reported ≥ 50% reduction of cigarette consumption at 6 and 12 months and quality of life at 6 and 12 months. All time-points for outcomes measures are set after randomization.

COMMENTS

The results could inform research, policymaking and health-care professionals regarding smoking cessation for patients living with cancer, and therefore have important implications for clinical practice and health enhancement.

Strategies for tobacco-free survivorship after breast cancer: The possible weaving of preoperative care and public health policies

Among smoker women with breast cancer quitting smoking has been shown to increase survival and surgical outcomes. Where surgery is indicated, the preoperative seems to be a crucial moment for smoking cessation interventions as it enhances recovery after surgery and motivates prolonged tobacco abstinence. Timing and frequency of preoperative quitting conversations were variables associated with quitting. An early, multidisciplinary, and personalized approach is recommended. A solid integration between primary care services and specialized care is challenging but feasible, implementing prehabilitation pathways that include tobacco treatment routinely as an integral part of breast cancer care. Smoking cessation programs before surgical procedures impact recidivism prevention, survivorship improvement, public health, and cost savings. The contribution of healthcare professionals can make a difference in tobacco control, collaborating with organizations, public health, and nursing research. Integrated solutions in oncological clinical care pathways might help patients build and maintain tobacco abstinence after breast cancer. Future research shall study when patients should abstain from smoking before oncological breast surgery.

Specialist cancer hospital-based smoking cessation service provision in Ireland

BACKGROUND

While much progress has been made in reducing tobacco use in many countries, both active and passive smoking remain challenges. The benefits of smoking cessation are universally recognized, and the hospital setting is an ideal setting where smokers can access smoking cessation services as hospital admission can be a cue to action. Consistent delivery of good quality smoking cessation care across health services is an important focus for reducing the harm of tobacco use, especially among continued smokers.

AIMS

Our objective was to document the smoking cessation medication and support services provided by specialist adult cancer hospitals across Ireland, a country with a stated tobacco endgame goal.

METHODS

A cross-sectional survey based on recent national clinical guidelines was used to determine smoking cessation care delivery across eight specialist adult cancer tertiary referral university hospitals and one specialist radiotherapy center. Survey responses were collected using Qualtrics, a secure online survey software tool. The data was grouped, anonymized, and analyzed in Microsoft Excel.

RESULTS

All responding hospitals demonstrated either some level of smoking cessation information or a service available to patients. However, there is substantial variation in the type and level of smoking cessation information offered, making access to smoking cessation services inconsistent and inequitable.

CONCLUSION

The recently launched National Clinical Guideline for smoking cessation provides the template for all hospitals to ensure health services are in a position to contribute to Ireland's tobacco endgame goal.

Smoking cessation interventions in patients diagnosed with head and neck cancers: A systematic review of randomized controlled trials

Objective

According to findings from the previous studies, quitting smoking can significantly reduce mortality from all causes and is linked to better treatment results. Even though quitting smoking has many benefits, little is known about the evidence supporting the particular quit services offered to smokers after a cancer diagnosis.

Methods

To find the articles related to area in question, different electronic databases including PubMed/Medline, Google Scholar, and EBSCO were searched on April 1st, 2023. All full text randomized controlled trials with one or more intervention and control groups that assessed the outcomes of smoking cessation interventions were included. Participants of included studies were adults diagnosed with head and neck cancer (HNC) and current smokers or those who had recently quit. There were interventions (pharmacological and/or pharmacological) that aimed to help patients with HNC succeed in quitting smoking.

Results

We identified 15352 papers from the initial search from different electronic databases, 2560 remained after excluding duplicates. After screening titles and abstracts for relevance, 2345 articles were removed. Full text articles of remaining 215 papers were assessed in depth by two reviewers for their eligibility, amongst which, 210 articles were excluded. Finally, we included five papers that met the inclusion criteria in the present systematic review.

Conclusion

According to the findings of this review, a multi - component strategy might very well benefit patients with HNC who smoke cigarettes after diagnosis. More studies with high methodological quality and standardized outcome measures must be conducted in this population to inform the development of smoking cessation program.

α7 nicotinic acetylcholine receptor interaction with G proteins in breast cancer cell proliferation, motility, and calcium signaling

Chronic smoking is a primary risk factor for breast cancer due to the presence of various toxins and carcinogens within tobacco products. Nicotine is the primary addictive component of tobacco products and has been shown to promote breast cancer cell proliferation and metastases. Nicotine activates nicotinic acetylcholine receptors (nAChRs) that are expressed in cancer cell lines. Here, we examine the role of the α7 nAChR in coupling to heterotrimeric G proteins within breast cancer MCF-7 cells. Pharmacological activation of the α7 nAChR using choline or nicotine was found to increase proliferation, motility, and calcium signaling in MCF-7 cells. This effect of α7 nAChR on cell proliferation was abolished by application of Gαi/o and Gαq protein blockers. Specifically, application of the Gαi/o inhibitor pertussis toxin was found to abolish choline-mediated cell proliferation and intracellular calcium transient response. These findings were corroborated by expression of a G protein binding dominant negative nAChR subunit (α7345-348A), which resulted in significantly attenuating calcium signaling and cellular proliferation in response to choline. Our study shows a new role for G protein signaling in the mechanism of α7 nAChR-associated breast cancer growth.

Qualitative evaluation of the implementation and future sustainability of an e-referral system for smoking cessation at a US NCI-designated comprehensive cancer center: lessons learned

BACKGROUND

Promoting smoking cessation is recognized as an essential part of cancer care. Moffitt Cancer Center, supported by the National Cancer Institute Cancer Moonshot Cancer Center Cessation Initiative, developed and implemented an opt-out-based automatic electronic health record (EHR)-mediated referral (e-referral) system for Tobacco Quitline services along with options for local group cessation support and an in-house tobacco treatment specialist. This study evaluated barriers and facilitators for implementation of the e-referral system.

METHOD

Steering committee members (N=12) responsible for developing and implementing the new clinical workflow and nurses (N=12) who were expected to use the new e-referral system completed semi-structured interviews. Qualitative thematic content analyses were conducted.

RESULTS

Interviewees perceived the e-referral system as an effective strategy for identifying and referring smokers to cessation services. However, barriers were noted including competing demands and perceptions that smoking cessation was a low priority and that some patients were likely to have low motivation to quit smoking. Suggestions to improve future implementation and sustainability included providing regular trainings and e-referral outcome reports and increasing the visibility of the e-referral system within the EHR.

CONCLUSION

Initial implementation of the e-referral system was perceived as successful; however, additional implementation strategies are needed to ensure sustainability at both the clinician and system levels. Recommendations for future modifications include providing regular clinician trainings and developing a fully closed-loop system. Implications for cancer survivors Initial implementation of an e-referral system for smoking cessation for cancer patients revealed opportunities to improve the smoking cessation referral process at cancer centers.

Appraisal and characterization of candida load isolated from the oral cavity of smokers

Cigarette smoking is regarded as a major global health risk, therefore the aim of this work was to investigate the association of oral Candida spp. as one of the etiological agents of denture stomatitis with smokers of cigarette, hookah (shisha), and electronic smoking, also a dose-response relationship between the duration of smoking and the probability of denture stomatitis between volunteers. Oral rinse samples were collected from 47 male volunteers including 34 smokers and 13 non-smokers, also data of volunteers were collected via a questionnaire forum. Patterns of smoking were shown that smokers using tobacco cigarettes 17 (36.2 %), electronic cigarettes 16 (34.04 %), and hookah smokers 8 (17.02 %). A comparison of smokers and non-smokers regarding effects on oral health showed significantly finding (P < 0.05) indicating that smoking affects oral health in all evaluated parameters (an oral mucosal abnormality, mouth ulcers, bad breath, and feeling of dry mouth). Out of 19 Candida isolates, 18 (94.7 %) were identified as Candida albicans and 1 (5.3 %) as Candida tropicalis. Among the volunteers who presented with oral Candida (19 volunteers), 17 (89.5%) were smokers, while non-smoker volunteers were 2 (10.5 %), so it can be concluded that smoking was a significant positive correlation to the presence of Candida in the oral cavity. Five volunteers suffered from chronic diseases; 4 (8.5%) diabetes mellitus and 1 (2.1%) anemia as a systemic predisposing factor for oropharyngeal infection. Amphotericin and Nystatin had varying degrees of activity against isolated Candida isolates.

[Smoking cessation in hospitalised patients - Initiate among inpatients, continue when outpatients - A Position Paper by the German Respiratory Society (DGP) Taskforce for Smoking Cessation]

Tobacco smoking is the greatest preventable health risk. The effects are serious, both individually and societal. Nevertheless, the current prevalence of tobacco smokers in Germany is still high at around 35 %. A recent strong increase in actively smoking adolescents (14- to 17-year-olds, current prevalence approx. 16 %) and young adults (18- to 24-year-olds, current prevalence approx. 41 %) is also a cause for concern. About a third of all inpatients continue smoking while being treated. The hospitalization of active smokers in acute and rehabilitation hospitals serves as a "teachable moment" for initiation of cessation offers. An intervention that begins in hospital and continues for at least a month after discharge results in about 40 % additional smokefree patients. It is scientifically well-researched, effective and cost-efficient. After initiation in hospital these measures can be continued via ambulatory cessation programs, rehabilitation facilities, an Internet or telephone service. In Germany, there are structured and quality-assured cessation offers, both for the inpatient and for the outpatient area. The biggest obstacle to broad establishment of such offers is the lack of reimbursement. Two feasible ways to change this would be the remuneration of the existing OPS 9-501 "Multimodal inpatient treatment for smoking cessation" and the establishment of quality contracts according to § 110a SGB V. An expansion of tobacco cessation measures in healthcare facilities would reduce smoking prevalence, associated burden of disease and consecutive costs.

Targeting immune cell types of tumor microenvironment to overcome resistance to PD-1/PD-L1 blockade in lung cancer

Lung cancer is the common malignant tumor with the highest mortality rate. Lung cancer patients have achieved benefits from immunotherapy, including immune checkpoint inhibitors (ICIs) therapy. Unfortunately, cancer patients acquire adaptive immune resistance, leading to poor prognosis. Tumor microenvironment (TME) has been demonstrated to play a critical role in participating in acquired adaptive immune resistance. TME is associated with molecular heterogeneity of immunotherapy efficacy in lung cancer. In this article, we discuss how immune cell types of TME are correlated with immunotherapy in lung cancer. Moreover, we describe the efficacy of immunotherapy in driven gene mutations in lung cancer, including KRAS, TP53, EGFR, ALK, ROS1, KEAP1, ZFHX3, PTCH1, PAK7, UBE3A, TNF-α, NOTCH, LRP1B, FBXW7, and STK11. We also emphasize that modulation of immune cell types of TME could be a promising strategy for improving adaptive immune resistance in lung cancer.