Smoking Cessation Training and Treatment: Options for Cancer Centres

Patients who achieve smoking cessation following a cancer diagnosis can experience an improvement in treatment response and lower morbidity and mortality compared to individuals who continue to smoke. It is therefore imperative for publicly funded cancer centres to provide appropriate training and education for healthcare providers (HCP) and treatment options to support smoking cessation for their patients. However, system-, practitioner-, and patient-level barriers exist that hamper the integration of evidence-based cessation programs within publicly funded cancer centres. The integration of evidence-based smoking cessation counselling and pharmacotherapy into cancer care facilities could have a significant effect on smoking cessation and cancer treatment outcomes. The purpose of this paper is to describe the elements of a learning health system for smoking cessation, implemented and scaled up in community settings that can be adapted for ambulatory cancer clinics. The core elements include appropriate workflows enabled by technology, thereby improving both practitioner and patient experience and effectively removing practitioner-level barriers to program implementation. Integrating the smoking cessation elements of this program from primary care to cancer centres could improve smoking cessation outcomes in patients attending cancer clinics.     

Health Risk Behavior of Romanian Adults having Relatives with Cancer

This study aimed to assess body features, and alimentary and lifestyle behavior related to cancer preventionamong Romanian adults having relatives with cancer. The study was performed in 2010/2011 in an oncologicalhospital in Cluj-Napoca, Romania. It involved 320 adults who had relatives with cancer. An anonymousquestionnaire was filled in by each participants; their weights and heights were measured and body mass index(BMI) was calculated, 56.6% of the participants having a value higher than 24.9. Almost all subjects ate less than400g of fruits and vegetables daily and 56% of the participants consumed more than 500 g of red meat weekly.One quarter of the study sample was performing less than 30 minutes of moderate physical activity daily. Some28.1% of the subjects were smokers. These data call for comprehensive actions to help Romanian cancer patientrelatives to respect the recommendations regarding healthy lifestyle promotion and cancer prevention. Healthprofessionals should periodically assess body composition and lifestyle components of adults who have relativeswith cancer in order to identify unhealthy behavior and offer them personalized education and counseling.     

Lessons from Cost-Effectiveness Analysis of Smoking Cessation Programs for Cancer Patients

Background: Smoking among patients diagnosed with cancer poses important health and financial challenges including reduced effectiveness of expensive cancer therapies. This study explores the value of smoking cessation programs (SCPs) for patients already diagnosed with cancer. It also identifies conditions under which SPCs may be wise investments. Methods: Using a simplified decision analytic model combined with insights from a literature review, we explored the cost-effectiveness of SCPs. Results: The findings provide insights about the potential impact of cessation probabilities among cancer patients in SCPs and the potential impact of SCPs on cancer patients’ lives. Conclusion: The evidence suggests that there is good reason to believe that SCPs are an economically attractive way to improve outcomes for cancer patients when SCPs are offered in conjunction with standard cancer care.     

Engaging Patients in Smoking Cessation Treatment within the Lung Cancer Screening Setting: Lessons Learned from an NCI SCALE Trial

Offering smoking cessation treatment at lung cancer screening (LCS) will maximize mortality reduction associated with screening, but predictors of treatment engagement are not well understood. We examined participant characteristics of engagement in an NCI SCALE cessation trial. Eligible LCS patients (N = 818) were randomized to the Intensive arm (8 phone counseling sessions +8 weeks of nicotine replacement therapy (NRT)) vs. Minimal arm (3 sessions + 2 weeks of NRT). Engagement was measured by number of sessions completed (none, some, or all) and NRT mailed (none vs. any) in each arm. In the Intensive arm, those with ≥some college (OR = 2.1, 95% CI = 1.1, 4.0) and undergoing an annual scan (OR = 2.1, 95% CI = 1.1, 4.2) engaged in some counseling vs. none. Individuals with higher nicotine dependence were more likely (OR = 2.8, 95% CI = 1.3, 6.2) to request NRT. In the Minimal arm, those with higher education (OR = 2.1, 95% CI = 1.1, 3.9) and undergoing an annual scan (OR = 2.0, 95% CI = 1.04, 3.8) completed some sessions vs. none. Requesting NRT was associated with more pack-years (OR = 1.9, 95% CI = 1.1, 3.5). Regardless of treatment intensity, additional strategies are needed to engage those with lower education, less intensive smoking histories, and undergoing a first scan. These efforts will be important given the broader 2021 LCS guidelines.     

The Tobacco Endgame—A New Paradigm for Smoking Cessation in Cancer Clinics

Smoking cessation represents an untapped resource for cancer therapy. Many people who smoke and have cancer (tobacco-related or otherwise) struggle to quit and as a result, jeopardise response to treatment, recovery after surgery and long-term survival. Many health care practitioners working in cancer medicine feel undertrained, unprepared and unsupported to provide effective smoking cessation therapy. Many institutions and healthcare systems do provide smoking cessation programs, guidelines and referral pathways for cancer patients, but these may be unevenly applied. The growing body of evidence, from both retrospective and prospective clinical studies, confirms the benefit of smoking cessation and will provide much needed evidence for the best and most effective interventions in cancer clinics. In addition to reducing demand, helping cancer patients quit and treating addiction, a firm commitment to developing smoke free societies may transform cancer medicine in the future. While the Framework Convention for Tobacco Control (FCTC) has dominated global tobacco control for the last two decades, many jurisdictions are starting to develop plans to make their communities tobacco free, to introduce the tobacco endgame. Characterised by downward pressure on tobacco supply, limited sales, limited access and denormalization of smoking, these policies may radically change the milieu in which people with cancer receive treatment, in which health care practitioners refine skills and which may ultimately foster dramatic improvements in cancer outcomes.     

Identifying Best Implementation Practices for Smoking Cessation in Complex Cancer Settings

Background: In response to evidence about the health benefits of smoking cessation at time of cancer diagnosis, Ontario Health (Cancer Care Ontario) (OH-CCO) instructed Regional Cancer Centres (RCC) to implement smoking cessation interventions (SCI). RCCs were given flexibility to implement SCIs according to their context but were required to screen new patients for tobacco status, advise patients about the importance of quitting, and refer patients to cessation supports. The purpose of this evaluation was to identify practices that influenced successful implementation across RCCs. Methods: A realist evaluation approach was employed. Realist evaluations examine how underlying processes of an intervention (mechanisms) in specific settings (contexts) interact to produce results (outcomes). A realist evaluation may thus help to generate an understanding of what may or may not work across contexts. Results: The RCCs with the highest Tobacco Screening Rates used a centralized system. Regarding the process for advising and referring, three RCCs offered robust smoking cessation training, resulting in advice and referral rates between 80% and 100%. Five RCCs surpassed the target for Accepted Referral Rates; acceptance rates for internal referral were highest overall. Conclusion: Findings highlight factors that may influence successful SCI implementation.     

Relatives of Prostate Cancer Patients have an Increased Risk of Prostate and Stomach Cancers: A Population-Based, Cancer Registry study in Finland

Objective: Five to ten percent of prostate cancers may be caused by inherited genetic defects. In order to explore the nature of inherited cancer risks in the genetically homogeneous Finnish population, we investigated the incidence of prostate cancer and other cancers in first-degree relatives of prostate cancer patients by linking the population-based parish records on relatives with the Finnish Cancer Registry (FCR) data. Methods: The study population was composed of first-degree relatives of two groups of prostate cancer patients diagnosed in Finland during 1988–1993: (1) all early-onset (60years) patients (n=557) from the entire country, (2) a sample (n=989) of prostate cancer patients diagnosed at an age of >60years. A total of 11,427 first-degree relatives were identified through parish records, and their cancer incidence was determined based on a total of 299,970 person-years. Standardized incidence ratios (SIR) were calculated based on expected cancer rates in the general population. Results: The SIR of prostate cancer was increased in both Cohort 1 (2.5, 95% CI 1.9–3.2) and Cohort 2 (1.7, 95% CI 1.4–2.1). The risk of prostate cancer was high for relatives of patients diagnosed at an early age, and then leveled off for patients in the median age of prostate cancer diagnosis (70–79 years). However, the prostate cancer risk for relatives of patients diagnosed 80years was again statistically significantly elevated (SIR 1.8, 95% CI 1.3–2.6), suggesting a contribution of genetic factors to prostate cancer also at a late age of onset. Gastric cancer was the only other cancer type with a significantly elevated risk among the relatives. Increased risk of gastric cancer was seen only in male relatives of prostate cancer patients diagnosed at an early age, with the highest risk detected for the male relatives of prostate cancer patients diagnosed at an age of 55 years or less (SIR 5.0, 95% CI 2.8–8.2). Conclusions: Our population-based study indicates that hereditary factors may play an important role in the development of prostate cancer among the relatives of men diagnosed both at younger and older ages. This finding is relevant in the context of our observations that HPCX (hereditary prostate cancer susceptibility locus on Xq27-28) linkage in Finland is found exclusively among families with late age of onset. The association of gastric cancer with prostate cancer has not been reported previously, and may reflect the effects of a novel predisposition locus, which increases the risk to both of these common tumor types.     

Changes in the Attitudes and Behavior of Relatives of Breast Cancer Patients Concerning Cancer Prevention and Screening

Background: Changes in the attitudes and behavior of relatives of breast cancer patients concerning cancerprevention and screening after diagnosis in a loved one were evaluated. Materials and Methods: Forty-threequestions were used to collect data from the relatives of the breast cancer patients who had been living withtheir relatives for at least one year. Results: The study group was composed of 171 female relatives (medianage: 43, range: 17-82 yr). After the patients were diagnosed with breast cancer, changes in the attitudes andbehavior of their relatives toward the prevention and screening of cancer were evident in 78 (45.6%) of the studyparticipants (e.g. eating habits, quit or reduced smoking , exercise habits). In addition, it was noted that somecharacteristics of the relatives had different effects on different attitudes and behavior. Conclusions: Awarenesson breast cancer among the relatives of breast cancer patients is useful for the management of health and socialproblems that can be seen in these individuals. At the same time, this information could help countries determinewhether their actual level of healthcare for early cancer diagnosis, prevention, and screening are adequate.     

Rates of Smoking Cessation at 6 and 12 Months after a Clinical Tobacco Smoking Cessation Intervention in Head and Neck Cancer Patients in Northern Ontario,Canada

Smoking during cancer treatment is associated with reduced treatment response and cancer recurrence in patients with tobacco-related cancers. The purpose of this study was to examine smoking characteristics in head and neck cancer patients (n = 503) with a history of smoking and examine the impact of an intensive clinical tobacco intervention to patients who were currently smoking. All participants completed an interviewer-administered questionnaire at study enrollment which examined smoking behaviours, motivations to quit, and strategies used to cessate smoking. Follow-up assessments were completed at 6- and 12-months which monitored whether patients had quit smoking, remained cessated, or continued to smoke since study recruitment. For those who were currently smoking (n = 186, 37.0%), an intensive clinical tobacco intervention that utilized the 3A’s—Ask, Advise, Arrange—and the Opt-Out approach was offered to assist with smoking cessation at their new patient visit and followed-up weekly during their head and neck radiation therapy for 7 weeks. At 6 months, 23.7% (n = 41) of those who were smoking successfully quit; 51.2% quit ‘cold turkey’ (defined as using no smoking cessation assistance, aids or pharmacotherapy to quit), while 34.9% used pharmacotherapy (varenicline (Champix)) to quit. On average, it took those who were smoking 1–5 attempts to quit, but once they quit they remained cessated for the duration of the study. Although the head and neck cancer patients in this study reported high levels of nicotine dependence, many were able to successfully cessate.     

Prevalence of Colorectal Cancer in Relatives of Iranian Patients Diagnosed with Colorectal Cancer

Background: A high rate of colorectal cancer occurrence is established in individuals with a positive familyhistory of this type of cancer. Objectives: The aim of this study was to investigate the prevalence of colorectalcancer in first degree and second degree relatives of colorectal cancer patients. Methods: Family medical historiesof 489 first degree relatives of colorectal cancer patients were obtained by a questionnaire. 249 average riskpatients with no family history of colorectal cancer were included as control patients. Results: In our study froma total of 489 case patients, 153 (31.3%) had at least one close relative affected by colon cancer. Case-controlanalysis showed an odd ratio of 3.1 (95% CI, 2.07 to 6.27) for one and 5.7 (CI, 2.39 to 13.56) for two affectedrelatives. Cases with a positive family history had a 3.006 times greater risk in developing colorectal cancer if afirst degree relative was affected comparing with a 4.898 time greater risk if a second degree family memberwas diagnosed with colorectal cancer .Our study indicated a higher risk for developing colorectal cancer in malefamily relatives 50 years and older. Rectal area was found the most tumor side affected in case and controlpatients. Conclusion: First-degree relatives of patients with colorectal cancer had an increased risk of developingthis type of cancer. The risk was greater when diagnosis was in male, elderly patients and other first-degreerelatives were affected.     

Implementation of Screening Colonoscopy amongst First-Degree Relatives of Patients with Colorectal Cancer in Turkey: a Cross-Sectional Questionnaire Based Survey

Objective: To evaluate the implementation of screening colonoscopy amongst first-degree relatives (FDRs)of patients with colorectal cancer (CRC) in Turkey. Materials and Methods: A total of 400 first-degree relatives(mean(SD)age: 42.5(12.7) years, 55.5% were male) of 136 CRC patients were included in this cross-sectionalquestionnaire based survey. Data on demographic characteristics, relationship to patient and family history formalignancy other than the index case were evaluated in the FDRs of patients as were the data on knowledge aboutand characteristics related to the implementation of screening colonoscopy using a standardized questionnaireform. Results: The mean(SD) age at diagnosis of CRC in the index patients was 60.0(14.0) years, while mean(SD)age of first degree relatives was 42.5(12.7) years. Overall 36.3% of relatives were determined to have knowledgeabout colonoscopy. Physicians (66.9%) were the major source of information. Screening colonoscopy wasrecommended to 19.5% (n=78) of patient relatives, while 48.7% (n=38) of individuals participated in colonoscopyprocedures, mostly (57.9%) one year after the index diagnosis. Screening colonoscopy revealed normal findingsin 25 of 38 (65.8%) cases, while precancerous lesions were detected in 26.3% of screened individuals. In 19.0% ofFDRs of patients, there was a detected risk for Lynch syndrome related cancer. Conclusions: In conclusion, ourfindings revealed that less than 20% of FDRs of patients had received a screening colonoscopy recommendation;only 48.7% participated in the procedure with detection of precancerous lesions in 26.3%. Rise of awarenessabout screening colonoscopy amongst patients with CRC and first degree relatives of patients and motivationof physicians for targeted screening would improve the participation rate in screening colonoscopy by FDRs ofpatients with CRC in Turkey.     

原发性肝癌患者与其一级亲属的血糖水平分析

[目的]分析启东地区原发性肝癌患者与其一级亲属及对照者血糖水平。[方法]肝癌患者448例（肝癌组）、肝癌患者一级亲属1282例（亲属组）及健康体检人员1236例（对照组）,均作HBsAg、空腹血糖检测,以χ2检验进行统计学处理。[结果]肝癌组的高血糖检出率显著性高于亲属组和对照组（χ2=16．64、64．80,P均〈0．01）;亲属组显著性高于对照组（χ2=24．33,P〈0．01）。肝癌组HBsAg阳性检出率显著性高于亲属组和对照组（χ2=382．91、726．61,P均〈0．01）;亲属组显著性高于对照组（χ2=91．04,P〈0．01）。[结论]高血糖和HBsAg可能是原发性肝癌的独立或协同危险因素,肝癌患者的一级亲属也可能是原发性肝癌的易感人群,应予高度重视。     

Evaluation of Breast Self-Examination (BSE) Application in First and Second Degree Relatives of Patients with Breast Cancer

Background: The aim of this study was to determine beliefs concerning breast self-examination in first- andsecond-degree relatives of patients with breast cancer and evaluate their breast self-examination (BSE) application.Materials and Methods: A survey study was conducted in an oncology polyclinic and general surgery clinic ofa hospital in Ankara, the capital of Turkey with a sample of 140 women. Results: It was determined that 60.7%of the participants had conducted BSE and 48.1% had undergone a clinical breast examination. Perceived selfefficacyof the women who performed BSE were significantly higher compared with women who did not practiceBSE (p<0.001) Furthermore, perceived barriers were lower among those who had performed BSE (p<0.001).Logistic regression analysis indicated that women who perceived higher self-efficacy (OR: 1.119, 95% CI: 1.056-1.185, p<0.001) and had regular CBE (OR: 8.250, 95% CI: 3.140-21.884, p<0.001) and educational status (OR:5.287, 95% CI: 1.480-18.880, p<0.01) were more likely to perform BSE. Conclusions: Findings from this studyindicated that perceived barriers, perceived self-efficacy, and educational status could be predictors of BSEbehavior among the first- and second-degree relatives of patients with breast cancer. Therefore, BSE trainingprograms that emphasize self-efficacy and address perceived barriers are recommended.     

Quality of Life of Family Members Living with Cancer Patients

Background: Due to the rapid progress of industrialization, the expansion of the nuclear family, and anincrease in women’s social activities, the burden of care of cancer patients has increased, so that all familymembers are now involved in care. We compared the health-related quality of life (HRQOL) between membersof families of cancer patients (hereafter, cancer families) and members of cancer-free families (non-cancerfamilies). Materials and Methods: The data were from the Community Health Survey (2012). The studypopulation included respondents at least 30 years of age. Data were adjusted for the following covariates:sex, age, education, marital status, household income, economic activity, household type, chronic disease, andperceived health status. Frequency analysis, analyses of variance, and multiple linear regression analysis wereperformed. Results: Among 163,495 respondents, 3,406 (2.1%) were part of a cancer family and 160,089 (97.9%)were part of a non-cancer family. Cancer families had lower EQ-5D scores than non-cancer families. However,by subgroup, the scores had significant association between cancer and non-cancer families only for females andfor those who worked. Conclusions: There was a significant relationship between HRQOL scores and being afamily member of a cancer patient. This indicates that the responsibility for care has been extended to the entirefamily, not only the primary caregiver.     

Cigarette Smoking and Pancreatic Cancer Risk: A Revisit with an Assessment of the Nicotine Dependence Phenotype

Background: Cigarette smoking is a well-established risk factor of pancreatic cancer (PC). Although anassociation between nicotine dependence phenotype, namely time to first cigarette (TTFC) after waking, andthe risk of several smoking-related cancers has been reported, an association between TTFC and PC risk hasnot been reported. We assessed the impact of smoking behavior, particularly TTFC, on PC risk in a Japanesepopulation. Materials and Methods: We conducted a case-control study using 341 PC and 1,705 non-cancerpatients who visited Aichi Cancer Center in Nagoya, Japan. Exposure to risk factors, including smoking behavior,was assessed from the results of a self-administered questionnaire. The impact of smoking on PC risk was assessedwith multivariate logistic regression analysis adjusted for potential confounders to estimate odds ratios (ORs) and95% confidence intervals (CIs). Results: Cigarettes per day (CPD) and/or smoking duration were significantlyassociated with PC risk, consistent with previous studies. For TTFC and PC risk, we found only a suggestiveassociation: compared with a TTFC of more than 60 minutes, ORs were 1.15 (95%CI, 0.65- 2.04) for a TTFC of30-60 minutes and 1.35 (95%CI, 0.85-2.15) for that of 0-30 minutes (p trend=0.139). After adjustment for CPDor smoking duration, no association was observed between TTFC and PC. Conclusions: In this study, we foundno statistically significant association between TTFC and PC risk. Further studies concerning TTFC and PCrisk are warranted.     

Evaluation of an Intervention to Enhance the Delivery of Smoking Cessation Services to Patients with Cancer

We describe a brief staff training program to improve the delivery of tobacco cessation services to patients with head and neck cancers. This study utilized a quasi-experimental design to compare the delivery of smoking cessation components and outcomes among patients exposed to either usual care (UC) or an enhanced cessation (EC) program implemented following a 1-h staff education program. Of the 179 subjects enrolled, 112 were recontacted by phone 1 month after their clinic visit. More patients in EC compared to UC reported that they were asked about their smoking status (94.2% vs. 76.6%, p = 0.01), advised to quit (92.3% vs. 72.3%, p = 0.01), prescribed cessation medications (30.8% vs. 3.3%, p < 0.001), and received a support call (53.8% vs. 11.7%, p < 0.001) at the 1-month follow-up. Quit attempts and quit rates between groups were similar. The EC intervention improved the delivery of cessation services in a busy clinical setting, but this failed to increase cessation rates after 1 month.     

Polymorphisms in Thymidylate Synthase and Methylenetetra-hydrofolate Reductase Genes and the Susceptibility to Esophageal and Stomach Cancer with Smoking and Drinking Habits

Thymidylate synthetase (TS) and methylenetetrahydrofolate reductase (MTHFR) are major enzymes in the ‍metabolism of folates, involved in DNA ‘breaks’, instability and hypomethylation.To investigate the possible relations ‍between the TS 3’-UTR and MTHFR C677T polymorphisms and environmental factors impacting on risk of ‍esophageal and stomach cancers, we conducted a case-control study in a high incidence region of China for these ‍cancers. We recruited 138 esophageal and 155 stomach cancer cases, and 223 controls. The TS 3’-UTR and MTHFR ‍C677T genotypes were detected by RFLP assay, using PCR products. The frequency of the -6 bp homozygous TS 3’- ‍UTR genotype was 37.7 % in controls, higher than in Caucasians, although the present distribution was not in ‍Hardy-Weinberg equilibrium. Ever-smoking with the -6 bp/-6 bp TS genotype elevated the ORs (2.61, 1.24-5.49; ‍3.54, 1.60-7.82) for cases of esophageal and stomach cancers, respectively, when compared with never-smoking with ‍the +6 bp/+6 bp and +6 bp/-6 bp genotypes. No combination between the TS and MTHFR genotypes gave increased ‍ORs. The present results suggest that TS polymorphism may modify the risk of esophageal and stomach cancer with ‍smoking, pointing to the necessity for further investigations with information on folate and methionine intake with ‍a larger population. ‍