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E.R. Gritz
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MTE 08 - Tobacco Control: What Do the Experts Do? (Ticketed Session) (ID 60)
- Event: WCLC 2015
- Type: Meet the Expert (Ticketed Session)
- Track: Prevention and Tobacco Control
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 07:00 - 08:00, 702+704+706
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MTE08.01 - Tobacco Control: What Do the Experts Do? (ID 1988)
07:00 - 07:30 | Author(s): E.R. Gritz
- Abstract
- Presentation
Abstract:
Introduction Cancer mortality continues to decline in the US and the number of cancer survivors continues to rise, currently estimated at 14.5 million in 2014 and predicted to reach 19 million by 2024 (ACS and NCI). The percent of adult cancer survivors who are current smokers has not changed dramatically over the past 10 years, and is comparable to the general population, except in the youngest age group, 18-44, where it is significantly higher (2000-2010 NHIS). The 2014 Report of the Surgeon General, "The Health Consequences of Smoking - 50 Years of Progress," cited 20,830,000 premature deaths caused by smoking and exposure to secondhand smoke (1965-2014). Smoking–related cancers accounted for 6,587,000 and lung cancers caused by exposure to secondhand smoke accounted for 263,000. Between 2005 and 2009, over 480,000 US deaths annually were attributable to cigarette smoking. Lung cancer accounted for almost 138,000 (29%). In 2015, the estimate is 158,040 lung cancer deaths – 86,380 (28%) in men and 71,660 (26%) in women, still the leading cause of cancer death in the US. The 2014 SGR concluded that there is a causal relationship between cigarette smoking and adverse health outcomes, and that quitting smoking improves the prognosis of cancer patients. In cancer patients and survivors, a causal relationship was concluded between smoking and all-cause mortality, cancer-specific mortality, and increased risk for second primary cancers known to be caused by smoking. The relationship is considered suggestive but not causal between cigarette smoking and risk of recurrence, poorer response to treatment and increased treatment-related toxicity. Among chronic disease populations (NHIS 2006 vs 2012), 15.2% of lung cancer survivors continue to smoke, compared to 20.9% in 2006. Among other smoking-related cancers, 33.8% of survivors continue to smoke, compared to 38.8% in 2006. Among persons with no chronic disease, the comparable percents of current smokers were 16.6% in 2012 and 19.3% in 2006. These elevated rates of current smoking among chronic disease survivors are truly alarming. Clearly, the need for tobacco cessation intervention is great among cancer patients and survivors. Addiction to cigarette smoking (and all tobacco use) is challenging to treat in both healthy individuals and in those with serious diseases. Nearly 70% of smokers say they want to quit, and nicotine dependence is considered a chronic relapsing disorder. Negative affect, particularly symptoms of depression or negative mood, is strongly related to higher smoking prevalence and relapse rates. MD Anderson’s Tobacco Treatment Program (TTP) In response to the great need to assist cancer patients and survivors in their efforts to stop using tobacco, in 2006 the Tobacco Treatment Program was established at MD Anderson, underwritten by funds from the State of Texas settlement with the tobacco industry. The program continues to be funded from that source, at no cost to participants. The Mission of the TTP is to implement a comprehensive tobacco-cessation and relapse prevention program for all MD Anderson patients and employees (including family members). The program is led by three faculty Directors, members of the Department of Behavioral Science: Paul Cinciripini, Ph.D., Program Director; Janice Blalock, Ph.D., Assistant Director; and Maher Karam-Hage, MD, Associate Medical Director. The program is staffed by a counseling team, a medical team, a data team and a number of research and administrative staff. The TTP provides a range of treatment options that become progressive more intense, to match the needs of each participant. Multiple options for service delivery include: Self-help educational packet and follow-up call; Motivational intervention, education and follow-up call; Telephone counseling only; and Comprehensive, individualized counseling involving in-person counseling and both in-person and telephone follow-up. This component includes pharmacotherapy and the assessment and treatment of psychiatric co-morbid disorders. In 2012, MD Anderson began automatic referral to the TTP of all patients who currently smoke or recently quit smoking for proactive assistance. The number of referrals/day more than quadrupled, from ~10/day to between 40-50/day (2012-2014 data). Recently, there has been an expansion of service to the Regional Care Centers via a Telemedicine Platform. In FY 14, 4,613 patients had a motivational interaction with program staff, including 3,639 current smokers and 974 recent quitters. The three top clinic sources were GU (16.8%), Head & Neck (14.6%) and Thoracic (14.3%). The data below are based on the subset of patients who participated in the “in-person” option. In terms of demographics: Ethnicity – 75.3% non-Hispanic white; 12.9% black/African-American; 6.9% Hispanic; and 4.9% other; Gender – 52.0% female and 48.0% male; Location – 56.1% Houston Metro area; Mean age – 55.7 years; Mean number of cigarettes smoked/day – 15.1; number of years smoked – 32.7. Psychiatric co-morbidity – 12% alcohol abuse, 13% major depression, 11% other depression, 13% anxiety, and 8% panic disorder; 61% no psychiatric disorder. Between 2006 and 2013, a cohort of 3404 individuals reached the 9 month time point since completing their initial individual consultation with TTP providers. Self-reported 7 day point prevalence abstinence information was determined for two analyses - Intent–To-Treat (ITT, all patients, excluding deceased) and Respondent-Only (RO, only those patients who responded to follow-up). Response rates for the RO analysis were high – 89% at 3 months, 83% at 6 months, and 76% at 9 months). The RO analysis was undertaken because patients cannot be reached at follow-up for reasons other than relapse to smoking, including illness, successful cessation, and other personal concerns. The ITT analysis utilized the traditional conservative approach of representing missing data as smoking. The 7 day point prevalence abstinence rates for ITT and RO analyses, at follow-up, were: 3 months – ITT 41.1%, RO 46.0% 6 months – ITT 39.1%, RO 47.2% 9 months – ITT 35.1%, RO 46.2% These data compare favorably with those of smoking cessation studies in the general population, using both pharmacotherapy and counseling. In conclusion, the MD Anderson Cancer Center seeks to reduce tobacco use and its adverse consequences in its own patient and employee population and in a set of new initiatives to extend its expertise throughout the Texas university system and institutions that serve vulnerable populations who consume tobacco (to be presented at IASLC).
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