Background: Continuing to smoke after cancer diagnosis has serious implications, leading to compromised treatment effectiveness, reduced survival, increased risk of recurrence, and impaired daily functioning. Despite these risks, about 30-50% of cancer patients continue to smoke and 40-50% of smokers with cancer relapse usually within a few months. Due to the aging of the population, the number of Veterans diagnosed with cancer each year is increasing. To optimize the effectiveness of their cancer treatment and quality of life, increased efforts to promote tobacco cessation within cancer care are needed. Rationale: While many people may consider stopping smoking after a cancer diagnosis to be an obvious decision, an effective tobacco cessation intervention for cancer patients remains elusive. Few studies have examined tobacco cessation among cancer patients. Of these, only one study found an intervention effect, with low quit rates (14-30%) across studies. This and other research suggests that most cancer patients do not understand the risk of continued smoking on their prognosis and treatment outcomes. While the role of risk perceptions in behavior change is strongly supported by theory, no studies have explored whether more clearly communicating the risks and consequences of tobacco use to patients improves quit rates over current cessation treatment. Therefore, this study will create a communication tool that helps patients make sense of the implications of continued smoking and aids providers in having these discussions to increase patient motivation and promote long-term cessation.
Specific Aims :
Aim 1. Develop a targeted risk communication tool to enhance clinical cessation interventions and educate cancer patients about risks associated with continued tobacco use. We will use patient cognitive interviews to collect feedback on patient reactions to the draft communication tool.
Aim 2. Conduct a randomized pilot study (best practices vs. best practices + targeted risk communication) among tobacco-dependent Veterans receiving outpatient cancer care. This pilot (N=118) study will a) provide preliminary data on motivation to quit, tobacco cessation outcomes, and patient acceptability in the Veteran cancer population and test the hypothesis that targeted risk communication will increase motivation to quit, and b) assess costs associated with each intervention arm. Methods: The research will be conducted in two phases. During the first developmental phase, we will work with health communications experts to draft a risk communication tool and refine it further using cognitive interviews with patients. In the second phase we will conduct a randomized pilot project to evaluate the potential of the risk communication tool to improve tobacco cessation outcomes. During a period of 18 months, oncology nurses will provide N=118 VA cancer patients with best-practices cessation treatment (advice, medications, and referral to the state Quitline) alone or in addition to reviewing an informational sheet with plain language explanations and visual representations of diagnosis-specific risk data related to smoking and cancer. Patient reactions and quitting outcomes will be surveyed at 2-weeks post-encounter and at 6-months. We will evaluate motivation to quit, 7-day abstinence, and moderators of cessation, as well as gather data related to costs. This innovative project has implications for improving the design of theory-based tobacco cessation programs and the quality of cancer care within VA.
Continuing to smoke after cancer diagnosis has serious negative consequences for patients including reduced treatment effectiveness, decreased survival, and greater risk of cancer returning. A large portion of cancer patients, however, continue to smoke. Cancer patients face a number of barriers to quitting smoking including high nicotine dependence, stigma and shame, and the perception that quitting cannot help them. Evidence suggests that having healthcare providers educate patients on the risk of continuing to smoke may increase their motivation for quitting. Therefore this study will work with experts in the field of health communication to develop a new patient education tool to help patients understand this important information and test its ability to increase quit rates among Veterans diagnosed with cancer. This project will produce an innovative program that can be used improve the quality of cancer care and tobacco cessation programs within VA.