Abstract
Purpose
Smoking is a risk factor for poor outcomes following breast reconstructive surgery. This project aimed to design and implement an intervention to consistently refer all breast cancer patients to tobacco treatment services.
Methods
In formative work, a set of processes for providers to consistently refer patients to a tobacco treatment specialist at the Nicotine Dependence Center (NDC) was designed. Elements included consistent documentation of smoking status, provider advice specific to the benefits of quitting to cancer care, referral to NDC using an “opt-out” strategy that emphasized smoking cessation as a standard part of breast cancer treatment, and reinforcement of the importance of the referral by multiple personnel. The number of referrals to the NDC and number of patients who attended their scheduled NDC appointment were measured before and 1 year after implementation. Qualitative evaluation was performed using semi-structured interviews with participating providers and patients regarding acceptability.
Results
The proportion of smoking patients referred to the NDC increased from 29% (22/75) before the intervention to 74% (20/27) afterward. Among those referred, attendance at the consultation increased from 41% (9/22) to 75% (15/20). This occurred despite provider interviews revealing knowledge gaps about the referral process and evidence of provider adaptation to accommodate personal practice. Feasibility and acceptability of the intervention were high.
Conclusion
These findings suggest that similar referral interventions for all cancer patients should be pursued with the aim of embedding tobacco dependence treatment seamlessly and consistently into the cancer treatment plan of every patient who smokes cigarettes.
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References
Andersen ZJ, Jorgensen JT, Gron R, Brauner EV, Lynge E (2017) Active smoking and risk of breast cancer in a Danish nurse cohort study. BMC Cancer 17:556
Cahill K, Lancaster T, Green N (2010) Stage-based interventions for smoking cessation. Cochrane Database Syst Rev 11:CD004492. https://doi.org/10.1002/14651858
Catsburg C, Kirsh VA, Soskolne CL, Kreiger N, Rohan TE (2014) Active cigarette smoking and the risk of breast cancer: a cohort study. Cancer Epidemiol 38:376–381
Damschroder LJ, Hagedorn HJ (2011) A guiding framework and approach for implementation research in substance use disorders treatment. Psychol Addict Behav 25:194–205
Gritz ER, Fingeret MC, Vidrine DJ, Lazev AB, Mehta NV, Reece GP (2006) Successes and failures of the teachable moment: smoking cessation in cancer patients. Cancer 106:17–27
Kispert S, McHowat J (2017) Recent insights into cigarette smoking as a lifestyle risk factor for breast cancer. Breast Cancer (Dove Med Press) 9:127–132
Knobloch K, Gohritz A, Reuss E, Vogt PM (2008) Nicotine in plastic surgery : a review. Chirurg 79:956–962
Nolan MB, Warner DO (2015) Safety and Efficacy of Nicotine Replacement Therapy in the Perioperative Period: A Narrative Review. Mayo Clin Proc 90(11):1553–1561. https://doi.org/10.1016/j.mayocp.2015.08.003
Nolan MB, Warner DO (2017) Perioperative tobacco use treatments: putting them into practice. BMJ 358:j3340
O’Neill AC, Haykal S, Bagher S, Zhong T, Hofer S (2016) Predictors and consequences of intraoperative microvascular problems in autologous breast reconstruction. J Plast Reconstr Aesthet Surg 69:1349–1355
Passarelli MN, Newcomb PA, Hampton JM, Trentham-Dietz A, Titus LJ, Egan KM, Baron JA, Willett WC (2016) Cigarette smoking before and after breast cancer diagnosis: mortality from breast cancer and smoking-related diseases. J Clin Oncol 34:1315–1322
Ramsay PP, Shortell SM, Casalino LP, Rodriguez HP, Rittenhouse DR (2016) A longitudinal study of medical practices’ treatment of patients who use tobacco. Am J Prev Med 50:328–335
Richter KP, Ellerbeck EF (2015) It’s time to change the default for tobacco treatment. Addiction 110:381–386
Rinker B (2013) The evils of nicotine: an evidence-based guide to smoking and plastic surgery. Ann Plast Surg 70:599–605
Sorensen LT, Horby J, Friis E, Pilsgaard B, Jorgensen T (2002) Smoking as a risk factor for wound healing and infection in breast cancer surgery. Eur J Surg Oncol 28:815–820
Warner DO (2006) Perioperative abstinence from cigarettes: physiological and clinical consequences. Anesthesiology 104:356–367
Wengler CA, Valente SA, Al-Hilli Z, Woody NM, Muntean JH, Abraham J, Tendulkar RD, Djohan R, O’Rourke C, Crowe JP, Grobmyer SR (2017) Determinants of short and long term outcomes in patients undergoing immediate breast reconstruction following neoadjuvant chemotherapy. J Surg Oncol 116(7):797–802. https://doi.org/10.1002/jso.24741
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This work was funded directly by Mayo Clinic.
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Nolan, M., Ridgeway, J.L., Ghosh, K. et al. Design, implementation, and evaluation of an intervention to improve referral to smoking cessation services in breast cancer patients. Support Care Cancer 27, 2153–2158 (2019). https://doi.org/10.1007/s00520-018-4486-5
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DOI: https://doi.org/10.1007/s00520-018-4486-5