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. 2014 Feb 15;120(4):562-9.
doi: 10.1002/cncr.28440. Epub 2013 Oct 25.

Automated tobacco assessment and cessation support for cancer patients

Graham W Warren  1 , James R Marshall, K Michael Cummings, Michael A Zevon, Robert Reed, Pat Hysert, Martin C Mahoney, Andrew J Hyland, Chukwumere Nwogu, Todd Demmy, Elisabeth Dexter, Maureen Kelly, Richard J O'Connor, Teresa Houstin, Dana Jenkins, Pamela Germain, Anurag K Singh, Jennifer Epstein, Katharine A Dobson Amato, Mary E Reid
Affiliations

Automated tobacco assessment and cessation support for cancer patients

Graham W Warren et al. Cancer. .

Abstract

Background: Tobacco assessment and cessation support are not routinely included in cancer care. An automated tobacco assessment and cessation program was developed to increase the delivery of tobacco cessation support for cancer patients.

Methods: A structured tobacco assessment was incorporated into the electronic health record at Roswell Park Cancer Institute to identify tobacco use in cancer patients at diagnosis and during follow-up. All patients who reported tobacco use within the past 30 days were automatically referred to a dedicated cessation program that provided cessation counseling. Data were analyzed for referral accuracy and interest in cessation support.

Results: Between October 2010 and December 2012, 11,868 patients were screened for tobacco use, and 2765 were identified as tobacco users and were referred to the cessation service. In referred patients, 1381 of those patients received only a mailed invitation to contact the cessation service, and 1384 received a mailing as well as telephone contact attempts from the cessation service. In the 1126 (81.4%) patients contacted by telephone, 51 (4.5%) reported no tobacco use within the past 30 days, 35 (3.1%) were medically unable to participate, and 30 (2.7%) declined participation. Of the 1381 patients who received only a mailed invitation, 16 (1.2%) contacted the cessation program for assistance. Three questions at initial consult and follow-up generated over 98% of referrals. Tobacco assessment frequency every 4 weeks delayed referral in < 1% of patients.

Conclusions: An automated electronic health record-based tobacco assessment and cessation referral program can identify substantial numbers of smokers who are receptive to enrollment in a cessation support service.

Keywords: cancer; cessation; clinical efficiency; electronic health record; electronic medical record; oncologist; smoking; tobacco.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES

Martin C. Mahoney has received compensation as a member of the Pfizer Speaker’s Bureau, he has served as a paid plaintiff expert witness in cases brought against tobacco manufacturers, and he serves on the editorial board of CA-A Cancer Journal for Clinicians. K. Michael Cummings has received grants from Pfizer Inc. to help establish hospital-based cessation services; he has served as a paid expert witness in litigation against cigarette manufacturers; and he is employed at the Medical University of South Carolina, where his job is to help establish tobacco cessation services for cancer patients. Richard J. O’Connor has received compensation from the US Food and Drug Administration as a consultant on their tobacco products scientific advisory committee (Tobacco Constituents Subcommittee), from Johns Hopkins University for consulting on international tobacco product design, and from the University of Massachusetts for consulting on questionnaire design for smokeless tobacco products; he has received lecture fees from the University at Buffalo for a lecture at the Research Institute on Additions on tobacco harm reduction; he has received compensation from the Centers for Disease Control and Prevention for preparation of a monograph chapter on smokeless tobacco products and from the Society for Research on Nicotine and Tobacco for an article on tobacco product surveillance; he has received compensation from the Connecticut Academy of Science and Engineering as a grant reviewer; and he is a member of the Committee on Scientific Standards for Studies of Modified-Risk Tobacco Products at the Institute of Medicine.

Figures

Figure 1
Figure 1
The algorithm for new patient screening and established patient screening is illustrated.
Figure 2
Figure 2
Patient referral characteristics and first contact outcomes are illustrated for patients who were referred to the cessation service.
See this image and copyright information in PMC

Comment in

  • "Meaningful use" provides a meaningful opportunity.
    Rabius V, Karam-Hage M, Blalock JA, Cinciripini PM. Rabius V, et al. Cancer. 2014 Feb 15;120(4):464-8. doi: 10.1002/cncr.28436. Epub 2013 Oct 25. Cancer. 2014. PMID: 24496865 Free PMC article. No abstract available.

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