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. 2017 Sep;15(5):443-450.
doi: 10.1370/afm.2100.

Physician Support of Smoking Cessation After Diagnosis of Lung, Bladder, or Upper Aerodigestive Tract Cancer

Amanda Farley  1 , Constantinos Koshiaris  2 , Jason Oke  3 , Ronan Ryan  1 , Lisa Szatkowski  4 , Richard Stevens  2 , Paul Aveyard  2
Affiliations

Physician Support of Smoking Cessation After Diagnosis of Lung, Bladder, or Upper Aerodigestive Tract Cancer

Amanda Farley et al. Ann Fam Med. 2017 Sep.

Abstract

Purpose: Smoking cessation after a diagnosis of lung, bladder, and upper aerodigestive tract cancer appears to improve survival, and support to quit would improve cessation. The aims of this study were to assess how often general practitioners provide active smoking cessation support for these patients and whether physician behavior is influenced by incentive payments.

Methods: Using electronic primary care records from the UK Clinical Practice Research Datalink, 12,393 patients with incident cases of cancer diagnosed between 1999 and 2013 were matched 1 to 1 to patients with incident cases of coronary heart disease (CHD) diagnosed during the same time. We assessed differences in the proportion for whom physicians updated smoking status, advised quitting, and prescribed cessation medications, as well as the proportion of patients who stopped smoking within a year of diagnosis. We further examined whether any differences arose because the physicians were offered incentives to address smoking in patients with CHD and not cancer.

Results: At diagnosis, 32.0% of patients with cancer and 18.2% of patients with CHD smoked tobacco. Patients with cancer were less likely than patients with CHD to have their general practitioners update smoking status (OR = 0.18; 95% CI, 0.17-0.19), advise quitting (OR = 0.38; 95% CI, 0.36-0.40), or prescribe medication (OR = 0.67; 95% CI, 0.63-0.73), and they were less likely to have stopped smoking (OR = 0.76; 95% CI, 0.69-0.84). One year later 61.7% of patients with cancer and 55.4% with CHD who were smoking at diagnosis were still smoking. Introducing incentive payments was associated with more frequent interventions, but not for patients with CHD specifically.

Conclusions: General practitioners were less likely to support smoking cessation in patients with cancer than with CHD, and patients with cancer were less likely to stop smoking. This finding is not due to the difference in incentive payments.

Keywords: cancer; primary care; smoking; smoking cessation.

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Conflict of interest statement

Conflicts of interest: P.A. reports grants from the Medical Research Council (MRC), National Institute for Health Research (NIHR), Cancer Research UK (CRUK), Economic and Social Research Council, and UK Centre for Tobacco and Alcohol Studies during the conduct of this study; A.F. reports grants from the NIHR, MRC, and CRUK during the conduct of this study; R.R. reports that he was partly funded by the National Health Service (NHS) (Heart of England NHS Foundation Trust) during the conduct of this study. All other authors report none.

Figures

Figure 1
Figure 1
Percentage of patients who had smoking status updated, advice to quit, and prescription of smoking cessation medications, and who quit within the first year after diagnosis before and after QOF (all cancer patients and matched CHD patients) between 1999 and 2013. CHD = coronary heart disease; OR = odds ratio; QOF = Quality and Outcomes Framework.
Figure 1
Figure 1
Percentage of patients who had smoking status updated, advice to quit, and prescription of smoking cessation medications, and who quit within the first year after diagnosis before and after QOF (all cancer patients and matched CHD patients) between 1999 and 2013. CHD = coronary heart disease; OR = odds ratio; QOF = Quality and Outcomes Framework.
Figure 1
Figure 1
Percentage of patients who had smoking status updated, advice to quit, and prescription of smoking cessation medications, and who quit within the first year after diagnosis before and after QOF (all cancer patients and matched CHD patients) between 1999 and 2013. CHD = coronary heart disease; OR = odds ratio; QOF = Quality and Outcomes Framework.
See this image and copyright information in PMC

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