A new study co-authored by University of Kentucky Markey Cancer Center researchers Jessica Burris, Ph.D., Timothy Mullett, M.D., and Graham Warren, M.D., Ph.D., shows that making smoking cessation assistance a standard part of cancer care is achievable on a national scale and can happen relatively quickly.
The study, published in the Journal of Clinical Oncology, examined the results of the Beyond ASK quality improvement initiative, a national program developed by the American College of Surgeons' (ACS) Commission on Cancer. The findings provide a framework for making cessation assistance routine care for all patients newly diagnosed with cancer.
Smoking among patients diagnosed with cancer is associated with treatment-related complications plus cancer recurrence, new primary cancers, poor survival and increased treatment costs. Despite these risk factors, nearly 15% of new patients diagnosed with cancer report current smoking with higher rates of smoking across Kentucky.
Beyond ASK was designed to help patients with cancer access evidence-based smoking cessation treatment, which can improve treatment outcomes. With research collaborators at MD Anderson, Warren has shown that quitting within six months of diagnosis can improve median survival by nearly four years.
Beyond ASK enrolled 324 cancer programs across the country. Participating programs received access to a practice change toolkit with evidence-based resources, training opportunities, electronic health record guidance and educational webinars.
By the end of the year-long project, the average rate at which programs offered cessation assistance to patients who smoke rose from 48% to 67.5%.
The study represents the largest annual reporting of smoking cessation assistance in cancer care to date, covering more than 446,000 patients with newly diagnosed cancer.
"There are few interventions across cancer care that can have as big an impact as quitting smoking after a cancer diagnosis, and these results clearly demonstrate that large-scale progress can be made through a highly respected accrediting organization such as the American College of Surgeons Commission on Cancer," said Warren, a professor and vice chair in the UK College of Medicine Department of Radiation Medicine.
"A cancer diagnosis can function as a teachable moment - a period in which motivation to change one's behavior to improve future health outcomes naturally spikes - but for the promise of a teachable moment to be realized for smoking cessation, it's imperative that the cancer care system proactively identifies everyone who smokes and offers them evidence-based cessation assistance. That's what Beyond ASK did - it fulfilled the promise of the teachable moment," said Burris, co-leader of Markey's Cancer Prevention and Control Research Program and an associate professor in the UK College of Arts and Sciences Department of Psychology.
Beyond ASK builds directly on Just ASK, an earlier national quality improvement initiative also led by Mullett, a Markey Cancer Center surgeon and former chair of the ACS Commission on Cancer. Just ASK focused on getting cancer programs to consistently ask patients about their smoking status. A follow-up study found that most programs participating in Just ASK improved their assessment rates. Beyond ASK was built to address building programs' capacity to offer evidence-based smoking cessation assistance.
The study also found that Beyond ASK led to improvements across nearly every type of cessation assistance measured, including in-office counseling, referrals to community-based programs, and web-based resources.
"Results from this study directly support improving survival across cancer care in the U.S., and further sets the stage for a new Smoking Cessation Accreditation standard by the Commission on Cancer disseminated across nearly 1,500 cancer treatment centers," said Mullett, professor in UK College of Medicine Department of Surgery and director of the Markey Cancer Network. "By requiring smoking cessation as an accreditation standard, we expect to see significant improvements in patient care and survival."
