Physician support of smoking cessation after diagnosis of lung, bladder, or upper aerodigestive tract cancer

Farley, Amanda and Koshiaris, Constantinos and Oke, Jason and Ryan, Ronan and Szatkowski, Lisa and Stevens, Richard and Aveyard, Paul (2017) Physician support of smoking cessation after diagnosis of lung, bladder, or upper aerodigestive tract cancer. Annals of Family Medicine, 15 (5). pp. 443-450. ISSN 1544-1717

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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.

Item Type: Article
Keywords: smoking, smoking cessation, cancer, primary care
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Epidemiology and Public Health
Identification Number: 10.1370/afm.2100
Depositing User: Szatkowski, Lisa
Date Deposited: 14 Sep 2017 09:55
Last Modified: 19 Nov 2017 17:53
URI: http://eprints.nottingham.ac.uk/id/eprint/46236

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