A Pharmacist-Delivered Tobacco Intervention Program in an Ambulatory Oncology Clinic

Ekaterina Kachur, PharmD BCOP
Pharmacist Clinical Coordinator—Hematology Oncology and Stem Cell Transplant
Levine Cancer Institute
Charlotte, NC

Smoking cessation is a crucial aspect of care for patients with a cancer diagnosis. The American Cancer Society reports that more than 30% of all cancer-related deaths and more than 70% of all lung cancer–related deaths are associated with tobacco use.¹ Tobacco cessation among oncology patients not only provides general health benefits but also prevents tumor progression, decreases the risk for secondary tumors, and reduces complications from therapy.² The importance of tobacco-cessation programs in oncology care is endorsed by major professional organizations like the American Society of Clinical Oncology and the National Comprehensive Cancer Network. Multiple studies have shown the effectiveness of pharmacist-delivered tobacco-cessation programs. However, only a few studies have evaluated this model in the population of oncology patients.

In 2018 Kimmel and colleagues conducted a prospective pilot study with a historical comparator arm in order to assess the impact of a pharmacist-delivered tobacco intervention program in an ambulatory oncology setting.³ Prior to the implementation of the tobacco intervention program in the oncology clinic at the University of Illinois Hospital, patients were referred to the Tobacco Treatment Center. However, high numbers of oncology patients were failing to keep their appointments at the Tobacco Treatment Center. The authors were hoping to increase the number of interventions by providing tobacco-cessation services in conjunction with other oncology clinic appointments.

Patients included in the study were divided into prospective and retrospective arms, with 12 patients in each. Patients in the prospective arm received tobacco-cessation services from oncology pharmacists at the time of their anticancer therapy visits. Patients were included if they had a cancer diagnosis, were receiving intravenous anticancer therapy at the time of enrollment, had self-identified as smokers, and had expressed interest in quitting. Patients in the retrospective arm received interventions at the Tobacco Treatment Center, a pharmacist-run clinic. Patients were included if they had a cancer diagnosis, were at least 18 years old, and had received tobacco interventions at the Tobacco Treatment Center after January 1, 2000. At the initial visit, patients in the prospective group received “Deciding How to Quit: A Smoker’s Guide,” a brochure published by the American Cancer Society, and were asked to complete the Fagerström Test for Nicotine Dependence. Oncology pharmacists conducting the visit provided behavior counseling, pharmacologic interventions, or both, according to the patient’s specific needs. Subsequent meeting frequency was determined by the participant’s cancer treatment schedule, and the number of visits was based on the participant’s individual needs. At each visit with the pharmacist, Smokerlyzer breath tests were administered to measure carbon monoxide levels. Patients were asked to complete a 12-item questionnaire to assess their satisfaction with the program at their last visit or 3 months after enrollment. The tobacco intervention program used in the oncology clinic was based on the model established at the Tobacco Treatment Center. Thus, patients in the retrospective group received similar interventions.

Of the 24 patients included in the study, 67% were women, and 88% were African American. The most common cancer types were breast cancer (33%), head and neck cancer (21%), and non-small-cell lung cancer (17%). The average number of visits with a pharmacist was similar for the groups: 3.3 in the prospective group and 3 in the retrospective group. More patients in the prospective arm (77%) initiated tobacco intervention treatment within 6 months of their diagnosis, compared with patients in the retrospective arm (17%). Carbon monoxide levels consistent with those of a nonsmoker were recorded in 4 of 11 patients (36%) in the prospective group and in 3 of 12 patients (25%) in the retrospective group. Pharmacologic interventions were prescribed for 10 patients in the prospective arm and for 8 patients in the retrospective arm. Commonly used agents were nicotine-replacement therapies and varenicline. Only 4 patients in the prospective arm completed the satisfaction survey; the average score was 4.625 on a 5-point Likert scale for general satisfaction.

Although this study had a small sample size, it demonstrates the feasibility and potential advantages of implementing pharmacist-driven tobacco-cessation programs in an ambulatory oncology setting. The delivery of smoking-cessation interventions is one way that pharmacists can have a significant impact on oncology patient outcomes and survivorship.

References

1. American Cancer Society. Cancer facts and figures-2014. Available at www.cancer.org/acs/groups/content/@research/documents/webcontent/acspc-042151.pdf. Accessed February 18, 2019.
2. Cox LS, Africano NL, Tercyak KP, Taylor KL. Nicotine dependence treatment for patients with cancer. Cancer. 2003;98:632-644. Erratum in Cancer. 2003;98:1104.
3. Kimmel J, Puri SC, Wilken L, Wirth S. Pharmacist-delivered tobacco intervention program in an ambulatory oncology clinic: a pilot study. J Hematol Oncol Pharm. 2018; 8(2):77-82.