ABSTRACT
BackgroundDespite the progress made in smoking reduction in Ireland, smoking remains a challenge, particularly in cancer patients where post-diagnosis smoking has detrimental impacts on treatment and survival. This audit was of existing hospital smoking cessation services (SCS) for all patients (including cancer) at the eight specialist adult cancer hospitals (tertiary referral university hospitals) and one specialist radiotherapy hospital.MethodsAn audit was conducted online, completed by smoking cessation (SC)/health promotion officers at each hospital in 2021, with questions based on literature review and the (first) consultative National Clinical Stop Smoking Guideline (published 2022).ResultsOne hospital did not participate due to unavailability of relevant staff. SCS were provided at 7 of 9 (77.8%) hospitals, predominantly to inpatients on admission or during hospital stay (5;55.5%) but also at lower rate at discharge (3;33.3%) and in outpatients (4;44.4%). SCS were provided in the main by medical, nursing and hospital SC officers (6;66.6%);just 44.4%% noted alignment with community SC (for ongoing support). SCS provided included brief intervention and or ongoing support (6;66.6%), intensive support (4;44.4%), follow up phone support (2;22.2%). SCS were delivered mainly (pre-COVID) as individual face-to-face (5;55.5%) but phone (4;44.4%), online (3;33.3%) and group work (1;11.1%%) were also utilised. Nicotine Replacement Therapy was the first-choice in 2021 which almost all provided (7;77.8%), with fewer offering varenicline (5;55.5%) or bupropion (2;22.2%). SCS was promoted on the hospital website in 55.5% despite hospital campuses being smoke-free, however, SC information was provided in appointment letters. Most hospitals (6;66.6%) provide/promote SC training;and 4 (44.4%) have staff trained to deliver intensive stop-smoking advice.Six (66.6%) of 9 hospitals provided SCS to cancer patients attending outpatient clinics, day units, inpatients or other departments (e.g., radiology, emergency). However, many hospitals noted low referral rates for cancer patients. While 6 hospitals recorded data on overall SCS uptake, one recorded it specifically for cancer patients. Cancer patients who smoke are automatically referred to SCS (at diagnosis/when starting systemic anti-cancer therapy/radiotherapy) and routinely prescribed SC medications at one hospital. Few oncology staff had received SC intervention training.ConclusionA hospital visit/admission provides a cue to action for smokers and is an important opportunity for brief intervention by healthcare professionals to promote SC. This first National Clinical Guideline should assist necessary strengthening of hospital SCS and promote smoking cessation support, particularly among cancer patients.
ABSTRACT
OBJECTIVE: To evaluate effects of remote monitoring of adjuvant chemotherapy related side effects via the Advanced Symptom Management System (ASyMS) on symptom burden, quality of life, supportive care needs, anxiety, self-efficacy, and work limitations. DESIGN: Multicentre, repeated measures, parallel group, evaluator masked, stratified randomised controlled trial. SETTING: Twelve cancer centres in Austria, Greece, Norway, Republic of Ireland, and UK. PARTICIPANTS: 829 patients with non-metastatic breast cancer, colorectal cancer, Hodgkin's disease, or non-Hodgkin's lymphoma receiving first line adjuvant chemotherapy or chemotherapy for the first time in five years. INTERVENTION: Patients were randomised to ASyMS (intervention; n=415) or standard care (control; n=414) over six cycles of chemotherapy. MAIN OUTCOME MEASURES: The primary outcome was symptom burden (Memorial Symptom Assessment Scale; MSAS). Secondary outcomes were health related quality of life (Functional Assessment of Cancer Therapy-General; FACT-G), Supportive Care Needs Survey Short-Form (SCNS-SF34), State-Trait Anxiety Inventory-Revised (STAI-R), Communication and Attitudinal Self-Efficacy scale for cancer (CASE-Cancer), and work limitations questionnaire (WLQ). RESULTS: For the intervention group, symptom burden remained at pre-chemotherapy treatment levels, whereas controls reported an increase from cycle 1 onwards (least squares absolute mean difference -0.15, 95% confidence interval -0.19 to -0.12; P<0.001; Cohen's D effect size=0.5). Analysis of MSAS sub-domains indicated significant reductions in favour of ASyMS for global distress index (-0.21, -0.27 to -0.16; P<0.001), psychological symptoms (-0.16, -0.23 to -0.10; P<0.001), and physical symptoms (-0.21, -0.26 to -0.17; P<0.001). FACT-G scores were higher in the intervention group across all cycles (mean difference 4.06, 95% confidence interval 2.65 to 5.46; P<0.001), whereas mean scores for STAI-R trait (-1.15, -1.90 to -0.41; P=0.003) and STAI-R state anxiety (-1.13, -2.06 to -0.20; P=0.02) were lower. CASE-Cancer scores were higher in the intervention group (mean difference 0.81, 0.19 to 1.43; P=0.01), and most SCNS-SF34 domains were lower, including sexuality needs (-1.56, -3.11 to -0.01; P<0.05), patient care and support needs (-1.74, -3.31 to -0.16; P=0.03), and physical and daily living needs (-2.8, -5.0 to -0.6; P=0.01). Other SCNS-SF34 domains and WLQ were not significantly different. Safety of ASyMS was satisfactory. Neutropenic events were higher in the intervention group. CONCLUSIONS: Significant reduction in symptom burden supports the use of ASyMS for remote symptom monitoring in cancer care. A "medium" Cohen's effect size of 0.5 showed a sizable, positive clinical effect of ASyMS on patients' symptom experiences. Remote monitoring systems will be vital for future services, particularly with blended models of care delivery arising from the covid-19 pandemic. TRIAL REGISTRATION: Clinicaltrials.gov NCT02356081.