Actual and Potential Role of Primary Care Physicians in Cancer Prevention.

Although the role of primary care in cancer prevention has been proven, its assumptions are still insufficiently implemented and the actual rates of cancer prevention advice delivery remain low. Our study aimed to identify the actual and potential role of primary care physicians (PCPs) in the cancer prevention area. Design of the study is a cross-sectional one, based on a survey of 450 PCPs who took part in a nationwide educational project in Poland. Only 30% of PCPs provide cancer prevention advice routinely in their practice, whereas 70% do that only sometimes. PCPs' actual role in cancer prevention is highly unexploited. They inquire routinely about the patient's smoking history (71.1%), breast cancer screening program (43.7%), cervical cancer screening (41.1%), patient's alcohol consumption (34%), patient's physical activity levels (32.3%), body mass index (29.6%), the patient's eating habits (28%) and patient's potential for sun/UV-Ray exposure (5.7%). The potential role of PCPs in cancer prevention is still underestimated and underutilized. Action should be taken to raise awareness and understanding that PCPs can provide cancer prevention advice. Since lack of time is the main obstacle to providing cancer prevention advice routinely, systemic means must be undertaken to enable PCPs to utilize their unquestionable role in cancer prevention.

The COVID-19 Pandemic and Smoking Cessation-A Real-Time Data Analysis from the Polish National Quitline.

Since the outbreak of the COVID-19 pandemic, tobacco research has delivered new evidence on the harmfulness of smoking in the context of SARS-CoV-2 infection and the course of the COVID-19 disease. More and more research proves that smoking is an important risk factor contributing to increased risk of mortality among COVID-19 patients. The aim of this study was to assess whether and how the COVID-19 pandemic impacted decisions about quitting smoking. A total of 4072 records of anonymized data were obtained from the Polish National Quitline. Between 15 April 2020 and 31 May 2021, the callers were asked about the COVID-19 pandemic and its influence on their decisions on smoking continuation or cessation. Our results indicate that smokers are very receptive to communication concerning COVID-19 and smoking risk. This phenomenon can possibly be connected to the immediate potential health consequences of smoking and COVID-19 virus infection. Results may indicate that putting emphasis on arguments combined with short-term health consequences of smoking may result in better outcomes in smoking cessation. There is a need for further and constant education on tobacco-related health harm. Our results showed that an irregular and mass communication on health consequences may result in high effectiveness in smoking cessation.

An attempt to assess knowledge about tobacco dependence among students at the Medical University in Wroclaw.

INTRODUCTION: Tobacco smoking is still one of the greatest, avoidable, singular causes of death. Although students of medical faculties are expected to have solid knowledge about smoking hazards, a significant number of them still smoke. AIM: The aim of the study was to assess knowledge on tobacco dependence in a sample of students at the Medical University in Wroclaw. MATERIAL AND METHODS: Between 2009-2011, non-compulsory lectures on the diagnosis and treatment of tobacco dependence were provided for 3(rd) to 6(th) year students of medicine at the Medical University in Wroclaw (170 students). The questionnaire contained 10 questions about smoking-related diseases and medicines used in tobacco dependence treatment. RESULTS: 21% of students smoked cigarettes and 79% were never smokers. 36% of the study group was exposed to passive smoking at the university. Nearly 80% of survey respondents agreed with the statement that cigarette smoking can lead to psychological addiction as strong as drug addiction, but more than 12% of the respondents perceived smoking just as a strong habit. Only 6 out of 10 surveyed students recognised tobacco dependence as an illness classified in an international classification of diseases and health problems (ICD-10). The correct amount of the chemical substances to be found in tobacco smoke was known by 67.1% of all surveyed students. The vast majority of the surveyed students indicated correctly 2 brands of nicotine replacement therapy, but none of them could name even one chemical and corresponding trade name of the pharmaceutical with central effect. CONCLUSIONS: The level of knowledge about the diagnosis and treatment of tobacco dependence among the students of the Medical Faculty in Wroclaw Medical University is low, and requires improvement through educational activities at both facultative and compulsory study level. Special attention should be paid to pharmaceutical treatment of the tobacco dependence syndrome.

Placebo-controlled trial of cytisine for smoking cessation.

BACKGROUND: Cytisine, a partial agonist that binds with high affinity to the α(4)ß(2) nicotinic acetylcholine receptor, is a low-cost treatment that may be effective in aiding smoking cessation. This study assessed the efficacy and safety of cytisine as compared with placebo. METHODS: We conducted a single-center, randomized, double-blind, placebo-controlled trial. Participants were randomly assigned to receive cytisine or matching placebo for 25 days; participants in both groups received a minimal amount of counseling during the study. The primary outcome measure was sustained, biochemically verified smoking abstinence for 12 months after the end of treatment. Of 1542 adult smokers screened, 740 were enrolled and 370 were randomly assigned to each study group. RESULTS: The rate of sustained 12-month abstinence was 8.4% (31 participants) in the cytisine group as compared with 2.4% (9 participants) in the placebo group (difference, 6.0 percentage points; 95% confidence interval [CI], 2.7 to 9.2; P=0.001). The 7-day point prevalence for abstinence at the 12-month follow-up was 13.2% in the cytisine group versus 7.3% in the placebo group (P=0.01). Gastrointestinal adverse events were reported more frequently in the cytisine group (difference, 5.7 percentage points; 95% CI, 1.2 to 10.2). CONCLUSIONS: In this single-center study, cytisine was more effective than placebo for smoking cessation. The lower price of cytisine as compared with that of other pharmacotherapies for smoking cessation may make it an affordable treatment to advance smoking cessation globally.

Cigarette smoking among a sample of PONS study subjects: preliminary assessment.

AIM: To evaluate the prevalence, socio-demographic patterns and behavioural characteristics of tobacco smoking in a pilot group of PONS respondents. MATERIALS AND METHODS: Open-ended prospective cohort study conducted in Swietokrzyskie Province. A pilot group of subjects aged 45-64 years was examined. Data on smoking were collected with the use of the Health State Questionnaire administered by the CAPI method. RESULTS: 62.6% of males and 45.5% of females participating in the PONS study were ever smokers. In the male population, the percentage of current and former smokers were 19.8% and 42.8%. In females, these percentages were at the lower level of 15.3% and 30.3%, respectively. Self-reported data on smoking prevalence seem to be consistent with objective assessment of exposure to tobacco smoke (measured by carbon monoxide level in exhaled lung air), especially for non-smokers. CONCLUSIONS: The analysis found substantial differences in the level of current and former smoking between PONS study and nation-wide surveys conducted in the adult Polish population. Percentages of current smokers in the PONS study are two or even more times lower, and the prevalence of former smoking is almost two times higher than among adult Poles. The above differences may result from social characteristics of the fi rst group of PONS subjects and their health behaviours. PONS subjects who decided to take pat in the fi rst phase of the study are proportionally better educated than a comparable age group of the adult Polish population, and therefore may be more health-oriented than respondents from the general population. Therefore, it is recommended that the next phase of the PONS study should promote and focus on the less educated inhabitants of the study areas, especially males.

An uncontrolled trial of cytisine (Tabex) for smoking cessation.

OBJECTIVES: Cytisine (Tabex) has been licensed in Eastern Europe as an aid to smoking cessation for 40 years. Cytisine is a partial agonist with high affinity binding to the alpha4beta2 nicotinic acetylcholine receptor believed to be central to the rewarding effect of nicotine. There is insufficient information on effectiveness to warrant licensing by modern standards. To assess whether full-scale controlled trials are warranted, this study sought to obtain an estimate of the 12-month continuous abstinence rates of smokers using cytisine with minimal behavioural support. DESIGN: An uncontrolled, open-label trial. SETTING: A smokers' clinic in an oncology centre in Warsaw, Poland. SUBJECTS: 436 consecutive attendees of the smokers' clinic of whom 191 were male. The mean dependence score (Fagerstrom Test for Nicotine Dependence) was 6.1. INTERVENTION: The standard regimen of Tabex (cytisine) was used, involving 25 days of treatment with minimal behavioural support. MAIN OUTCOME MEASURE: Self-reported continuous abstinence for 12 months; with abstinence verified by carbon monoxide at the final follow up (after 12 months). RESULTS: 60 participants (13.8% of the total sample) were abstinent for 12 months. Of the 315 subjects, who had taken the drug, 49 (15.5%) stopped cytisine because of adverse effects (mostly gastric disturbances and nausea), although they were not serious. The frequency of the minor adverse effects, primarily gastric disturbance, was similar to that observed in previous studies with the drug. CONCLUSIONS: The long-term abstinence rates were similar to those observed in smokers receiving nicotine replacement therapy. Full-scale randomised trials of cytisine (Tabex), conducted to the standards required by regulatory authorities, are warranted.