Title: Formative research to inform the development of a smoking cessation intervention for childhood, adolescent and young adult cancer survivors
Funder: Department of Health and Social Care

Abstract: Research Question: How might smoking cessation among childhood and young adult (CAYA) cancer survivors be better supported? Background: CAYA cancer survivors are a growing and ageing population. Advances in treatment mean >80% achieve long-term cure. However, effects of some cancer treatments - especially pulmonary and cardiac toxicities &ndash; compromise survivors health and leave them vulnerable to adverse late-effects. For CAYA survivors, tobacco smoking is the most important preventative cause of ill-health and early death. Smoking exacerbates survivors risks of cardiovascular and respiratory diseases, and second cancers - the most common causes of morbidity and mortality in this population. Despite this, a substantial proportion of CAYA survivors smoke. Although clinical practice guidelines state that survivors should be advised on smoking and cessation, most survivors do not receive such advice and most healthcare professionals involved in their care do not consider they are the right source of this advice. Effective strategies to support smoking cessation among CAYA survivors are urgently needed. The few available interventions suffer from methodological limitations. Empirical research on CAYA survivors perceptions of smoking, smoking cessation and what helps or hinders quitting, is lacking. Whether existing services could better support CAYA survivors to quit is unclear. Aims & Objectives: To provide the foundation for future development of a tobacco smoking cessation intervention for CAYA survivors, this project will: scan the landscape to identify and describe smoking cessation services for adolescents/young adults, or cancer patients/survivors; explore the perceptions of CAYA survivors who are current or recent ex-smokers of (a) factors that influence their smoking behavior and (b) advice and support to quit; work with survivors and other stakeholders to consider the potential for a smoking cessation intervention for CAYA survivors. Methods: Phase 1 will involve an environmental scan of existing smoking cessation services for either adolescents/young people, or cancer patients/survivors, in England. We will examine, in detail, what these services involve, how they are accessed, what they cost and whether they have been evaluated. Phase 2 will involve semi-structured interviews with up to 30 CAYA survivors who are current- or recent ex-smokers. Interviews will explore survivors perceptions of: their health; influences on their smoking behaviour; what helped (or would help) or hinders quitting; and their views and experiences of smoking cessation advice and services. Phase 3 will draw on co-design approaches. In two workshops, one with survivors and one with professionals, participants will review Phase 1 and 2 findings and consider intervention potential. Outputs will be a preliminary logic model of the problem and potential areas for future intervention development. PPI: PPI will be integral throughout the project. Dissemination: Findings will be disseminated to patient groups, healthcare professionals and researchers, through conference presentations, journal papers, plain English summaries, project website, infographics, YouTube videos and tweets. We will draft a grant application to develop and test the intervention. Anticipated Impact: Long-term, this project has potential to reduce smoking prevalence in CAYA survivors thereby reducing smoking-related morbidity and mortality among this population, yielding benefits for patients, the NHS and society.

Lay abstract: Each year in the UK approximately 4000 young people aged under 25 are diagnosed with cancer. Improvements in treatment mean that 80% of them will be cured of their cancer. However, some cancer treatments can cause harm to their lungs or heart, leaving them vulnerable to problems in later life. The chance that these young cancer survivors will have problems in later life is increased if they smoke tobacco; survivors who smoke are more likely than the general population of having another cancer in later life and of developing, or dying from, a lung or heart problem. Despite this, many young cancer survivors smoke tobacco. Our initial work found that 15% smoke; and many had tried, unsuccessfully, to quit. It is recommended that healthcare professionals advise cancer survivors about smoking and how to stop. However, cancer doctors and nurses don t always do this and often feel that they are not right person to provide this advice and support. In addition, although quitting smoking has been very successful in the general population, the approaches used to help people quit don t work well in cancer survivors. This is probably because we do not fully understand why cancer survivors smoke, or what helps or hinders them to quit. A stop smoking programme specifically for young cancer survivors is needed. This project will involve three related pieces of research which will lay the foundations for this programme. In Phase 1, we will identify existing stop smoking services for either adolescents/young people, or cancer patients/survivors, in England. We will examine what these services involve, how they are accessed, what they cost and whether they work. In Phase 2, we will interview up to 30 young cancer survivors (currently aged 16-29 years old) who are either current smokers or recent ex-smokers. We will explore: how they think about their health; why they smoke(d); what helped (or would help) them quit; and their views and experiences of stop smoking services and advice. In Phase 3, we will hold two workshops: one with young cancer survivors and one with professionals. These workshops will discuss the Phase 1 & 2 results and start working together to consider a stop smoking programme for young cancer survivors. Advice from patients and the public will be sought throughout the project. We will distribute our results to patient groups, cancer and public health professionals and researchers through conference presentations, journal papers, plain English summaries and a YouTube video. We will apply for funding to develop and test the stop smoking programme in the future. Long-term this project could help young cancer survivors stop smoking: this would lower their chances of second cancers and smoking-related diseases and cut costs to the NHS.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: STROKE;CARDIOVASCULAR;CANCER AND NEOPLASMS;RESPIRATORY