Efficacy of a smoking cessation program for patients with lung cancer.
Authors: Bhasin Amman , Melby Garrett Denison , Bassounas Nicole , Wen Kuang-Yi , Micaily Ida 
Published: September 2024

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Background:
Smoking cessation improves overall mortality and cancer-specific mortality in patients with lung cancer. However, cessation is rarely successful without medical assistance, indicating a need for focused intervention in patients with lung cancer. Referrals for formal counseling can facilitate access to smoking cessation resources and serve as an impetus for cessation. In this study, we analyzed the efficacy of the smoking cessation program at our institution’s cancer center and identified opportunities for improvement in patient outreach, education, recruitment, and retention.
Methods:
A retrospective chart review of patients at our institution's cancer-dedicated smoking cessation center was conducted between January 1, 2022, to August 31, 2023. All referred patients with primary lung cancer or documented lung metastasis were included. Patient demographic and medical information were collected from the electronic medical record. Data was analyzed with descriptive (frequency, mean, median, interquartile ranges (IQR), 95% confidence interval) and inferential (t-test, Chi-Squared/Fisher’s Exact) statistics. P-value <0.05 was deemed significant.
Results:
138 patients were referred for smoking cessation counseling, 24 (17.4%) attended counseling, and 14 (58.3%) attended ≥2 visits. Patients had a median time from referral to first session of 14 days (IQR=8.5). All counseled patients were prescribed nicotine replacement therapy (NRT) with 19 receiving multiple modalities. Of the 23 patients actively smoking at first meeting, 19 (82.6%) saw some reduction in packs/day (PPD) compared with 55 (51.9%, n=106) in actively smoking non-counseled patients (p=0.006). Counseled patients saw improvement in packs/day smoking with a mean reduction of 0.66 PPD (p=0.0001, [0.36, 0.95 95% CI]). Patients who attended >2 meetings saw a mean PPD reduction of 1.13 (p=0.004, [0.49, 1.78 95% CI]). In patients who did not attend counseling, 82 (71.9%, n=114) were never successfully contacted. There was no significant difference in age, gender, race, or insurance between patients who attended or did-not-attend counseling.
Conclusions:
Our smoking cessation program demonstrates effectiveness in facilitating a significant decrease in PPD. However, low utilization presents an opportunity for quality improvement to identify barriers to engagement and improve patient outreach. Proposed interventions include strategies such as patient-portal mediated outreach, provider reminders in the EMR, and utilization of referral and scheduling at initial oncology appointment as quality metrics.

Smoking cessation program.

Program Efficacy

Number of Visits

Mean Packs/Day Decrease [95% CI]

1 (n=9)
0.31 [-0.12, 0.73]

2 (n=6)*
0.56 [0.20, 0.91]

>2 (n=8)**
1.13 [0.49, 1.78]

Total (n=23)***
0.66 [0.36, 0.95]

Attended Counseling n (%)

Did Not Attend Counseling n (%)

Patients with Any Decrease in Packs/Day*
19 (82.6)
55 (51.9)

Patients Attaining Relapse Free Cessation
9 (37.5)
26 (22.8)

*p<0.05, **p<0.005, ***p<0.0005.