Tobacco Use and Cessation in Cancer Screening, Diagnosis, Treatment, and Survivorship
NCI is involved in multiple initiatives to support and stimulate research to better understand tobacco use and its treatment in the settings of cancer screening, diagnosis, treatment, and survivorship.
Tobacco Use After Diagnosis
Studies comparing cancer patients who smoke cigarettes at the time of diagnosis to former or never smokers have demonstrated increased difficulty with surgical wound healing and more treatment morbidity; reduced radiation and chemotherapy efficacy; reduced time to recurrence, progression, and second primary cancers; and increased mortality. Many research questions remain to be addressed related to tobacco use by cancer patients, but research in this area is impeded by inadequate assessment of tobacco use after cancer diagnosis and a lack of valid, harmonized measures that are tailored to the trajectory of cancer diagnosis, treatment and survivorship.
To facilitate research in this area, NCI has partnered with the American Association for Cancer Research (AACR) to form the NCI-AACR Cancer Patient Tobacco Use Assessment Task Force (PDF). The Task Force developed measures that have undergone clinical testing and are now available for use in all cancer research. Visit the Tobacco Use by Cancer Patients workspace at https://www.gem-measures.org to access the latest information and updates. Findings from the Task Force on recommended measures, protocol for measurement, and priority research areas are provided in the following two publications:
Research priorities, measures, and recommendations for assessment of tobacco use in clinical cancer research
Land SR, Toll BA, Moinpour CM, Mitchell SA, Ostroff JS, Hatsukami DK, Duffy SA, Gritz ER, Rigotti NA, Brandon TH, Prindiville SA, Sarna LP, Schnoll RA, Herbst RS, Cinciripini PM, Leischow SJ, Dresler CM, Fiore MC, Warren GW. (2016) Research priorities, measures, and recommendations for assessment of tobacco use in clinical cancer research.Clinical Cancer Research. 2016;22(8): 1907-13.
Cognitive testing of tobacco use items for administration to cancer patients and survivors in clinical research
Land SR, Warren GW, Crafts JL, et al. Cognitive testing of tobacco use items for administration to patients with cancer and cancer survivors in clinical research. Cancer 2016;122(11):1728-34.
Smoking Cessation and Lung Cancer Screening
In 2013, the United States Preventive Services Task Force recommended adults ages 55-80 with a 30 pack-year smoking history (who currently smoke or have quit in the past 15 years) undergo annual low-dose computed tomography (LDCT) lung cancer screening. Smoking cessation treatment during LDCT screening offers the potential to help reduce tobacco use rates and smoking-related morbidity and mortality. Smoking and exposure to secondhand smoke causes more than 440,000 premature deaths from cancer, heart disease, stroke, and lung disease in the U.S. each year. Research is needed regarding changes in the rates of smoking cessation that coincide with the expansion of LDCT facilities. LDCT lung cancer screening provides a crucial opportunity to deliver smoking cessation services to current cigarette smokers. Research is also needed to identify feasible approaches for providing these services in a variety of clinical settings. The National Cancer Institute (NCI) has awarded six grants to support research on the design and implementation of smoking cessation interventions in lung cancer screening settings (RFA-CA-15-011). NCI plans to provide a total of $18.4 million to support the projects for five years.
- Paul Cinciripini, Ph.D., University of Texas MD Anderson Cancer Center, Optimizing Effectiveness of Smoking Cessation Intervention During LDCT screening for Lung Cancer (CA207078)
- Kristie Foley, Ph.D., and Caroline Chiles, M.D., Wake Forest University Health Sciences, Implementation of Smoking Cessation Services within NCI NCORP Community Sites with Organized Lung Cancer Screening Programs (CA207158)
- Taylor Hays, M.D., and David Midthun, M.D., Mayo Clinic Rochester, Smoking Cessation in Lung Cancer Screening: Integrated Digital/Clinical Approach (CA207048)
- Jamie Ostroff, Ph.D., and Donna Shelley, M.D., Memorial Sloan Kettering Cancer Center, Optimizing Tobacco Treatment for Smokers Seeking Lung Cancer Screening (CA207442)
- Kathryn Taylor, Ph.D., Georgetown University, Integrating Evidence-Based Smoking Cessation Interventions into Lung Cancer Screening Programs: A Randomized Trial (CA207228)
- Benjamin Toll, Ph.D., Medical University of South Carolina, Gain-framed Messages and NRT Sampling to Promote Smoking Cessation in Lung Cancer Screening Programs (CA207229)
The newly funded grants will advance scientific understanding of the components and characteristics of effective smoking cessation interventions in the lung cancer screening setting and will provide models for the implementation of evidence-based cessation interventions in such screening settings across the nation.
The Smoking Cessation at Lung Examination (SCALE) Collaboration is a National Cancer Institute (NCI) sponsored initiative, led by funded investigators (from the 6 projects listed above and two related projects) and NCI staff, to share data and methods to enable cross-project research on smoking cessation interventions in the setting of LDCT lung cancer screening. SCALE members convened from 10/2016-12/2016 to reach consensus on the selection of measures that are most important for research in this setting. The panel selected measures in the domains of demographics and psychological characteristics, medical characteristics and outcomes, tobacco use behavior, implementation, and organizational characteristics. The measures collection may be retrieved from https://www.gem-beta.org/Public/wsoverview.aspx?wid=33&cat=8. SCALE members will also share best approaches to measure feasibility, cost, and other implementation outcomes and to disseminate results and resources.
Contributors to the development of the SCALE Measures Special Collection were David Abrams (Legacy for Health), David Chambers (NCI),
Caroline Chiles (Wake Forest University), Paul Cinciripini (MD Anderson Cancer Center), Kristie Foley (Wake Forest University), Taylor Hays (Mayo Clinic), Jaimee Heffner (Fred Hutchinson Cancer Center), Anne Joseph (University of Minnesota), Annette Kaufman (NCI), Stephanie Land (NCI), Rafael Meza (University of Michigan), Jamie Ostroff (Memorial Sloan-Kettering Cancer Center), Alex Rothman (University of Minnesota), Elizabeth Seaman (NCI), Donna Shelley (New York University), Kathryn Taylor (Georgetown University), Benjamin Toll (MUSC), Gordon Willis (NCI) and Steve Zeliadt (University of Washington).
Chapter 6, Cancer, The Health Consequences of Smoking – 50 Years of Progress: A Report of the Surgeon General. (January 2014)
American Society of Clinical Oncology Tobacco Cessation and Control Resources
Harms of Smoking and Benefits of Smoking Cessation
How To Handle Withdrawal Symptoms and Triggers When You Decide To Quit Smoking
Light Cigarettes and Cancer Risk
March 2015 – Official NCI Board of Scientific Advisors Meeting presentation, Smoking Cessation within the Context of Lung Cancer Screening RFA Concept (beginning at 4:49:50).
Tobacco Use by Cancer Patients in Clinical Trials, Presentation to the NCI Division of Extramural Affairs Clinical Trials and Translational Research Advisory Committee (CTAC) (beginning at 2:42)
Reducing Tobacco-Related Cancer Incidence and Mortality: Summary of an Institute of Medicine Workshop (2012) and full report
National Cancer Institute Conference on Treating Tobacco Dependence at Cancer Centers