AACR calls for clinicians to pay more attention to patients’ tobacco use

Statement makes strong recommendations to help cancer patients end tobacco use

MD Anderson News Release 04/09/13

The American Association for Cancer Research (AACR) today released policy guidelines urging greater focus on assessing tobacco use and offering tobacco cessation services to cancer patients during clinical visits.

The statement, published in the AACR journal Clinical Cancer Research and announced at the AACR Annual Meeting 2013, addresses the benefits of tobacco-cessation, the effects of continued tobacco use on cancer outcomes and other health consequences for cancer patients and offers guidelines for tackling tobacco use.

In the U.S. alone, nearly 30 percent of all cancer-related deaths and 87 percent of all lung cancer-related deaths are attributed to tobacco use, according to data included in the tobacco policy statement. The statement also reports that nearly 70 percent of tobacco users want to quit and more than 50 percent have attempted to quit at least once.

“The numbers are staggering,” said Ellen R. Gritz, Ph.D., professor and chair of the Department of Behavioral Science at The University of Texas MD Anderson Cancer Center and co-author on the paper. “The policy statement is of great importance to all physicians and oncology providers, in particular, because it highlights the importance of tobacco cessation, from the points of view of both the treating physicians’ and other healthcare providers’, and the patient.”

In the statement, the AACR Tobacco and Cancer Subcommittee called for several action items to help end tobacco use in cancer patients ­including:

  • Documented assessment of tobacco use by cancer patients during clinic visits and in oncology clinical trials.
  • Development of universal standards for the measurement of tobacco use.
  • Offering tobacco-cessation assistance and support for tobacco users.
  • Collaborative support and funding for tobacco-cessation programs and tools.

Gritz, who has been a member of the AACR Tobacco and Cancer Subcommittee for four years, emphasized the statement endorses the need for institutional change in terms of rigorous assessment of tobacco use status by cancer patients from the time of diagnosis, during treatment and throughout survival.

“Tobacco cessation can make a critical difference during treatment and afterwards, including affecting survival outcomes and quality of life,” said Gritz. “We also need to continue to offer cessation assistance or referral to those who have recently quit and may need support in remaining tobacco-free.”

The statement cites data from a plethora of research studies that indicate cancer patients’ continuing to smoke raises the risk of  treatment complications, development of secondary cancers, and other health risks – congestive heart failure, heart disease and pulmonary disease.

The committee also suggests that assessing tobacco use in cancer patients will ensure the capture of confounding factors in clinical trial outcomes. “Further research on the effects of tobacco use on cancer treatment and outcomes is also critical, especially in the clinical setting and in oncology clinical trials,” said Gritz.

Results from a recent national survey by the National Cancer Institute's (NCI's) Clinical Trials Cooperative Group Program indicated only 29 percent of registered clinical trials assessed tobacco use during enrollment and even fewer tracked current smoking status in trial participants.

“All physicians and health care providers will eventually ask their patients about tobacco use as a part of the Affordable Care Act, which is moving all institutions to an electronic medical record and developing meaningful use criteria to assess smoking status,” said Paul Cinciripini, Ph.D., professor in the Department of Behavioral Science and director of MD Anderson’s Tobacco Treatment Program – a comprehensive tobacco-cessation program for MD Anderson patients, employees and their families.

The program has seen a 35 percent increase in overall patient referrals due to MD Anderson oncologists automatically referring patients based on tobacco assessment. It’s just one of several tobacco-cessation mechanisms in place at MD Anderson to assess tobacco use and help patients quit.

“The general public needs to be aware of increased risk and poorer survival outcomes to emphasize that it is never too late to stop smoking -- quitting tobacco use and remaining tobacco-free affects persons dealing with cancer and their family members who smoke,” said Gritz. “The diagnosis and treatment of cancer provides a ‘teachable moment’ to stop smoking for family members and to reduce secondhand smoke exposure in the household.”

Last fall, MD Anderson President, Ronald DePinho, M.D., announced an institutional commitment through the launch of the Moon Shots Program to improve survival in eight cancers, one of which is lung cancer that accounts for more than 160,000 U.S. deaths annually. A Cancer Prevention and Control platform is being organized to support tobacco-cessation across all moon shots.

Recognizing that institutional changes do not happen overnight, Gritz hopes the statement will motivate the National Cancer Institute (NCI) to adopt a mandate to collect standardized information on tobacco use in all NCI-sponsored clinical trials, thus setting a standard for oncology in clinical settings. 

“Clinical trials might also be mandated to incorporate cessation support, if the patient does not already have such support,” said Gritz. “It might prove to be beneficial for the NCI to support a mechanism for eventual pooling of data and meta-analysis of the effects of tobacco discussed in this policy paper with further implications for treatment and vulnerable sub-populations.”

Co-authors with Ellen Gritz, Ph.D., are Benjamin A. Toll, Ph.D., and AACR Tobacco and Cancer Subcommittee chair, Roy S. Herbst, M.D., Ph.D., of Yale Cancer Center, Yale University School of Medicine, Thomas H. Brandon, Ph.D., of H. Lee Moffitt Cancer Center & Research Institute,  and Graham Warren, M.D., Ph.D., of Hollings Cancer Center, Medical University of South Carolina.