- Tobacco dependence treatment at King Hussein Cancer Center: Moving forward in light of reported outcomes of care
Tobacco dependence treatment at King Hussein Cancer Center: Moving forward in light of reported outcomes of care
Availing tobacco dependence treatment (TDT) services is a recognized and important standard in cancer care. Tobacco use during cancer care detrimentally influences the outcomes of surgery, chemotherapy and radiation, increases the risk of recurrence and incidence of new primary neoplasms, and results in a poorer quality of life. In light of this knowledge, the King Hussein Cancer Center established a TDT clinic in 2008 to provide TDT for all cancer patients and survivors at KHCC: the clinic provides comprehensive care for cancer patients who are tobacco users, offering one on one counseling and pharmacological support when possible.
Since its inception, the TDT has been following and documenting abstinence status for all its patients. In the first published analysis (2011) reporting outcomes of treatment, one-year abstinence rates were approximately 21%. Patients who failed to abstain at one year reported personal or professional stressful situations as the main reason for failing. This analysis also revealed a difference between abstinence rates of light (less than 10 cigarettes per day, CPD) smokers and those smoking 10 or more CPD. As a result, a follow-up analysis was conducted to focus specifically on moderate to heavy smokers (10 or more CPD) across both short (3-months) and longer-term (6 and 12 months) abstinence, the results of which were also published. The follow-up analysis revealed substantially lower rates of abstinence: at 3, 6 and 12 months from the start of treatment at the TDT clinic, moderate to heavy smokers achieved 23%, 11% and 6% abstinence, respectively. The main reason cited for failure at 3 months was not being able to handle withdrawal, while those who failed at 6 or 12 months reported most frequently personal or professional stress as the reason they began smoking again (similar to our first published analysis).
Our recent results highlight the difficulty of achieving good success rates when treating highly addicted tobacco users in the presence of a challenging co-morbid condition, and within an overall environment (Jordan) that has not been conducive to smokers seeking to quit. Generally, exposure to secondhand smoke (SHS) remains very high both at homes and in public places,, rendering social and community support for smoking cessation low. The results also confirm observations that are continuously raised by clinic staff: the need for intensification, customization and prolongation of treatment efforts (given that our data suggest that the challenges of abstinence change with time); the urgency of mobilizing family and social support to protect patients from SHS; and the need to reconsider the TDT clinic’s definition of success – while our analyses reveal low abstinence rates among moderate to heavy smokers, many patients fail to abstain but manage to reduce their tobacco consumption significantly. It is through these analyses that the clinic has been able to identify points in the care process that need intensification, and additional outcomes that need to be examined. Further research will necessarily ensue in order to ensure that outcomes of care can be improved for patients.
Dr. Nour Obeidat is the Head of the Applied Research Unit in the Cancer Control Office at King Hussein Cancer Center, and is a pharmacist and holds a PhD in Pharmaceutical Health Services Research.
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- King Hussein Institute for Biotechnology and Cancer, Center of Consulting (CoC) University of Jordan, Department of Statistics, Jordan. The National Survey on Knowledge, Attitudes, and Practices Towards Cancer Prevention and Care in Jordan, 2011: end of project report. Available upon request from CoC.