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The Catalyst

Cessation program for patients in development

By Ashley Barker
Public Relations

Reducing tobacco use has been high on MUSC’s priority list since the campus became tobacco-free in March 2012.

But more work needs to be done, according to Graham Warren, M.D., Ph.D., vice chairman for research in the MUSC Department of Radiation Oncology at Hollings Cancer Center. 

MUSC’s Dr. Graham Warren was the lead author of a report in the Journal of Thoracic Oncology that stated only 40 percent of lung cancer doctors routinely provide assistance to help their patients stop smoking.
MUSC’s Dr. Graham Warren was the lead author of a report in the Journal of Thoracic Oncology that stated only 40 percent of lung cancer doctors routinely provide assistance to help their patients stop smoking.

Warren’s most recent report, released in March in the Journal of Thoracic Oncology, helped inspire a new program for patients.

The study of lung cancer doctors found that 90 percent believe tobacco use affects cancer treatment outcomes and that tobacco cessation should be provided, but only 40 percent routinely provide assistance to help their patients stop smoking.

“Continued tobacco use by cancer patients increases mortality, increases cancer recurrences, increases the risk of getting another cancer later and increases toxicity associated with treatment,” Warren said. “We’re looking at the biology behind how tobacco products decrease the effectiveness of cancer treatment.”

As much as it seems like common sense, the issue of cancer patients continuing to use tobacco products is what Warren and a team of more than 50 investigators at seven different institutions in the United States have devoted years of research to try to understand.

For about eight years, Warren has been evaluating the effects of tobacco-related products on cancer response, primarily involving radiation and chemotherapy.

“We have an enormous amount of information leading up to a diagnosis, but we have proportionally very little information after a cancer diagnosis. Assessing what patients do, whether they keep smoking and if they quit what helps them, are big questions,” Warren, who joined MUSC on Feb. 18, said.

Warren is working with the report’s co-author, Michael Cummings, Ph.D., professor in the Department of Psychiatry and Behavioral Sciences and co-director of Tobacco Policy and Control at Hollings Cancer Center, and several other MUSC employees on a two-fold approach to tobacco cessation in patients.

Dr. Michael Cummings
Dr. Michael Cummings

The first part of their program, named SC Quits, is expected to be introduced hospitalwide within the next six months, according to Cummings. He explained that when a patient is identified as a smoker, he or she will be assessed and automatically referred into a cessation follow-up service.

“If you’ve had a heart attack, or you’ve got COPD, or if you broke your leg and want to have it repaired quicker, it doesn’t help to be smoking. Smoking has bad outcomes on a lot of things,” Cummings said. “We have many patients who come to MUSC, about 27,000 hospital adult discharges each year. Roughly about 5,000 of those people are going to be cigarette smokers. It’s a teachable moment.”

The service will then contact the patient by phone after he or she is discharged. If the patient is interested in quitting, he or she will be provided access to support back at the hospital, at a local community resource or at a primary doctor.

Dr. Danielle Scheurer
Dr. Danielle Scheurer

Danielle Scheurer, M.D., medical director of quality for the Medical University Hospital Authority and overseer of the implementation of the hospital-based program, said, “MUSC is thrilled to be a leader in the state around tobacco cessation, as evidenced by these efforts. To promote population health, we have a moral obligation to do everything we can to assist tobacco users in cessation efforts.”

The second part of the SC Quits program, which is being spearheaded by Warren, targets cancer patients.

When a cancer patient is identified as a tobacco user, instead of the physician or nurse having to be trained on the methods of quitting smoking, the physician will refer the patient to a dedicated tobacco cessation specialist.

“Providing good evidence can sometimes be best accomplished by taking a few people who are very good at tobacco cessation and keeping them updated and trained,” Warren said. “It’s a lot easier than trying to train hundreds of practitioners every year on the effects of tobacco and cessation. Our goal is to try to assist clinicians in helping provide cessation support of cancer patients, not take the patients away from them.”

The ultimate decision still remains in the hands of the patient, which is something that Warren has found to be beneficial to cancer patients who tend to lose much of their decision-making abilities.

“When a cancer patient is diagnosed, a lot of times they don’t have control of what they’re doing. Chemotherapy, radiation and surgery are the mainstays of cancer treatment. That can be very stressful, which could make people want to smoke more,” he said. “Smoking cessation is something that I can recommend, but only a patient can decide to do it. It is one part of cancer treatment that can really make a difference in the outcome that is completely in control of the patient. We can help them stop, with medication and support, but it’s up to the patient.”

Once the cessation program is fully in place at MUSC, Warren and Cummings are both interested in expanding it to other hospitals and cancer centers around the country.

“My hope is to network this into every hospital and to all cancer centers,” Cummings said. “There are 70 comprehensive or NCI-designated cancer centers. Why not have everyone utilize the same system rather than having them invent their own thing?”

Both researchers suggested that it’s never too late to quit smoking. Their research has found that stopping the habit at any stage of life can give a patient some health benefits.

“The majority of the side effects from tobacco – heart disease, lung cancer, etc. – show up down the road,” Warren said. “Even if tobacco miraculously disappeared from the planet today, a significant medical burden is still coming 10 to 30 years down the road. Smoking cessation now reduces the risk and improves the health of all patients.”

May 9, 2013

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