戒烟纳入肿瘤治疗：在国家癌症研究所指定的癌症中心循证戒烟治疗的覆盖面和有效性

SCI 29 December 2022

Integrating Tobacco Treatment Into Oncology Care: Reach and Effectiveness of Evidence-Based Tobacco Treatment Across National Cancer Institute-Designated Cancer Centers

 (JCO, IF: 50.717)

Hohl SD, Matulewicz RS, Salloum RG, et al. Integrating Tobacco Treatment Into Oncology Care: Reach and Effectiveness of Evidence-Based Tobacco Treatment Across National Cancer Institute-Designated Cancer Centers. J Clin Oncol 2022:JCO2200936.

PURPOSE 目的  

Quitting smoking improves patients' clinical outcomes, yet smoking is not commonly addressed as part of cancer care. The Cancer Center Cessation Initiative (C3I) supports National Cancer Institute-designated cancer centers to integrate tobacco treatment programs (TTPs) into routine cancer care. C3I centers vary in size, implementation strategies used, and treatment approaches. We examined associations of these contextual factors with treatment reach and smoking cessation effectiveness.

戒烟可以改善患者的临床结果，但吸烟通常不被视为癌症治疗的一部分。癌症中心戒烟计划(C3I)支持国家癌症研究所指定的癌症中心将戒烟计划(TTPs)纳入常规癌症护理。C3I中心的规模、实施策略和治疗方法各不相同。我们研究了这些背景因素与治疗覆盖和戒烟效果的关系。

METHODS 方法

This cross-sectional study used survey data from 28 C3I centers that reported tobacco treatment data during the first 6 months of 2021. Primary outcomes of interest were treatment reach (reach)-the proportion of patients identified as currently smoking who received at least one evidence-based tobacco treatment component (eg, counseling and pharmacotherapy)-and smoking cessation effectiveness (effectiveness)-the proportion of patients reporting 7-day point prevalence abstinence at 6-month follow-up. Center-level differences in reach and effectiveness were examined by center characteristics, implementation strategies, and tobacco treatment components.

这项横断面研究使用了来自28个C3I中心的调查数据，这些中心报告了2021年前6个月的烟草治疗数据。感兴趣的主要结果是治疗覆盖率(reach)——目前被确定为吸烟的患者中接受至少一种循证戒烟治疗(如咨询和药物治疗)的比例，以及戒烟有效性(effectiveness)——在6个月随访中报告7天点戒烟率的患者比例。通过中心特征、实施策略和戒烟治疗组成部分来检验中心水平的治疗覆盖率和有效性差异。

RESULTS 结果

Of the total 692,662 unique patients seen, 44,437 reported current smoking. Across centers, a median of 96% of patients were screened for tobacco use, median smoking prevalence was 7.4%, median reach was 15.4%, and median effectiveness was 18.4%. Center-level characteristics associated with higher reach included higher smoking prevalence, use of center-wide TTP, and lower patient-to-tobacco treatment specialist ratio. Higher effectiveness was observed at centers that served a larger overall population and population of patients who smoke, reported a higher smoking prevalence, and/or offered electronic health record referrals via a closed-loop system. 

在总共692,662名独立的患者中，有44,437人报告目前吸烟。在各个中心，中位数为96%的患者接受了吸烟筛查，吸烟流行率中位数为7.4%，治疗覆盖率为中位数15.4%，有效率中位数为18.4%。与高治疗覆盖率相关的中心水平特征包括较高的吸烟率、全中心TTP的使用以及较低的患者与戒烟专家的比例。在服务于更大总人口和吸烟患者群体、报告吸烟流行率更高和/或通过闭环系统提供电子健康记录转诊的中心，观察到更高的有效性。

CONCLUSION 结论

Whole-center TTP implementation among inpatients and outpatients, and increasing staff-to-patient ratios may improve TTP reach. Designating personnel with tobacco treatment expertise and resources to increase tobacco treatment dose or intensity may improve smoking cessation effectiveness.

住院患者和门诊患者全中心实施TTP，提高员工与患者比例可提高TTP覆盖面。指定具有戒烟专业知识和资源的人员来增加烟草治疗剂量或强度可以提高戒烟效果。

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