Smoking patterns and the intention to quit in German cancer patients: a cross-sectional study.

BACKGROUND: Continued smoking after a cancer diagnosis can be associated with lower treatment tolerance, poorer outcomes, and reduced quality of life compared to non-smoking cancer patients or to those who have quit. Yet about 60% of patients continue to smoke after being diagnosed and find it difficult to quit. To address this problem, it is necessary to identify current and past smoking patterns (e.g., frequency of use, types of tobacco products) and determine whether there is motivation to quit. Similarly, factors associated with continued smoking should be identified. These data will provide the basis for the development of smoking cessation programs tailored to the needs of cancer patients. METHODS: A questionnaire was distributed to cancer patients older than 18 years in a German Comprehensive Cancer Center. Participating cancer patients were divided into three main groups: 1) patients who stopped smoking before being diagnosed with cancer (Ex-before); 2) patients who stopped smoking after a cancer diagnosis (Ex-after); and 3) patients who currently smoke cigarettes (CS). Sociodemographic, medical, and psychosocial data were collected, as well as smoking patterns and the motivation to quit smoking. RESULTS: About half of patients (51%) who smoked before diagnosis continue to smoke after a cancer diagnosis. Being diagnosed with a tobacco-related cancer type was associated with a decreased probability of continued smoking. Patients with tobacco-related tumors and receiving positive support in burdensome situations were more likely to have a higher cigarette dependence. Of all CS, 59.1% had intention to quit, and 22.7% reported having taken action to quit. The support by a smoking cessation program was considered important. CS were willing to spend up to €100 for support and were open to multiple sessions per week, group sessions, one-on-one sessions and/or online support. CONCLUSION: These findings underscore the importance of educating cancer patients about the consequences of smoking and to provide them with support to quit. Identified risk factors may further help to recognize cancer patients with high risk of continued smoking after diagnosis. TRIAL REGISTRATION: The study was registered at OSF ( https://osf.io/3c9km ) and published as a study protocol at " https://bmjopen.bmj.com/content/13/4/e069570 ".

Psychometric evaluation of the German version of the Patient Satisfaction with Cancer-related Care questionnaire.

BACKGROUND: Patient satisfaction is a fundamental aspect of perceived health care quality. The original English version of the Patient Satisfaction with Cancer-related Care (PSCC) is a psychometrically validated, one-dimensional instrument with relevance to cancer-related care. The goal of the study was to perform a psychometric validation of the PSCC in German (PSCC-G). METHODS: A sample of 394 cancer patients were recruited at oncological clinics in Hamburg, Germany. Patients completed the PSCC-G, three subscales of the Patient Satisfaction and Quality in Oncological Care (PASQOC), and one subscale from the German version of the Recherché Evaluative sur la Performance des Réseaux de Santé (RESPERE-60) questionnaire. We conducted exploratory and confirmatory factor analyses (EFA and CFA) to determine the factorial validity, and we calculated Cronbach's coefficient alpha (α) to test the internal consistency of the PSCC-G. We examined the correlation between the PSCC-G and four subscales measuring additional dimensions of PS with care. We also conducted a multiple linear regression analysis to determine whether sociodemographics, self-perceived health status, and treatment setting predict scores on the PSCC-G. RESULTS: The EFA (using principal axis) revealed a one-factor solution. The Cronbach's α was 0.92. The convergent validity showed high correlations between three different subscales measuring patient satisfaction and the PSCC-G. Overall, males, older age patients, and those with a higher self-perceived health status were more satisfied with their cancer care based on their higher scores on the PSCC-G. CONCLUSION: The PSCC-G is a reliable and valid instrument that can assess satisfaction with cancer-related care for German-speaking cancer patients.

Alcohol consumption in cancer patients receiving psycho-oncologic care analysis of socio-demographic, health-related and cancer-related factors.

PURPOSE: The carcinogenic effects of alcoholic beverages and the negative impact of alcohol consumption on cancer progression and treatment outcomes are well established in oncology research. Many cancer patients experience significant psychological distress, often manifesting as elevated levels of depression and anxiety. In the general population, alcohol consumption is commonly used as a coping mechanism for such distress. For cancer patients facing substantial psychological challenges, psycho-oncology care is available to help manage their symptoms and the overall impact of their condition. However, there is limited understanding of the alcohol consumption patterns in this particularly vulnerable group of patients, as well as the disease-related factors that may influence their drinking behavior. This study aims to examine the prevalence of potentially risky alcohol consumption in cancer patients receiving psycho-oncology care and to identify sociodemographic, health-related, and psychosocial factors associated with alcohol consumption after cancer diagnosis. By understanding drinking patterns and the factors associated with them, we aim to promote healthier behaviors and enhance treatment outcomes for cancer patients receiving psycho-oncology care. METHODS: A consecutive sample of 1.225 patients from the psycho-oncology outpatient clinic of the University Medical Center Hamburg Eppendorf (UKE) was analyzed with regard to their alcohol consumption behavior using the Alcohol Use Disorders Identification Test-Consumption Items (AUDIT-C). Self-report questionnaires were employed to assess sociodemographic, health-related, and cancer-specific information. For statistical analysis, multiple linear regression was utilized. RESULTS: In the sample of cancer patients receiving psycho-oncology support one in six of both female and male patients showed risky alcohol drinking behavior (e.g. AUDIT-C above three for women and four for men). In the analysis (R-Square: 0.056) male gender (regression coefficient B 0.686, 95% CI: 0.453-0.919) and patients reporting a higher physical health-related quality of life (SF8-PCS) (B 0.021, 95% CI: 0.011-0.032) were associated with higher levels of alcohol consumption, whereas having children (B -0.481, 95%CI: -0.700- -0.262) was associated with lower alcohol consumption. With regard to cancer type, a single-factor analysis of variance with gender as the centered covariate showed that patients with gastrointestinal cancer had had lower average consumption levels compared to the groups of patients with breast cancer, melanoma, genitourinary cancer, and lymphoma. Also, patients with sarcoma had lower average consumption levels than patients with lymphoma. CONCLUSIONS: The results allow to identify patient characteristics and cancer types associated with higher or lower alcohol consumption levels and higher likelihood of risky consumption behavior in this sample of cancer patients receiving psycho-oncological support. IMPLICATIONS FOR CANCER SURVIVORS: Cancer patients are particularly susceptible to the hazardous effects of alcohol consumption. The results of this study help to identify cancer patients at risk of worsening prognosis due to alcohol consumption and to develop intervention programs to minimize alcohol consumption in this group.

Smoking patterns and the intention to quit in German patients with cancer: study protocol for a cross-sectional observational study.

INTRODUCTION: Patients who continue to smoke cigarettes after a cancer diagnosis can experience poorer treatment tolerance and outcomes than those who quit immediately. Identifying risk factors specific to patients with cancer who smoke, as well as their smoking behaviours (eg, frequency of use, types of tobacco products), dependency level and quit intentions, is necessary to better inform patients and encourage quitting smoking after a cancer diagnosis. This study aims to examine the occurrence of smoking in patients with cancer treated at specialised oncology departments and outpatient clinics based within the metropolitan region of Hamburg, Germany, and presents an analysis of their smoking patterns. This understanding is the first step in developing an adequate smoking cessation intervention and shall contribute to a sustainable improvement in the treatment results, long-term survival and quality of life of patients with cancer. METHODS AND ANALYSIS: A questionnaire will be administered to patients with cancer (N=865) aged 18 years and above in the catchment area of Hamburg, Germany. Data acquisition includes sociodemographic, medical and psychosocial data as well as information on current smoking patterns. To identify the associations between smoking patterns and sociodemographic characteristics, disease-related variables, and psychological risk factors, descriptive statistics and multiple logistic as well as multinomial regressions will be performed. ETHICS AND DISSEMINATION: This study was registered at Open Science Framework (https://doi.org/10.17605/OSF.IO/PGBY8). It was approved by the ethics committee of the local psychological Ethic committee at the centre of psychosocial medicine Hamburg, Germany (LPEK) (tracking number: LPEK-0212). The study will be carried out in accordance with the Code of Ethics of the Declaration of Helsinki. The results will be published in peer-reviewed scientific journals.

Practice patterns, experiences, and challenges of German oncology health care staff with smoking cessation in patients with cancer: a cross-sectional survey study.

PURPOSE: Often, cancer patients do not receive education about the negative consequences of smoking on the treatment outcome. To support cancer patients in the process of smoking cessation, it is essential to involve oncology staff. This study aims to learn about the experiences and attitudes from the point of view of oncology staff and, thus, how a smoking intervention should be designed. The study aims to engage all oncology staff due to the unclear responsibility for providing smoking cessation education, support, and motivating cancer patients to quit smoking. METHODS: N = 354 German oncology staff (oncologists, nurses, psycho-oncologists, others) filled out a 5-point Likert scale-based questionnaire regarding practices, potential barriers, and attitudes towards smoking cessation between October 2021 and June 2022. The questionnaire was developed by Derksen et al. (2020), translated and slightly modified for the use of this study. It was distributed to all leading oncology staff in our Cancer Center Network with a request to share with all oncology staff. Flyers were also handed out in all oncology wards and outpatient clinics in the same Cancer Center Network. RESULTS: Most oncology staff ask cancer patients about their current smoking status (curative, M = 2.27; SD = 1.59; palliative, M = 2.90; SD = 1.83), but they rarely treat or refer patients for a smoking cessation intervention (curative, M = 4.78; SD = 1.20; palliative, M = 4.99; SD = 1.06). Smoking behavior of curative cancer patients is addressed more than that of palliative cancer patients (d = - 37). Regression analyses of key dependent variables showed that profession, setting, and the belief that continued smoking affects treatment outcome explained the variance of asking patients if they smoke, advising to stop smoking and lack of time (without profession). CONCLUSION: Involving oncology staff in motivating cancer patients who smoke to quit and referring them to smoking cessation services should take the different attitudes and knowledge of the staff into account to improve treatment that supports tobacco cessation. IMPLICATIONS FOR CANCER SURVIVORS: Cancer patients have special needs when it comes to a cessation program. In the long term, survivors will benefit from tailored smoking cessation education and services provided by oncology staff to help them quit smoking after a cancer diagnosis.

The prognostic impact of the smoking status of cancer patients receiving systemic treatment, radiation therapy, and surgery: A systematic review and meta-analysis.

INTRODUCTION: Cigarette smoking represents the main risk factor for cancer development; however, less is known about the effects of active smoking on the outcome of cancer patients receiving systemic treatment, radiation therapy, or surgery. METHODS: A systematic review and meta-analysis were conducted searching the PubMed® and Web of Science® Library databases using specific Medical Subject Headings terms. Studies reporting on the prognostic impact of the smoking status concerning survival endpoints in cancer patients treated with systemic treatment, radiation therapy, or surgery were eligible for inclusion. RESULTS: Of 1.380 articles reviewed, 12 reports including data from 31.785 patients with six different cancer types were considered eligible for inclusion. According to the meta-analysis of the overall effect, active smoking during cancer treatment was associated with an impaired overall survival (OS) and cancer-specific mortality (CSM) as compared to former or never smokers (OS: hazard ratio (HR) = 1.61, 95% CI: 1.19-2.17, p = 0.007; CSM: HR = 1.25, 95% CI: 1.01-1.54, p = 0.046). Moreover, smoking cessation led to a similar OS and CSM when comparing former to never smoking patients (OS: HR = 1.01, 95% CI: 0.87-1.18, p = 0.818; CSM: HR = 1.04, 95% CI: 0.91-1.20, p = 0.324). CONCLUSION: These results underline active smoking during cancer treatment as an independent adverse prognostic factor, while smoking cessation can result in similar outcomes compared to never smokers. Limitations of the study were a substantial study heterogeneity concerning different cancer entities and variations of treatment modalities.

Changes in cigarette smoking behavior among breast cancer and unaffected women - A prospective study in the MARIE cohort.

BACKGROUND: Smoking cessation after a cancer diagnosis can reduce adverse cancer treatment outcomes. Whether a breast cancer diagnosis, a cancer commonly seen as unrelated to smoking cigarettes, motivates changes in smoking behavior is not fully understood. We aimed to compare long-term changes at three follow-up times of cigarette smoking behavior in women with breast cancer and baseline age- and region-matched unaffected women. METHODS: We used longitudinal data from the population-based case-control study MARIE (Mamma Carcinoma Risk Factor Investigation). Women with breast cancer (N = 3813) and unaffected women (N = 7341) aged 50-74 years were recruited from 2002 to 2005. Analyses on changes in smoking were based on data from those who also completed follow-up 1 in 2009-2012, follow-up 2 in 2014-2016 and follow-up 3 in 2020. Multinomial logistic regression for changes (quitting, stable, or start smoking) adjusted for age, study region, education, comorbidities, living situation, and follow-up time, was applied to examine the associations between breast cancer status and changes in smoking behavior. RESULTS: Women with breast cancer had significantly higher odds than unaffected women of quitting smoking (OR = 1.38, 95 % CI: 1.01-1.89) and lower odds of returning to smoking (OR = 0.29, 95 % CI: 0.09-0.94) at follow-up 1, but were more likely to start or return to smoking at follow-up 2 (OR = 2.11, 95 % CI 1.08-4.15). No significant group differences were found for changes in smoking behavior at follow-up 3. CONCLUSION: Our findings indicate that short-term changes in smoking behavior can be attributed to a breast cancer diagnosis, but that over time the effect diminishes and changes in smoking no longer differ between breast cancer and breast cancer-free women. To support smoking cessation and to prevent relapse, guidelines to address smoking in cancer care, as well as comprehensive tobacco treatment services, are needed.

The Impact of Smoking Cessation and Continuation on Recurrence and Survival in Patients with Head and Neck Cancer: A Systematic Review of the Literature.

BACKGROUND: The impact of smoking continuation or cessation on the outcome of head and neck cancer (HNC) patients concerning recurrence and survival rates is not well understood. We aimed to analyze the prognostic role of smoking habits in patients with newly diagnosed HNC and the effects on survival, recurrence rates, and second primary tumor (SPT) development. METHODS: A systematic literature review of the databases PubMed and Web of Science was performed in October 2019 using the search words "head and neck cancer" and "smoking cessation." Articles analyzing the effects of ongoing smoking or smoking cessation in HNC patients were included. RESULTS: Twelve studies published from 1993 to 2016 including 6,308 patients with HNC of stages I-IV were eligible for analysis. The median follow-up was 5 years. Six of 8 studies revealed an improved outcome concerning the median overall survival or survival rates favoring smoking cessation. Regarding recurrence rates, 5 of 6 studies indicated a statistically significant benefit associated with smoking cessation, and 2 of 3 studies showed a lower risk for SPT associated with postdiagnosis smoking cessation. CONCLUSION: Smoking cessation in patients with newly diagnosed HNC is associated with improved outcomes concerning overall survival, recurrence rates, and SPTs. Further research is needed to validate these results and to evaluate the specific effects on different tumor types and treatment approaches.