Improvement of Smoking Abstinence Rates With Increased Varenicline Dosage: A Propensity Score-Matched Analysis.

PURPOSE/BACKGROUND: It is unclear whether increasing the dose of varenicline beyond the standard dose of 2 mg/d would improve smoking abstinence. METHODS: We examined the effect of 3 mg/d of varenicline on smoking abstinence among smokers who had reduced their smoking by 50% or more in response to 2 mg/d for at least 6 weeks but had not quit smoking. Of 2833 patients treated with varenicline, dosage of a subset of 73 smokers was increased to 3 mg/d after 6 weeks. We used a propensity score analysis involving multiple baseline covariates to create a comparative sample of 356 smokers who remained on 2 mg/d. All smokers received concurrent and similar smoking-cessation counseling. RESULTS: At 3 months, we found higher 7-day point prevalence smoking-abstinence rate in the 3-mg group (26%) than in the 2-mg group (11.5%, χ = 10.60, P < 0.001; risk ratio [RR], 2.3; 95% confidence interval [CI], 1.4-3.6). The difference in abstinence rates remained significant at the 6-month (P < 0.001; RR, 2.6; 95% CI, 1.6-3.9) and 9-month follow-up (P < 0.001; RR, 2.2; 95% CI, 1.4-3.3). CONCLUSIONS: A relatively small increase in the daily dose of varenicline seems to offer a benefit for those who are not able to achieve total abstinence after approximately 6 weeks of 2 mg/d.

Tobacco Cessation Treatment Pathways for Patients With Cancer: 10 Years in the Making.

Tobacco use is the most common cause of preventable morbidity and mortality in the United States; it accounts for one-third of all cancer deaths and is thought to account for half of preventable cancer deaths. This article describes the Tobacco Treatment Program at a major academic cancer center. Patients and employees may access these services in a number of ways. All current smokers and recent quitters are proactively contacted and invited to participate. Services provided are tailored to the motivational level of individual patients and their immediate medical needs. The treatment pathways we present are based on our experience from the last 10 years in treating more than 5,000 unique patients with around 60,000 patient visits. These pathways include behavioral counseling and pharmacotherapy, including first-line, second-line, and off-label medication use. This article describes the program with the goal of providing guidance and ideas to others who are developing treatment programs and providing treatment to tobacco users.

Selection of optimal tobacco cessation medication treatment in patients with cancer.

BACKGROUND: Tobacco use is responsible for almost half a million deaths per year in the United States, and it accounts for one-third of all cancer deaths. Limited data concerning tobacco treatment among patients with cancer are available. In addition, these patients often have complicated medical histories and are taking multiple medications. No clear, published procedures exist to help the healthcare provider select the proper medication for tobacco cessation in that context. OBJECTIVES: This article describes the screening process established within the Tobacco Treatment Program (TTP) at the University of Texas MD Anderson Cancer Center to minimize the risk of prescribing a contraindicated tobacco cessation medication to patients with cancer. The screening process developed and used by the TTP is presented as a viable model for selecting appropriate tobacco cessation medications for patients with cancer. METHODS: The electronic medical record of each patient who uses tobacco is carefully reviewed once he or she is scheduled for a consultation. A summary is produced with a standardized template and used later as a template for the medical provider evaluation. Precautions are put in place with consideration of the characteristics of each of the tobacco cessation medications (e.g., mechanism of action, route of administration, interactions with other medications, possible side effects, contraindications). Since 2006, the TTP has had more than 4,000 new patients and more than 39,000 follow-up visits. FINDINGS: Because each patient with cancer has unique medical, psychological, and social circumstances, the process of selecting the optimal tobacco cessation medication needs to be individualized. Oncology healthcare providers should follow some form of screening to tailor a medication plan to each patient.

Colorectal cancer screening among Latinos from U.S. cities along the Texas-Mexico border.

Colorectal cancer (CRC) screening rates are comparatively low for U.S. Hispanics. To learn more about the factors influencing CRC screening among Hispanics living along the U.S.-Mexico border, 12 focus groups were conducted with Hispanic men and women aged 50 years and older in three Texas counties; Cameron County (Brownsville), Webb County (Laredo), and El Paso County, (El Paso). The focus group guide contained questions about health care behavior, knowledge about CRC, experiences with cancer, and factors that influence CRC screening. A total of 92 individuals participated with the majority aged 50-69 (75%). Twenty percent were born in the United States and 51% had lived in the United States for more than 20 years. Participants had low levels of education, income, and insurance coverage. The analysis revealed several overarching and contextual themes relating to knowledge, attitudes, beliefs, and emotions about cancer and CRC screening. A prevalent theme that emerged from all groups was frustration and a lack of confidence in the U.S. healthcare system. Few participants had been advised by their providers to obtain CRC screening. Lack of patient knowledge about colorectal cancer and screening appeared to be a critical factor influencing screening. Themes about death and pain due to cancer were prevalent as were cultural factors such as machismo and embarrassment. System level barriers such as cost, medical insurance and transportation also impacted screening. These findings suggest that strategies are needed to educate Hispanic residents of border communities about CRC and to motivate them to undergo CRC screening.