Smoking Cessation by Phone Counselling in a Lung Cancer Screening Program: A Retrospective Comparative Cohort Study.

Introduction: Smoking cessation integration within lung cancer screening programs is challenging. Currently, phone counselling is available across Canada for individuals referred by healthcare workers and by self-referral. We compared quit rates after phone counselling interventions between participants who self-refer, those referred by healthcare workers, and those referred by a lung cancer screening program. Methods: This is a retrospective cohort study of participants referred to provincial smoking cessation quit line in contemporaneous cohorts: self-referred participants, healthcare worker referred, and those referred by a lung cancer screening program if they were still actively smoking at the time of first contact. Baseline, covariates (sociodemographic information, smoking history, and history of mental health disorder) and quit intentions (stage of change, readiness for change, previous use of quit programs, and previous quit attempts) were compared among the three cohorts. Our primary outcome was defined as self-reported 30-day abstinence rates at 6 months. Multivariable logistic regression was used to identify whether group assignment was associated with higher quit rates. Results: Participants referred by a lung cancer screening program had low quit rates (12%, 95% CI: 5-19) at six months despite the use of phone counselling. Compared to patients who were self-referred to the smoking cessation phone helpline, individuals referred by a lung cancer screening program were much less likely to quit (adjusted OR 0.37; 95% CI: 0.17-0.8), whereas those referred by healthcare workers were twice as likely to quit (adjusted OR 2.16 (1.3-3.58)) even after adjustment for differences in smoking intensity and quit intentions. Conclusions: Phone counselling alone has very limited benefit in a lung cancer screening program. Participants differ significantly from those who are otherwise referred by healthcare workers. This study underlines the importance of a dedicated and personalized tobacco treatment program within every lung cancer screening program. The program should incorporate best practices and encourage treatment regardless of readiness to quit.

Effect of an interdisciplinary rehabilitation program on quality of life in patients with head and neck cancer: review of clinical experience.

BACKGROUND: Patients with head and neck cancer experience complex posttreatment challenges. In a preliminary uncontrolled study, we evaluated the extent to which they can benefit from an interdisciplinary rehabilitation program. METHODS: Twenty-seven patients completed an 8-week nutrition-rehabilitation program. Six-minute walk distance (6MWD), body weight, symptom burden, distress, and quality of life were assessed at baseline and at the end of the program. RESULTS: Patients improved their mean 6MWD by 59 m (effect size = 0.8), and 78% of patients either maintained or increased their body weight. They also reported a clinically meaningful reduction in severity of insomnia, pain, weakness, anorexia, shortness of breath, depression and distress, and improvement in quality of life (effect sizes = 0.6-0.9). However, they reported no change in symptom interference with function. CONCLUSION: An interdisciplinary rehabilitation program may be beneficial to patients with head and neck cancer after treatment, but its effects should be evaluated in a controlled trial.