|
Advertisement |
|
|
||
 |
|
|||||
|
|||||
|
 |
||||||
|
||||||
|
||||||
|
© 2002 American Society for Clinical Oncology Tobacco Use Outcomes Among Patients With Lung Cancer Treated for Nicotine DependenceByFrom the Nicotine Research Center, Department of Psychiatry and Psychology, Department of Oncology, and Section of Biostatistics, Mayo Clinic, Rochester, MN. Address reprint requests to Christi A. Patten, PhD, Mayo Clinic, Nicotine Dependence Center Research Program, 200 First St SW, Rochester, MN 55905; email: patten.christi{at}mayo.edu
PURPOSE: There is a current lack of consensus about the effectiveness of nicotine dependence treatment for cancer patients. This retrospective study examined the 6-month tobacco abstinence rate among lung cancer patients treated clinically for nicotine dependence. PATIENTS AND METHODS: A date-of-treatment matched case control design was used to compare lung cancer patients (201 lung cancer patients, 41% female) and nonlung cancer patients (201 controls, 45% female) treated in the Mayo Clinic Nicotine Dependence Center between 1988 and 2000. The intervention involves a brief consultation with a nicotine dependence counselor. A treatment plan individualized to the patient’s needs is then developed. The primary end point was the self-reported, 7-day point prevalence abstinence from tobacco at 6-month follow-up. RESULTS: At baseline, compared with the controls, the lung cancer patients were significantly older (P < .001), reported higher motivation to stop smoking (P = .003), and were at a higher stage of change (P = .002). The 6-month tobacco abstinence rate was 22% for the lung cancer patients compared with 14% of the control patients (P = .024). After adjusting for age, sex, baseline cigarettes smoked per day, and stage of change, no significant difference was detected between lung cancer patients and controls on the tobacco abstinence rate. CONCLUSION: The results suggest that nicotine dependence treatment is effective for patients with a diagnosis of lung cancer. The majority of lung cancer patients were motivated to stop smoking.
LUNG CANCER IS the leading cause of cancer mortality in the United States,1,2 and cigarette smoking is responsible for 87% of all lung cancers. Moreover, continued smoking in patients with a diagnosis of lung cancer is associated with decreased survival,3 development of a second primary cancer4-6 and increased risk of developing or exacerbating other medical conditions, such as chronic obstructive pulmonary disease, coronary heart disease, peripheral vascular disease, stroke, and peptic ulcers.7 In addition, the primary forms of treatment for cancer (eg, chemotherapy, radiation treatment) are likely to produce more complications and greater morbidity among smokers than nonsmokers.8 Despite these risks associated with continuing to smoke after receiving a diagnosis of lung cancer, little empirical attention has been given to treating cigarette smoking in lung cancer patients. Estimates of the natural history of smoking abstinence after a diagnosis or treatment for lung cancer range from approximately 37% to 79%.9-13 To date, only one published study14 has evaluated a stop smoking intervention designed specifically for lung cancer patients. That study examined the efficacy of a nurse-managed smoking intervention among 15 cigarette smokers with a suspected diagnosis of lung cancer admitted to an inpatient thoracic surgery unit for diagnostic testing. The intervention consisted of three, 25-minute daily visits during hospitalization, and five weekly follow-up telephone calls. At 6 weeks after treatment, the biochemically confirmed 7-day point prevalence smoking abstinence rate was 40%. Unfortunately, this rate is not much higher than the spontaneous smoking abstinence rate reported among lung cancer patients.11 Recommendations from the National Cancer Institute Lung Cancer Progress Review Group15 emphasize the need for increased research on the treatment of nicotine dependence in lung cancer patients. Some studies have evaluated the efficacy of smoking treatment approaches with other cancer patient populations, including those with breast, prostate, cervical, or head and neck cancer.16 Short-term (eg, 4 to 6 weeks postintervention) smoking abstinence rates obtained in these studies range from 21% to 75%.17-19 There are few data on the long-term tobacco abstinence rates among cancer patients receiving a tobacco cessation intervention.20 The purpose of this study was to examine the baseline characteristics and the 6-month tobacco abstinence rate among lung cancer patients treated clinically for nicotine dependence as compared with a date-of-treatment matched control group. In addition, among lung cancer patients only, the association between baseline characteristics (eg, stage of lung cancer diagnosis) and 6-month tobacco abstinence was examined.
Patients The study was approved by the Mayo Clinic institutional review board. Tobacco users with a diagnosis of lung cancer (lung cancer patients, n = 201) and tobacco users without a diagnosis of lung cancer (controls, n = 201) treated at the Mayo Clinic Nicotine Dependence Center (NDC) were studied. The lung cancer patients were identified by use of a cross-referencing procedure conducted between an existing NDC database of patients seen by the NDC staff and the Mayo Clinic medical index and tumor registry where the diagnosis of lung cancer is recorded. The NDC database, medical index, and tumor registry use the patient’s clinic number as the unique identifier. The NDC began treating patients for nicotine dependence on April 26, 1988, and 6-month follow-up data had been entered in the NDC database through March 30, 2000, when the study was initiated. Thus, the lung cancer patients included all patients who (1) received an initial NDC intervention between April 26, 1988, and September 30, 1999; (2) were current tobacco users, defined as any tobacco use during the 6 months before the NDC intervention; and (3) received a diagnosis of lung cancer before their initial NDC intervention. Patients were excluded if they denied general research authorization for use of their medical information. The controls consisted of current tobacco users, without a diagnosis of lung cancer, treated by NDC staff within 1 day of the dates that the specified patients were seen for the intervention. Selecting a comparison group from the general NDC patient population allows inclusion of patients with and without other cancers, tobacco-related disease, and other medical diagnoses. The date-of-treatment matched control method of selection accounts for changes in pharmacotherapy options available over the 10-year period of the study and other temporal changes in the clinical experience of NDC staff. The lung cancer patients were also identified as residential, treated within the NDC 8-day residential treatment program,21 or nonresidential, treated within an NDC outpatient or inpatient consultation,22 to account for differences in the tobacco abstinence rate as a result of the intensity of the intervention provided and treatment setting. For each residential lung cancer patient, a control patient was selected randomly from the immediately preceding residential program. For each nonresidential lung cancer patient, a control patient was selected randomly from patients receiving an NDC consultation within 1 day.
Procedure Follow-up consists of telephone calls by trained interviewers who did not provide the intervention at 1, 3, and 6 months’ follow-up. The patient’s self-reported tobacco use status is obtained at each contact. Although no specific advice or counseling is provided to patients during this call, encouragement and support to maintain abstinence or to make another stop attempt are provided.
Measures Medical record review. The medical records were abstracted by a physician investigator (J.O.E.). Medical records were reviewed for patient baseline characteristics missing from the NDC database. In addition, tobacco-related diseases were abstracted on the basis of our previous study of tobacco-related morbidity and mortality28 to determine whether the lung cancer patients and controls were comparable on diagnoses other than lung cancer. Specifically, the medical records were reviewed for other neoplasms, chronic obstructive pulmonary disease, cerebrovascular disease, peripheral vascular disease, coronary artery disease, other cardiovascular disease, diabetes, major depressive disorder, and alcohol and drug abuse or dependence. Tumor registry. Information on the lung cancer diagnosis for the lung cancer patients, including stage, grade, histology, and date of diagnosis, was abstracted electronically from the tumor registry. The data gathered from the medical record and tumor registry covered the medical history at the time of and up to 24 years before the date of the NDC consultation. Tobacco use status. The primary end point was the 6-month self-reported point prevalence tobacco use status. Patients were considered abstinent from tobacco if they self-reported not using cigarettes, cigars or pipes (not even a puff), or use of any smokeless tobacco products in the 7 days before the telephone interview. This definition of point prevalence abstinence is consistent with consensus statements from the Society for Research on Nicotine and Tobacco Subcommittee on Abstinence Measures.29 Information on whether or not the patient had died at the time of follow-up was gathered from an institutional electronic database. By use of an intent-to-treat approach, patients missing the 6-month tobacco use outcome for any reason, including refusal to respond, inability to contact, or death, were classified as using tobacco.
Statistical Analysis
Among the lung cancer patients only, comparisons were made between those using and not using tobacco at the 6-month follow-up to determine if any baseline characteristics were associated with tobacco abstinence. Comparisons were made by the
Patients Table 1 lists the baseline characteristics of the lung cancer patients and the controls. Overall, 43.3% of the patients were female, and 97.2% were white. Compared with the controls, the lung cancer patients were older (P < .001) and had used tobacco for a longer period of time (P < .001). Age of initiation and years of tobacco use are likely highly correlated variables. The lung cancer patients were approximately 11 years older and had smoked approximately 10 years more than the controls. Thus, both groups seem to have had a similar age of tobacco use initiation. Compared with controls, lung cancer patients reported fewer prior stop attempts (P = .023), higher levels of motivation to stop smoking (P = .003), and a higher stage of change (P = .002). Further, the lung cancer patients were more likely than controls to have been referred by a Mayo health care provider (P < .001) and seen in an inpatient setting (P < .001). Compared with the controls, the patients with lung cancer had a higher frequency of other neoplasms (P < .001) and a lower frequency of diabetes (P = .035). Thus, overall, the lung cancer patients and controls were fairly similar with respect to the frequency of medical diagnoses.
Among the lung cancer patients, 77% were seen by an NDC counselor within 3 months from the date of their lung cancer diagnosis, 89% were diagnosed with non–small-cell lung cancer, and the majority (93%) had potentially resectable (stage I, II, or III) disease.
Tobacco Abstinence Rates By use of an intent-to-treat approach, the 7-day point prevalence tobacco abstinence rate at 6 months was 22% for the lung cancer patients and 14% for the controls. By use of conditional logistic regression, the lung cancer patients were significantly more likely to achieve 6-month tobacco abstinence compared with the controls (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.09 to 3.30; P = .024). After adjusting for age, sex, mean cigarettes per day over the 6 months before the intervention, and stage of change, there was no evidence of a significant difference in the abstinence rates between lung cancer patients and controls. In this analysis, patients with missing data for average cigarettes per day over the past 6 months (three controls) and stage of change (one lung cancer patient) were eliminated from the model (total of four matched sets). An additional analysis was performed in which the missing values were imputed with the respective median values of these variables for patients with data, with no substantial changes in the results (P > .05). Analyses were also conducted eliminating the 18 matched sets for the lung cancer patients who were deceased at the time of the 6-month follow-up. The 7-day point prevalence tobacco abstinence rate at 6 months was 24.6% for the lung cancer patients and 12.6% for the controls. By use of conditional logistic regression, the lung cancer patients were significantly more likely to achieve 6-month tobacco abstinence compared with the controls (OR, 2.57; 95% CI, 1.39 to 4.76; P = .003). Again, after adjusting for age, sex, mean cigarettes per day over the 6 months before the intervention, and stage of change, there was no evidence of a significant difference in the abstinence rates between lung cancer patients and controls. Additional analyses were conducted with the assumption that the 18 lung cancer patients who died before their 6-month outcome were abstinent from tobacco. With this assumption, the 7-day point prevalence 6-month tobacco abstinence rate was 31% for the lung cancer patients and 14% for the controls. By use of conditional logistic regression, the lung cancer patients were more likely to be abstinent at 6 months compared with controls (OR, 3.5; 95% CI, 1.93 to 6.33; P < .001). After adjusting for age, sex, mean cigarettes per day over the 6 months before the intervention, and stage of change, the lung cancer patients were more likely than controls to be abstinent from tobacco at 6 months (OR, 2.57; 95% CI, 1.20 to 5.49; P = .015). As before, four matched sets were eliminated because of missing data for average cigarettes per day and stage of change. If the missing data are imputed with the respective median values of these variables for patients with data, the lung cancer patients were more likely than controls to be abstinent (OR, 2.65; 95% CI, 1.24 to 5.62; P = .012).
Univariate Association of Baseline Characteristics and Tobacco Abstinence Among Lung Cancer Patients
This study found that a clinical intervention for nicotine dependence is effective for patients with a diagnosis of lung cancer. No previous work has examined the long-term tobacco abstinence outcomes among lung cancer patients treated clinically for nicotine dependence. Moreover, there is limited information14 on the efficacy of tobacco interventions for smokers with a diagnosis of lung cancer. Strengths of this study are the large number of patients with lung cancer treated for nicotine dependence and the extensive information from the medical record that was available to characterize these patients. The 6-month tobacco abstinence rate of 22% observed among the lung cancer patients was substantially lower than estimates (range, 37% to 79%) of the natural history of tobacco cessation reported among lung cancer patients.9,11 However, the lung cancer patients included in this study may not be representative of the average lung cancer patient who uses tobacco as a result of referral bias. For example, smokers with lung cancer who have not stopped using tobacco may have higher levels of nicotine dependence, higher levels of psychiatric comorbidity, or greater difficulty quitting, and therefore may have been selectively referred for treatment. Alternatively, the lung cancer patients who were referred for tobacco intervention may have had greater motivation to stop smoking relative to the general population of lung cancer patients. We were not able to evaluate how many tobacco users with lung cancer, over the time frame of this study, were not referred for treatment in the NDC. Therefore, the results cannot be generalized to all lung cancer patients who use tobacco. Examination of interventions offered to all lung cancer patients within a given setting may address some of these shortcomings. Although some health care providers may be concerned about adding a nicotine dependence intervention during a potentially stressful time of initial diagnosis, the current findings provide some support for early intervention in this population. Patients who received a diagnosis of lung cancer within 3 months before the initial NDC intervention were more likely to be abstinent from tobacco at 6-month follow-up compared with lung cancer patients whose diagnosis occurred at an earlier time point. It is also notable that the majority of lung cancer patients were motivated to stop using tobacco, and three of four reported being in the preparation or action stage of change before the intervention. Consequently, these patients were ready to engage in a clinical intervention and were prime candidates for nicotine dependence treatment. The finding that stage of change was associated with 6-month tobacco abstinence in the lung cancer patients is consistent with a study by Gritz et al20 that found stage of change predicted continuous abstinence at 1 year after tobacco use treatment for patients with head and neck cancer. These findings are also consistent with what we have found previously for a general NDC patient population.27 In fact, in a post hoc analysis, we found that stage of change was significantly (P = .036) associated with tobacco abstinence among the controls, with higher rates of abstinence for those in the action stage. Because the action stage represents tobacco abstinence ranging from the time of the intervention to the previous 6 months, it is unclear how much new cessation is actually taking place for lung cancer patients or controls in the action stage. To address this, we examined the setting where the intervention was conducted and time of last cigarette smoked for the 207 patients in the action stage. Excluding residential patients, 56% (113 of 202) were hospitalized at the time of the consultation. The variable on time of the last cigarette smoked was only available for 22 patients because it was added to the questionnaire in 1996. Of these, 87% had been abstinent for less than 7 days. Thus, many patients in the action stage likely represented tobacco users who were hospitalized (involuntary abstinence) and/or had stopped their tobacco use for a relatively short period of time. Our findings challenge the oncology treatment community to invest in nicotine dependence treatment with patients who continue to smoke after a cancer diagnosis. The lung cancer patients did not differ from controls on cigarettes smoked per day before the intervention. However, they reported fewer previous stop attempts than controls that may indicate lower past motivation. In a post hoc analysis of patients with available data (n = 242), there was also some evidence to suggest that they had a higher smoking rate when smoking the heaviest compared with controls (P = .051), which may indicate greater previous levels of nicotine dependence. For example, the proportion of patients smoking 40 or more cigarettes per day was 53% for the lung cancer patients versus 38% for controls. Nonetheless, before the NDC intervention, the lung cancer patients were in a more advanced stage of readiness to change and were more highly motivated to stop tobacco use than controls. Most importantly, they demonstrated successful nicotine dependence treatment outcomes with even greater 6-month tobacco abstinence rates than the general patient sample. Thus, although health care professionals are urged to provide treatment to all patients who use tobacco, the findings clearly endorse active, early intervention for patients with lung cancer. In particular, providers could capitalize on the patient’s recent lung cancer diagnosis, motivation to stop smoking, and advanced stage of change, by offering effective tobacco cessation interventions in proximity to the time of initial diagnosis. Characteristics associated with tobacco abstinence identified in this study could be used in the design of a prospective clinical trial in lung cancer patients who smoke. We did not perform a multivariate analysis of baseline characteristics associated with tobacco abstinence in lung cancer patients because of the large number of variables included relative to the small number of events (ie, patients abstinent from tobacco). More intensive or tailored interventions may be needed to enhance the tobacco abstinence rate in lung cancer patients. For example, incorporating a nicotine dependence intervention into the overall oncology treatment or adding support from the treatment team or from family members may enhance treatment outcomes.20,32 Indeed, the clinical practice guidelines33 on treatment of tobacco use and dependence provide evidence for the effectiveness of intratreatment and extratreatment support and recommend including a social support component in relapse prevention. Emphasizing tobacco abstinence for all household members may be an additional approach because 40% of lung cancer patients lived with other smokers. Interestingly, characteristics specific to the lung cancer diagnosis such as stage, grade, and histology were not associated with tobacco abstinence. Some patients with lung cancer may not be aware of or understand the nuances and implications of these details of their diagnosis, and subsequently, the degree to which such characteristics may influence motivation to stop smoking is unknown. The study design did not allow for examination of the effect of tobacco abstinence on response to lung cancer treatment, secondary morbidity, or mortality among lung cancer patients. We did not review the medical record for information after the NDC consultation, nor did we collect death certificate information. A survey conducted as part of the Lung Cancer Study Group among former smokers with resected non–small-cell lung cancer34 found that some of the benefits of stopping smoking were general improvement in respiratory capabilities, decreased shortness of breath, less coughing, and decreased sputum production. Also reported was an enhanced sense of smell and taste, improved appetite, a better ability to sleep, less daytime fatigue, improved mood, and a generally improved sense of self-worth. These findings accentuate the importance of tobacco dependence interventions for lung cancer patients who continue to use tobacco. This study has several limitations. The sample had limited ethnic diversity. In addition, the lung cancer patients were not matched with the control patients on variables other than date of treatment. The two groups were found to differ significantly on several baseline characteristics, including age, years of tobacco use, number of prior stop attempts, and level of motivation to stop smoking. Thus, any difference in the tobacco abstinence rate between the two groups cannot be fully accounted for by the presence or absence of a diagnosis of lung cancer. However, the two groups were fairly similar with respect to the presence of other medical diagnoses that were abstracted from the medical records. In addition, matching the groups on time of treatment reduced the influence of trends in clinical recommendations for pharmacotherapy, addiction, behavioral therapy, and relapse prevention approaches. Moreover, the patients were matched according to whether or not they received residential treatment to reduce the potential influence of intensity of the intervention. A related limitation is that all variables found to differ significantly between the lung cancer patients and controls (Table 1) were not included as covariates in the multivariate analysis because of the extent of missing data for most of these that would result in the deletion of a substantial number of matched sets from the analysis, and because some of these variables had limited generalizability to other settings (eg, referral source). An additional limitation of our study is that we relied on self-report of tobacco use. We did not obtain biochemical confirmation of abstinence because the intervention was implemented as a clinical service and not as a research protocol. Furthermore, our outcome measure was 7-day point-prevalence abstinence, and we did not collect data on interval tobacco use status to determine the rates of continuous abstinence from tobacco. The Society for Research on Nicotine and Tobacco Subcommittee on Abstinence Measures29 emphasized the need to report both the point prevalence and continuous abstinence rates as outcomes of nicotine dependence interventions. Another drawback was that there were limited data available to characterize the recent smoking behavior of patients in the action stage of change. Finally, this study did not provide a direct comparison of lung cancer patients to other cancer populations or to other groups of patients with specific medical diagnoses. At this stage of research, examining the baseline characteristics and tobacco use outcomes among lung cancer patients was deemed to be the first step in developing effective interventions. Because lung cancer patients who continue to use tobacco are at greater risk for treatment side effects, are more likely to develop second primary cancers, and are at high risk for developing future tobacco related morbidity and mortality, attention to the treatment of nicotine dependence in this group is warranted. Lung cancer patients are generally motivated to stop using tobacco. Moreover, the tobacco abstinence rate in this group is as high or greater than a general NDC patient population. Health care providers should therefore be encouraged to offer nicotine dependence interventions to lung cancer patients. Future research should examine nicotine dependence treatment outcome among tobacco users with a diagnosis of lung cancer, with a more diverse populations and a randomized controlled study design used.
Supported in part by clinical research grant no. 1200-99 from the Mayo Clinic. This study was conducted by L.S.C. during a fellowship at the Mayo Clinic. We thank Ivana Croghan, PhD, Judith Trautman, Darrell Schroeder, and Kenneth Offord for their contribution to the data analysis and their help conducting the study.
Preliminary findings from this study were presented in part at the Twenty-Second Annual Meeting of the Society of Behavioral Medicine, Seattle, WA, March 2001.
1. American Cancer Society: Cancer facts and figures 2000. New York, NY, American Cancer Society, 2000 2. Centers for Disease Control and Prevention: Reducing tobacco use: A report of the Surgeon General—Executive summary. MMWR Morb Mortal Wkly Rep 49: 1-27, 2000[Medline] 3. Johnston-Early A, Cohen MH, Minna JD, et al: Smoking abstinence and small cell lung cancer survival: An association. JAMA 244: 2175-2179, 1980[Abstract] 4. Johnson BE, Ihde DC, Matthews MJ, et al: Non–small cell lung cancer: Major cause of late mortality in patients with small cell lung cancer. Am J Med 80: 1103-1110, 1986[CrossRef][Medline] 5. Kawahara M, Ushijima S, Kamimori T, et al: Second primary tumors in more than 2-year disease-free survivors of small-cell lung cancer in Japan: The role of smoking cessation. Br J Cancer 78: 409-412, 1998[Medline]
6. Richardson GE, Tucker MA, Venzon DJ, et al: Smoking cessation after successful treatment of small-cell lung cancer is associated with fewer smoking-related second primary cancer. Ann Intern Med 119: 383-390, 1993 7. US Department of Health and Human Services: The health benefits of smoking cessation: A report of the Surgeon General. DHHS Publication No. (CDC) 90-8416. US Department of Health and Human Services, Centers for Disease Control, Centers for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1990 8. Gritz ER: Smoking and smoking cessation in cancer patients. Br J Addict 86: 549-554, 1991[CrossRef][Medline] 9. Cox LS, Sloan JA, Patten CA, et al: Smoking behavior of 226 patients with diagnosis of stage IIIA/IIIB non–small cell lung cancer. Psychooncology (in press)
10. Dresler CM, Bailey M, Roper C, et al: Smoking cessation and lung cancer resection. Chest 110: 1199-1202, 1996 11. Gritz ER, Nisenbaum R, Elashoff RE, et al: Smoking behavior following diagnosis in patients with stage I non–small cell lung cancer. Cancer Causes Control 2: 105-112, 1991[CrossRef][Medline] 12. Knudsen N, Schulman S, van den Hoek J, et al: Insights on how to quit smoking: A survey of patients with lung cancer. Cancer Nurs 8: 145-150, 1985[Medline] 13. Sarna L: Smoking behaviors of women after diagnosis with lung cancer. J Nurs Scholarsh 27: 35-41, 1995 14. Wewers ME, Jenkins L, Mignery T: A nurse-managed smoking cessation intervention during diagnostic testing for lung cancer. Oncol Nurs Forum 24: 1419-1422, 1997[Medline] 15. National Cancer Institute: Report of the Lung Cancer Progress Review Group. Bethesda, MD, National Cancer Institute, 2001 16. Pinto BM, Eakin E, Maruyama NC: Health behavior changes after a cancer diagnosis: What do we know and where do we go from here? Ann Behav Med 22: 38-52, 2000[Medline] 17. Griebel B, Wewers ME, Baker CA: The effectiveness of a nurse-managed minimal smoking cessation intervention among hospitalized patients with cancer. Oncol Nurs Forum 25: 897-902, 1998[Medline] 18. Stanislaw AE, Wewers ME: A smoking cessation intervention with hospitalized surgical cancer patients: A pilot study. Cancer Nurs 17: 81-86, 1994[Medline] 19. Wewers ME, Bowen JM, Stanislaw AE, et al: A nurse-delivered smoking cessation intervention among hospitalized postoperative patients-influence of a smoking-related diagnosis: A pilot study. Heart Lung 23: 151-156, 1994[Medline] 20. Gritz ER, Carr CR, Rapkin D, et al: Predictors of long-term smoking cessation in head and neck cancer patients. Cancer Epidemiol Biomarkers Prevent 2: 261-270, 1993[Abstract] 21. Hays TJ, Wolter TD, Eberman K, et al: Residential (inpatient) treatment compared with outpatient treatment for nicotine dependence. Mayo Clin Proc 76: 124-133, 2001[Medline] 22. Hurt R, Lauger G, Offord K, et al: An integrated approach to the treatment of nicotine dependence in a medical center setting: Description of the initial experience. J Gen Intern Med 7: 114-116, 1992[Medline] 23. Dale LC, Olsen DA, Patten CA, et al: Predictors of smoking cessation among elderly smokers treated for nicotine dependence. Tob Control 6: 181-187, 1997[Abstract] 24. Hurt RD, Dale LC, McClain FL, et al: A comprehensive model for the treatment of nicotine dependence in a medical setting. Med Clin North Am 76: 495-514, 1992[Medline] 25. Heatherton TF, Kozlowski LT, Frecker RC, et al: The Fagerström test for nicotine dependence: a revision of the Fagerström tolerance questionnaire. Br J Addict 86: 1119-1127, 1991[CrossRef][Medline] 26. Prochaska JO, DiClemente CC: Stages and processes of self-change of smoking: Toward an integrative model of change. J Consult Clin Psychol 51: 390-395, 1983[CrossRef][Medline] 27. Rohren CL, Croghan IT, Hurt RD, et al: Predicting smoking cessation outcome in a medical center from stage of readiness: Contemplation versus action. Prev Med 23: 335-344, 1994[CrossRef][Medline] 28. Hurt RD, Offord KP, Croghan IT, et al: Mortality following inpatient addictions treatment: Role of tobacco use in a community-based cohort. JAMA 275: 1097-1103, 1996[Abstract] 29. Hughes JR, Keely JP, Niaura RS, et al: Measures of abstinence in clinical trials: Issues and recommendations. Nicotine Tob Res (in press) 30. Breslow NE, Day NE: Statistical methods in cancer research: The analysis of case control studies (vol 1:32). IARC Scientific Publications 32:5-338, 1980 31. Schroeder DR, Ferguson JA, Patten CA, et al: Predictors of 6 month tobacco abstinence among 1224 cigarette smokers treated for nicotine dependence. 7th Annual Meeting of the Society for Research on Nicotine and Tobacco, Seattle, WA, 2001 (abstr) 32. Schilling A, Conaway MR, Wingate PJ, et al: Recruiting cancer patients to participate in motivating their relatives to quit smoking. Cancer 79: 152-160, 1997[CrossRef][Medline] 33. Fiore MC, Bailey WC, Cohen SJ, et al: Treating tobacco use and dependence: A clinical practice guideline. AHRQ publication no. 00-0032. Rockville, MD, US Department of Health and Human Services, 2000 34. Knudsen N, Schulman S, Fowler R, et al: Why bother with stop-smoking education for lung cancer patients? Oncol Nurs Forum 11: 30-33, 1984[Medline] Submitted October 18, 2001; accepted May 8, 2002. This article has been cited by other articles:
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|||||||||||
|
|||||||||||
|
|
Copyright © 2002 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
|
TOP
ABSTRACT
INTRODUCTION
2 test for categorical variables. The 7-day point-prevalence tobacco abstinence rate at 6 months was compared between the lung cancer patients and controls by the conditional logistic regression methodology of Breslow and Day
.05 were considered statistically significant. 
