Rapid systematic review of smoking cessation interventions for people who smoke and have cancer

Abstract Background Higher rates of cancer are reported in smokers compared to non-smokers, and continued smoking following a cancer diagnosis is associated with reduced health outcomes and survival. Despite international evidence of increased risks, a substantial percentage of people with a cancer diagnosis continue to smoke. Patients may be unaware of the additional risks associated with continued smoking, and health care professionals may not engage with quit supports. As part of a larger feasibility study to develop a smoking cessation pathway in cancer services in Ireland, a rapid review of the evidence was completed. Methods Systematic searches of PubMed, Embase, and CINAHL 2015 to December 2020 were conducted; with studies restricted to adults with a cancer diagnosis [lung, breast, cervical, head and neck] and published in English. No restriction was placed on study designs. 6404 studies were identified and uploaded into COVIDENCE platform, Cochrane's systematic review methods were adopted throughout, PRISMA reporting guidelines were used, and narrative data synthesis was completed (CRD 42020214204). Results The twenty-three-studies report evidence from USA, Canada, England, Lebanon, and Australia. The setting for all interventions was hospitals and cancer clinics. Evidence identifies high dropout rates, inconsistencies in approaches and duration of smoking cessation interventions with varied outcomes. A wide-ranging number of critical components emerged associated with optimal quit support- including the timing of and frequency of quit conversations, use of electronic records, in-person support meetings, provision of nicotine replacement therapy and extended use of Varenicline, smoking cessation services embedded in oncology depts, and engaging with families wanting to quit at the same time. Conclusions Developing tailored smoking cessation interventions are needed for smokers diagnosed with cancer to enable engagement. Key messages • Continued smoking following a cancer diagnosis is associated with reduced health outcomes. • Smoking cessation programmes for cancer patient should be tailored to meet needs.

Stopping smoking can considerably cut one's risk of developing cancer compared to continued smoking (i.e. up to 50% after 5 years for esophageal cancer and after 10 years for lung cancer).Much less is known about whether quitting smoking may bring a survival advantage to people who are active smokers at the time of cancer diagnosis.We conducted a systematic review and meta-analysis of the studies that examined the prognostic effect of quitting smoking at or around diagnosis among cancer patients.We searched MEDLINE and EMBASE for articles published until 30th March 2022 that reported the impact of quitting smoking at or around diagnosis on cancer patients' survival (any type).Separately for each cancer site, study-specific data were pooled into summary relative risk (SRR) and corresponding 95% confidence intervals (CI) using random effect meta-analysis models, investigating sources of heterogeneity and bias.Fortythree articles were included, including 20 for lung cancer (LC), 16 for head and neck cancer (HNC), and less than 10 for bladder, breast, gastrointestinal tract, and other sites.Quitting smoking at or around diagnosis was associated with longer overall survival (SRR 0.71, 95% CI 0.64-0.80) in LC patients (consistently for non-small cell and small cell LC) as well as HNC patients (SRR 0.80, 95% CI 0.70-0.91).No significant publication bias was found.For the other body sites, the studies were limited in number, which prevented metaanalyses, but results were generally consistent with a beneficial effect of smoking cessation on survival.Quitting smoking at or around diagnosis is associated with a significantly improved overall survival of smokers diagnosed with LC and HNC and shows beneficial effects in patients with other cancers.Physicians should offer smoking cessation counselling to smokers who start diagnostic workup for suspected cancer, and smoking cessation strategies should arguably become part of standard multidisciplinary oncological care.

Background:
Higher rates of cancer are reported in smokers compared to non-smokers, and continued smoking following a cancer diagnosis is associated with reduced health outcomes and survival.Despite international evidence of increased risks, a substantial percentage of people with a cancer diagnosis continue to smoke.Patients may be unaware of the additional risks associated with continued smoking, and health care professionals may not engage with quit supports.As part of a larger feasibility study to develop a smoking cessation pathway in cancer services in Ireland, a rapid review of the evidence was completed.Methods: Systematic searches of PubMed, Embase, and CINAHL 2015 to December 2020 were conducted; with studies restricted to adults with a cancer diagnosis [lung, breast, cervical, head and neck] and published in English.No restriction was placed on study designs.6404 studies were identified and uploaded into COVIDENCE platform, Cochrane's systematic review methods were adopted throughout, PRISMA reporting guidelines were used, and narrative data synthesis was completed (CRD 42020214204).

Results:
The twenty-three-studies report evidence from USA, Canada, England, Lebanon, and Australia.The setting for all interventions was hospitals and cancer clinics.Evidence identifies high dropout rates, inconsistencies in approaches and duration of smoking cessation interventions with varied outcomes.A wide-ranging number of critical components emerged associated with optimal quit support-including the timing of and frequency of quit conversations, use of electronic records, inperson support meetings, provision of nicotine replacement therapy and extended use of Varenicline, smoking cessation Background: According to WHO, approximately one in three people worldwide live with a chronic, painful musculoskeletal (MSK) disorder.Low back pain (LBP), neck pain (NKP), osteoarthritis (OST) and rheumatoid are among the most disabling MSK disorders.According to the Global Burden of Disease (GBD) study, LBP was the leading global cause in terms of years lived with disability and OST showed an increase in prevalence and is predicted to be one of the leading future causes.Our study aimed to analyse the burden of these MSK disorders in Belgium, providing a summary of morbidity and mortality outcomes from 2013 to 2018.

Methods:
Prevalence and disability-adjusted life years (DALY) were computed using data from the Belgian health interview surveys from 2013 and 2018, the INTEGO database (Belgian registration network for general practitioners) and GBD study 2019.Mortality data was retrieved from the Belgian statistical office for people dying from RHE.Following GBD methodology, LBP, NKP and OST were assumed to not generate any deaths.

Results:
The prevalence of MSK disorders increased from 2013 to 2018 with OST being the disorder with the highest number of cases (1.7 million cases in 2018).The burden was higher in women and the gender disparities increased with age.Women died also more frequently due to RHE compared to men.In total MSK disorders contributed to 180,746 comorbidity-adjusted DALYs for female and 116,063 comorbidity-adjusted DALYs for men in 2018, with LBP being the largest contributor (140,031 DALY).

Conclusions:
The burden of MSK disorders has increased over the years.In 2018, 2.5 million Belgians were affected by at least one MSK disorder that resulted in almost 300,000 DALY.Our study provides valuable information of a part of the health burden that is known to have a great impact on the total burden of disease but that is sometimes disregarded by public health institutions.

Key messages:
MSK disorders represent a major health problem in Belgium.
Acting on risk factors associated to these disorders is crucial to mitigate their burden.were country-, sex-, age-and education-matched (1:2) to noncancer individuals (NC).Odds ratios (OR) and 95% confidence intervals (95%CI) were computed using logistic regression.

Conclusions:
CS were more likely to forgo medical treatment and to report healthcare postponements and to be unable to book an appointment than NC, which highlights the importance of closely monitoring the long-term impact of the COVID-19 pandemic along the cancer care continuum.

Key messages:
During the COVID-19 pandemic, a previous cancer diagnosis was associated with a more frequent report of appointment cancellations, postponements or denials.The first months of the COVID-19 pandemic led to changes in healthcare provided to cancer survivors, which may have a deleterious impact in their care and prognosis.