Helping cancer patients quit smoking by improving their risk communication: a randomized controlled trial

Abstract

BACKGROUND AND OBJECTIVES: Quitting smoking after being diagnosed with cancer could reduce the risk of disease advancement, minimize adverse treatment- related effects, improve prognosis, and enhance the quality of life. Nevertheless, many patients continue smoking after the diagnosis of cancer. We tested the effectiveness of a smoking cessation intervention using risk communication approach to help cancer patients quit smoking. METHODS: A randomized controlled trial was conducted on 528 patients who continued smoking and had medical follow- up at the out-patient clinics of the five major acute hospitals in Hong Kong, with 268 randomly assigned into the experimental and 260 into the control group. Subjects in the experimental group received health warnings of smoking based on a specially designed leaflet and patient-centred counselling from a nurse counsellor with emphasis on risk perceptions of smoking to cancer prognosis. Subjects in the control group received only usual care. All were followed up by telephone at 1week, 1 month, 3 months, 6 months and 12 months to assess smoking status. FINDINGS: About 72.9% of cancer patients were in the pre-contemplation stage of quitting at baseline. On average, they smoked 13 cigarettes per day for more than 42 years with moderate nicotine dependence. The average age of the patients was 58.9 and more than 80% of them were male. No significant differences were found in 6-month (15.7% vs 16.5%; p=0.78) and 12-month (14.9% vs 20.4%; p=0.10) self-reported 7-day point-prevalence smoking abstinence between the intervention and control group. However, difference was observed in self-reported 6-month smoking reduction by at least 50%: 16.8% of patients in the intervention group and 12.3% in the control group reported reduced smoking at 6 months (Odds Raito 1.44; 95% CI 0.89-2.35; p=0.14). CONCLUSION: This risk communication intervention was not effective for quitting but did increase smoking reduction in cancer patients. Very few smoking cessation programs target cancer patients, and very few healthcare professionals help this vulnerable group to quit smoking. Further trials on more effective smoking cessation interventions are needed.