Transcript Dr. Larry Pan and Chelsea Sogo

PETRA Workshop
Tobacco Cessation and Cancer Treatment
Dr. Larry Pan, MD, FRCPC
Radiation Oncologist
Chelsea Soga, MA, BSc RTT
Radiation Therapist and
Project Lead of the CTC Tobacco Cessation Project
November 3, 2015
Brackley Commons Community Centre
Decreasing PEI’s Cancer Burden
A significant proportion of cancer cases are
Predictable and Preventable
Magnitude of Impact of Tobacco
• Smoking contributes to 30% of all cancer
deaths
• Smoking accounts for approximately 80%
of lung cancer deaths
Magnitude of Impact of Tobacco
• Approximately 25% of patients referred to
cancer centres for oncologic treatment are
current or recent smokers (smoked in the
previous 6 months)
[Ontario data]
Surgeon General’s 2014 Report
In cancer patients and survivors, the
evidence is sufficient to infer a causal
relationship between cigarette smoking
and
increased all-cause mortality and cancer-specific
mortality
increased risk for second primary cancers known to
be caused by cigarette smoking, such as lung cancer
Smoking and Radiation Therapy
• Smokers who continue to smoke during RT
significantly lower rate of complete response to
radiation therapy (45% vs 74%)
significantly lower 2-year survival (39% vs 66%)
Browman GP at al. NEJM 1993
Smoking and Chemotherapy
• Irinotecan
Lowered dose-normalized area under plasma
concentration-time curve in smokers compared to
non-smokers
Grade 3 to 4 treatment-induced neutropenia:
6% smokers, 30% non-smokers
Van der Bol et al. J Clin Oncol 2007; 25: 2719- 2726
• Erlotinib
Lower overall response in smokers vs never smokers
(3.9 vs 24.7%; p, 0.001)
Shepherd FA et al NEJM 2005; 353: 123-132
Select Key Messages…
• Addressing the stigma of lung cancer… “victim
blaming”
• The benefits of smoking cessation is often much
greater than the benefits of some chemotherapeutic
agents or radiation therapy
• Smoking is the #1 cause of preventable death in
Canada
• We cannot deliver “quality cancer care” unless we also
focus on smoking cessation
• Performance indicators to drive quality improvement
PEICTC Tobacco Cessation
Program - Overview
Support for Cancer patients
• The gap: staff at the PEICTC do not have
a process or the training to support our
cancer patients while on treatment to quit
using tobacco.
• A tobacco cessation program will fill this
gap.
Funding Opportunity
• Canadian Partnership Against Cancer
(CPAC):
Integrating evidence-based tobacco
cessation and relapse prevention as a cancer
care quality improvement initiative
CPAC Objectives
• Support implementation of tobacco cessation
and relapse prevention into cancer systems.
• Facilitate knowledge sharing and learning
among involved cancer settings.
• Gather standard evaluation metrics from across
the Country.
PEICTC Goals
• Inform patients about the importance to
help quit smoking while on treatment.
• Provide patients with the support and
resources to overcome barriers to quit
smoking.
• Improve outcomes of patients undergoing
cancer treatment
PEICTC Program Scope
1. Establish a program based on Ottawa
Model of Smoking Cessation (OMSC)
2. Develop and implement staff training
modules
3. Improve access to pharmacotherapy
4. Evaluate project outcomes and success
1. Establish a program based on OMSC
• Sites include oncology departments at
QEH and PCH
• Model of Ask, Advise, Assess, Assist and
Arrange (5A's)
• Utilize TelAsk and Smokers helpline for
follow up care
2. Develop and implement staff training modules
• All staff trained on:
Tobacco addiction
Importance of tobacco cessation and
Overview of 5As of OMSC model
• Increased training for leaders or “quit
specialists”:
Performing the 5A and Consultation (Assess,
Assist and Arrange)
Online and In person training
3. Improve access to pharmacotherapy
• Develop report to provide evidence and
projections for required pharmacotherapy
support for cancer patients.
• Provide support to stakeholders towards
efforts to include cessation medication in
formulary
4. Evaluate project outcomes and success
• Patient evaluation
• Report on indicators to CPAC, Health PEI
and Stakeholders
• Knowledge transfer and Exchange
evaluation through CPAC
Time lines
•
•
•
•
Project begins Jan 2, 2016
Staff training plan begins Sept 2016
Project roll out to follow – Fall of 2016
National indicators reported in late 2017
Thank you!
• Stakeholder consultation plan
Stakeholder letter of support included in
proposal
Collaboration and information sharing to
continue throughout project
• Thank you for your support on our
proposal!
• We are looking forward to working with
you!