Long-Term Outcomes of an Intensive, Pre-OperativeTobacco Cessation Program for Lung Resection
*Joseph D Phillips, *Kayla A Fay, *Alexandra Fannin, *Timothy M Millington, *Rian M Hasson, *David J Finley
Dartmouth-Hitchcock Medical Center, Lebanon, NH
Objective: Evaluate the peri-operative and long-term rates of smoking cessation in patients undergoing an intensive, pre-operative smoking cessation program prior to lung resection.
Design: Retrospective cohort study of a prospectively collected database.
Setting: Rural, academic quaternary referral center.
Patients: Consecutive patients with confirmed or suspected lung cancer undergoing resection between January 1, 2015 and June 30, 2017. Eighty-two of the 340 patients were current smokers.
Intervention: Tobacco cessation counseling (TTC) by a certified tobacco treatment specialist (TTS) was offered, in addition to physician counseling. A 1-hour face-to-face meeting with motivational interviewing and treatment options discussion occurred. Pharmacotherapy (nicotine replacement, bupropion, varenicline, or none) was offered. Additional counseling was provided as needed. Carbon monoxide levels were measured via breath testing to confirm cessation.
Main Outcome Measures: The primary outcome was tobacco cessation prior to surgical resection. Secondary outcomes included rates of continued tobacco cessation up to 2 years following surgery.
Results: Nineteen patients opted out of TTC and 13 (68%) were able to quit by surgery. Rates of cessation were 37% at 6 months, 33% at 1 year, and 33% at 2 years in these 13 patients. Sixty-three patients had TTC and 47 (75%) were able to quit by surgery. Rates of tobacco cessation in the counseling group were 56% at 6 months, 45% at 1 year and 38% at 2 years. Return to smoking did not seem to be influenced by pathology or distance from the institution.
Conclusions: Tobacco cessation counseling can lead to a high rate of success in quitting, particularly in the setting of upcoming lung resection. Further study is needed to exam how to ensure long-term tobacco cessation.
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