Tobacco use impacts cancer outcomes in many ways, including an increased risk for second cancers, recurrence and even death.
Kentucky has one of the nation’s highest smoking rates, but the UK Markey Cancer Center hopes to change that number through the Markey CARES (Cancer-specific, Assessment, Referral, Engagement, and Support) Tobacco Treatment Program. Funded by a grant from the National Cancer Institute, the program supports efforts to educate patients on the benefits of quitting as well as to train providers to offer guidance and support.
Markey, the only NCI-designated center in Kentucky, competed with more than 30 other NCIdesignated cancer centers for the two-year grant awarded in 2017. As a part of the grant, which was recently extended for an additional year, Markey agreed to sustain the program financially once funding runs out.
The CARES program developed at Markey includes changes to the electronic medical record to ensure providers ask every cancer patient about their tobacco use at each visit. Patients who use tobacco are also asked if they intend to quit and if they would like help in doing so.
“By simply asking patients if they smoke, we are sending a message that this is something that matters – in the same way we treat blood pressure and changes in weight as vital signs,” says Jessica L. Burris, PhD, assistant professor of psychology and a member of the Markey team. “We’re trying to send the message that this is something we care about, this is something that matters and we can help you with.”
As part of the CARES program, many providers, including social workers, pharmacists, nurses and other allied health professionals, received tobacco treatment specialist training. Nurses at Markey affiliate network hospitals throughout Kentucky were also trained, so they can provide tobacco cessation services to patients who stay closer to home for some or all of their cancer treatment.
“We have really amazing patients and outstanding clinicians. If we can work together and capitalize on the strengths we have, we can really move the needle in terms of tobacco use. It’s not just a quality of life issue. It’s a quantity of life issue.” Jessica Burris, PhD
Messaging includes a patient education booklet available in waiting rooms, website content and information on TV monitors in the cancer center that reinforces the benefits of quitting, especially for those with cancer. Providers are encouraged to reassure patients who use tobacco that they don’t need to feel embarrassed about asking for help, and that it isn’t too late to make a positive change for their health.
It can be difficult for cancer patients to give up a significant coping mechanism like tobacco use in the midst of the stress of diagnosis and treatment. Plus, many people feel they should be able to rely on their willpower to quit, but research and data don’t support that approach, Burris says. For patients who ask for help quitting, tobacco treatment specialists can provide free individualized counseling and give reliable advice about other evidence-based support, including medication, free phone-based counselors and an online community.
CARES program data shows 22 percent of Markey’s cancer patients use some form of tobacco. Of that number, about 20 percent have asked for and received help through the CARES program so far. Burris’ next goal is raising that number significantly.
“Yes, our [tobacco use] prevalence rate is higher in Kentucky and we have some barriers other states don’t have in terms of a patient population that is often struggling with poverty,” Burris explained. “We also have really amazing patients and outstanding clinicians. If we can work together and capitalize on the strengths we have, we can really move the needle in terms of tobacco use. It’s not just a quality of life issue. It’s a quantity of life issue.”