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12-10-2022 | Lung cancer | Adis Journal Club | Article

Oncology and Therapy

The Role of Electronic Patient-Reported Outcome Measures in Assessing Smoking Status and Cessation for Patients with Lung Cancer

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Authors: James Convill, Fiona Blackhall, Janelle Yorke, Corrine Faivre-Finn & Fabio Gomes

Abstract

Introduction

Smoking cessation following lung cancer diagnosis is recommended to improve patient outcomes. Electronic Patient Reported Outcome Measures (ePROMs) may be useful for identifying and facilitating cessation support in patients that continue to smoke after a cancer diagnosis. The primary aim was to investigate the level of agreement between clinician-reported and self-reported patient smoking status during the first visit to a cancer centre (I). Secondary aims included investigating differences between cancer-specific characteristics between never smokers and current/ex-smokers (IIA), and the self-reported frequency of smoking cessation after diagnosis of lung cancer (IIB).

Methods

Retrospective single-centre study carried out at a tertiary cancer centre in the UK. Lung cancer patients that completed at least one ePROM questionnaire within 6 weeks of their first visit to the cancer centre (baseline), between February 2019 and February 2020, were included in the study. All ePROM questionnaires included a question regarding smoking status to allow comparison with the clinician records. Patients were offered these electronic questionnaires at each subsequent visit to the hospital.

Results

Of 195 patients included, 24 (12.3%) demonstrated discordance between clinician-reported and self-reported smoking status at the baseline assessment. Clinician-reported ‘current smokers’ were more likely to be discordant with self-reported smoking status, compared with clinician-reported ‘ex-smokers’ and ‘never smokers’ (P = 0.017). Never smokers were more likely to have adenocarcinoma (P < 0.005), present with stage IV cancer (P = 0.023) and receive treatment with palliative intention (P = 0.042), compared with current and ex-smokers. Of those that were reported by clinicians as being current smokers, 9/38 (23.7%) were self-reported ex-smokers. A sub-group of 137 patients completed at least one additional ePROM questionnaire after the baseline and were included in the smoking cessation analysis. Thirty-eight patients were clinician-reported as ‘current smokers’ at baseline. Of these, 9 subsequently stopped smoking, 17 continued and 3 had short periods of cessation, identified through self-reporting.

Conclusion

In most cases, there is concordance between clinician- and self-reported smoking status. A small area of discordance was identified where clinicians reported some patients as ‘current smokers’, whilst patients self-reported having stopped. The causes for this were not explored and require further investigation. This study supports the use of ePROMs as a helpful tool to assess smoking status, and it can be used to identify patients for smoking cessation referral.

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Key Summary Points

It is recognised that those patients who continue smoking following a lung cancer report having a lower quality of life and worse physical health outcomes.

Therefore, it is important to identify those that are still smoking and make appropriate referrals to smoking cessation services. An independent questionnaire, such as an electronic Patient Reported Outcome Measure (ePROM), would be well poised to aid in identifying those patients that still smoke.
Do patients report a different smoking status on an electronic independent questionnaire compared with what they report to clinicians at their initial clinic visit?
Patients that self reported as current smokers were more likely to have discordant records than never/ex-smokers (P < 0.05).
Discordance between patient and clinician warrants follow-up or immediate referral to smoking cessation services.
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