WCLC 2021 | Evidence-based approaches to smoking cessation

I’m Matt Steliga, a thoracic surgeon here at the University of Arkansas. And while I’m a thoracic surgeon, I focus on some things outside of the operating room as well. Our team’s been quite active in smoking cessation and giving patients the best possible opportunities to quit smoking. We know that it’s important for people to quit smoking even after they’re diagnosed with cancer. Some patients, family members, and even clinicians might feel a sense of futility. “It’s too late. They already have cancer. What difference might it make?” When in actuality, quitting smoking after a diagnosis improves patient outcomes. People can tolerate treatment better, whether it’s surgery, chemotherapy, or radiation, and many treatments are more effective in patients who are not smoking, as the tobacco can weaken the patient, impair their immune system, it can lead to increased risk of respiratory infections and a host of other problems. So we find it’s very important for people to quit smoking.

However, it’s not always an easy journey. Tobacco, and nicotine in the tobacco, is incredibly addictive and it’s hard for people to quit. Not everybody. Some patients can just put it down and quit right on the spot, but not everybody’s like that. Some patients need additional support, and we’ve found that evidence-based strategies with counseling and pharmacotherapy are the best ways to help our patients quit. Counseling can be in many different formats. Telephone counseling is in the form of quitlines or other support services and group support systems, and also individual one-on-one counseling.

We’ve found it very effective to do individual counseling by bringing the counseling services to the patients. We train our nurses, nurse practitioners, respiratory therapists and others in methods of tobacco treatments as certified tobacco treatment specialists. So that way, when the patient comes in for their routine care, they’re already seeing someone who may have a little extra knowledge and background in helping them quit smoking, and we integrate that in their normal workflow so patients don’t have to go to other places or seek outside support. We’ve found it’s very helpful to get the nurse practitioners that coordinate our clinic, the resources and background and additional training to help counsel patients.

As far as the counseling strategies, there’s numerous different ways, and we often have to adapt that to each individual patient. One type of approach is called motivational interviewing, where we use a series of questions to help that patient move closer towards gaining confidence of quitting and seeing the benefits of it. And for pharmacotherapy, we use nicotine replacement, most often in the term of patches and oftentimes in the combination of patches plus gum, but there’s also lozenges or nasal spray, or even a prescription nicotine inhaler. And we use all these different methods to give patients the best possible chances of quitting.

And even though some may quit, relapse is common. So we check in with them often at each and every visit, and sometimes even between visits with phone calls, because overall our goal isn’t just to do more surgery or give more chemotherapy or administer radiation. Our goal is to help our patients live longer, better lives and getting them to quit smoking is just one piece of that puzzle that helps them live longer, better lives, and it helps us realize our full potential as clinicians and physicians.

So thank you. Thank you for paying attention, and thank you for your interest in this topic. We all work very hard on it because we find it’s close to our mission and it aligns with the goals that we all have.