Smoking Cessation in the Thoracic Surgery Patient Hilary W. Crittenden, MSN, RN, FNP-C, CTTS Division of Thoracic Surgery Duke University Health System Durham, North Carolina
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Smoking Cessation in the Thoracic Surgery Patient
Hilary W. Crittenden, MSN, RN, FNP-C, CTTSDivision of Thoracic SurgeryDuke University Health SystemDurham, North Carolina
Presenter
Presentation Notes
Good afternoon and thank you for having me.
Disclosures:I have no conflicts of interest and no disclosures.
Objectives
•Describe the correlation between smoking and post-operative complications in the thoracic surgery patient
•Discuss the benefits of pre-operative smoking cessation counseling in the thoracic surgical oncology clinic setting
•Review the current FDA-approved medications for smoking cessation and their guidelines for use
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Today I would like to talk with you about the relationship between smoking and post-op complications in thoracic surgery patients and the impact we as providers can have in getting our patients to quit. I will also review current FDA approved smoking cessation medications and their implications for use.
Case study: 75 yo Philip Morris• Biopsy-
proven NSCLC
• >50 packyears
• No desire to quit when we first meet
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Mr. Morris is a 75 year-old male who presents to the thoracic surgery clinic with a recent diagnosis of biopsy-proven non-small cell lung cancer involving the right upper lobe. He started smoking with friends at age 15. By the time he was 18, he was smoking a pack a day and has smoked at that rate ever since. Despite his diagnosis, he has little desire to quit smoking.
Smoking after a lung cancer diagnosis:•Continued tobacco use compromises the effectiveness and increases the complication rates of three primary cancer treatments: surgery, chemotherapy and radiotherapy.
•In patients undergoing surgery, continued cigarette smoking is associated with slower wound healing, higher surgical site infection rates and prolonged hospitalization.
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Patients who continue to smoke after they are diagnosed with lung cancer increase their chance of complications from the three main treatment modalities. For patients having surgery, ongoing tobacco abuse increases surgical site infection, prolongs hospital length of stay, and leads to slower wound healing.
Smoking after a lung cancer diagnosis
•Components of tobacco smoke significantly impact clearance and delivery of many cytotoxic agents, resulting in their decreased efficacy and higher toxicity.
•Compared to former smokers and patients who stopped smoking before starting treatment, current smokers have lower response rates to radiation therapy and acerbated radiation side effects, such as oral mucositis, weight loss and fatigue.
Toll, et al, Clinical Cancer Research 2013
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Smoking has a negative impact on the clearance and delivery of many chemotherapy agents leading to decreased efficacy and higher levels of toxicity. Side effects of radiation therapy are increased in ongoing smokers who have lower response rates to treatment than former smokers and patients who quit smoking prior to initiation of therapy.
Smoking after a lung cancer diagnosis
•Smoking after a cancer diagnosis results in higher risk of developing secondary cancers, poorer general health and increased all cause mortality.
• Overall, patients who continue to smoke after cancer diagnosis almost double their risk of dying, compared to those who quit.
Jassem, J: Smoking after diagnosis of cancer. IASLC presentation 10/2017
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And patients who continue to smoke after their cancer diagnosis increase their risk of developing a secondary cancer. Compared to patients who quit smoking, ongoing smokers have poorer general health and nearly double their chances of dying.
Smoking and increased risk of post-operative complications
Post-operative pulmonary complications
Risk factors include:•Age•Pulmonary function•Cardiovascular comorbidities•Smoking status•Chronic obstructive pulmonary disease
Musallam et al, JAMA Surgery, 2013
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This audience understands the significance of post-operative pulmonary complications in the thoracic surgery patient. They are the most frequently observed complications following lung resection, of which pneumonia and atelectasis are common. They are not only the cause of significant mortality and morbidity, but they have enormous economic impacts including increased length of stay and ICU admission. Most frequent risk factors are listed here. Smoking is obviously the only modifiable risk factor.
Preoperative smoking associated with increased risk of post-op:
•General morbidity•Wound complications•General infections•Pulmonary complications•Neurological complications•Admissions to the intensive care unit
Gronkjaer et al, Annals of Surgery, 2014
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We know that preoperative smoking is associated with an increased risk of: general morbidity, general infection, wound complications, pulmonary and neurological complications, and ICU admission.
Marino et al, The Annals of Thoracic Surgery, 2016
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A study published in the Annals of Thoracic Surgery in 2016 revealed that nearly half of the thoracic surgeons surveyed would not perform certain operations on current smokers. But only 14% tested patients for smoking preoperatively. And two thirds of the surgeons thought the ideal time between smoking cessation to surgery was 2-4 weeks. There was significant disagreement in the CT Surgery community with regard to how to help their patients quit smoking and further studies were recommended.
Smoking and timing of cessation on postoperative pulmonary complications after curative-intent lung cancer surgery
Journal of Cardiothoracic Surgery 2017 12:52Published on: 19 June 2017
This Photo by Unknown Author is licensed under CC BY
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A 2017 study published in the Journal of Cardiothoracic Surgery found that patients who continued to smoke up to the date of curative-intent lung cancer surgery had a higher postoperative morbidity, including higher frequency of PPC, longer hospital stays, and a higher frequency of ICU admission. It revealed that approximately 1 in 5 patients continue to smoke prior to curative-intent surgery for NSCLC. Because of the known benefits of preoperative smoking cessation, it was recommended that all patients should undergo formal smoking cessation as part of the routine work up. The question of optimum timing for preoperative smoking cessation however is yet to be defined.
And yet, studies show that……
50-83% of cancer patients continue to smoke after diagnosis
Duffy et all, Community Oncology 2012
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The research shows that once a patient has been diagnosed with cancer, the risks of continuing to smoke are high and that many patients who relapsed after surgery did so within the first 2 months. And just about half of lung cancer patients who were smoking at diagnosis, continued to smoke 1-2 years after their surgery.�
Quitting before thoracic surgery
•When is the best time?
•Is there risk in quitting too close to surgery?
Myers et all, JAMA Internal Medicine, 2011
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So, when is the optimal time to quit before thoracic surgery? In a perfect world, we would say at least 6 weeks. But we all know that lung cancer does not wait. Some studies found that 6 weeks of preoperative smoking cessation is required to avoid the bronchorrhea associated with the regeneration of cilia that occurs between 2 and 4 weeks after smoking cessation. Others found that quitting just 3-5 days before surgery can improve clearance and decrease in secretions.
• There is decrease in risk of post-op pulmonary complications with increasing time since cessation.
• At least four weeks is desired• Abstinence of >10 weeks showed complication rates
similar to those in patients who had never smoked.• ALL patients should be advised to stop smoking
before undergoing lung surgery.
Zaman, M., Bilal, H., Mahmood, S., & Tang, A (2012) ). Does getting smokers to stop smoking before lung resections reduce risk? Journal of Interactive Cardiovascular and Thoracic Surgery, 14(3), 320-323
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A study published in a 2012 issue of Interactive Cardiovascular Thoracic Surgery Journal showed that while 4 weeks of cessation showed benefit, greater than 10 weeks of abstinence led to complication rates similar to those of never-smokers.
The perioperative period offers a genuine opportunity for smoking cessation
Preoperative smoking cessation should be routinely recommended independently of the timing of the intervention, even though the benefits increase in proportion with the length of cessation
Pierre, et al. Anaesth Crit Care Pain Med, 2017
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We need to urge our patients to quit smoking at every opportunity. At Duke, we require that our patients quit at least THREE weeks prior to undergoing lung resection surgery.
We can make a difference! • Smokers listen to their health care providers.
• Even brief adviceincrease the chances that your patient will try to quit and be successful.
• One quarter of adult smokers said their health care provider never advised them to quit.
Hughes, J.R. Journal of General Internal Medicine, 2003
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Smokers cite health care practitioners’ advice as an important motivation for them to quit smoking …..even when we spend just a few minutes in counseling. And yet, studies showed that about 25% of adult smokers said their health care provider never advised them to quit.
Perhaps more than anyone, WE have a teachable moment.......
…greatest success is achieved among cancer patients who are offered cessation treatments immediately after their diagnosis. The longer the lapse between diagnosis and initiation of a cessation program the lower likelihood of success......
Duffy et al, Community Oncology, 2012
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We see patients at some of the darkest moments of their lives.....when they may be most vulnerable to make significant and lasting change. And when their loved ones and support people might be willing to change their own habits in order to help them.
So how do we do this?
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We know that counseling from medical providers helps. And FDA-approved medications for cessation help. The combination of the two leads to the greatest success. Our goal should be to reinforce the benefits of quitting AND then give our patients the tools to quit all in one setting.
Behavioral therapy:•Health provider advice and counseling
•Tailored self-help materials
•Telephone counseling •Smoking cessation clinics
USPSTF 2015 Update on Tobacco Cessation in Adults: Behavioral and Pharmacotherapy Interventions
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According to the United States Preventative Services Task Force 2015 update, providing intense behavioral support to smokers receiving pharmacotherapy may increase cessation rates. In our particular patient population, this includes......
Make it specific to YOUR lung cancer patient
The immediate benefits:•Improved oxygenation•Lowered blood pressure•Improved smell/taste = appetite•Improved circulation and breathing•Increased energy•Improved immune response
Sanderson Cox et al, Journal of Clinical Oncology, 2002Cataldo et al, Oncology, 2010
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Counseling with a focus on the benefits specific to patients with lung cancer: both short-and long-term. You can tell your patients that as soon as they quit smoking they can expect improvements in oxygenation, blood pressure, appetite, circulation and breathing. They will benefit from more energy and a stronger immune system.
The long term benefits:•Decreased risk of recurrent or secondary tumor
•Increased survival time•Decreased post-operative complications•Improved response to chemotherapy and radiation therapy
•Improved quality of life
Sanderson Cox et al, Journal of Clinical Oncology, 2002Cataldo et al, Oncology, 2010
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And over time, they lower their risk of developing recurrent cancer or a new cancer, increase their survival time, reduce post-op complications, improve their response to systemic therapy, and allow for an overall improved quality of life. �
1-800-Quit-NowQuit-lines:•Effective and evidence-based • Produce higher quit rates than with counseling alone
•Rates even higher when combined with meds•Cost-effective when compared to other common disease prevention interventions
•Available in all 50 statesUSPSTF 2015 Update on Tobacco Cessation in Adults: Behavioral and Pharmacotherapy InterventionsCenters for Disease Control and Prevention Fact Sheet: Quitline FAQs for Health Care Providers, updated 12/2017
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Compared to no-intervention, telephone quit-lines have been shown to increase 6 month smoking cessation rates. They are cost-effective as they are free, and they are available in all fifty states.
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At Duke, we are fortunate to have a dedicated smoking cessation clinic with medical and behavioral providers, as well as phone-based follow up for patients. They are working to embed their services into our perioperative medicine program.
Back to our patient……..
This Photo by Unknown Author is licensed under CC Y-SA
• Review link between smoking and lung cancer
• Explain benefits of quitting before surgery
• Advise patient to quit now
• Surgery scheduled in three weeks
Presenter
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As part of Mr. Morris’ initial evaluation, we spent time explaining the relationship between his smoking and lung cancer. We reviewed the short and long term benefits of smoking cessation prior to surgery. We then told him that while he has been deemed an appropriate surgical candidate for curative-intent lung cancer resection surgery (VATS right upper lobectomy), he needed to quit smoking immediately. With the support of his wife, he agreed to this and his procedure was scheduled for three weeks from the date of our initial visit.
In addition to counseling...
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In addition to counseling, all smokers attempting to quit should receive offer of pharmacotherapy. The USPSTF update of 2015 found that there was a statistically significant benefit of combined pharmacotherapy and behavioral interventions on smoking cessation at 6 months or more when compared with controls
PharmacotherapyFDA approved medications for
tobacco dependence:•Nicotine replacement therapy
–long and short acting•Bupropion•Varenicline
USPSTF Treating Tobacco Use and Dependence: Clinical practice Guidelines update 2015UpToDate Pharmacotherapy for smoking cessation in adults: Summary and Recommendations
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These are the FDA approved medications for smoking cessation. I will focus on those most commonly used in helping our patients quit prior to thoracic surgery with the goals of reducing post-op complications and ensuring lasting cessation.�
Nicotine ReplacementLong acting:•PatchShort acting:•Gum•Lozenge•Inhaler – prescription required
•Nasal spray – prescription required
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Nicotine replacement medications partially replace nicotine formerly obtained from smoking, minus the carcinogenic materials found in cigarettes. It reduces withdrawal symptoms and cravings, but it does not completely eliminate all withdrawal symptoms. Of these, nicotine inhalers and nasal spray are the only ones that require a prescription. While not required for the patch, a prescription may reduce the cost for patients whose insurance companies cover smoking cessation meds.
Nicotine patch: dosing
Smoking Rate Dose<10 cpd 7-14 mg/d10-20 cpd 14-21 mg/d21-40 cpd 21-42 mg/d>40 cpd 42+ mg/d
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Nicotine patches come in 21, 14, and 7 mg. You base your dosage in mg on your patient’s cigarettes smoked per day. For example if he smokes 1 PPD, or 20 cigarettes, he should use a 21 mg patch. If he smokes ½ PPD, he should use a 14 mg patch. And if he smokes 2 PPD, he would require two 21 mg patches. He wears the patches for 24 hours including overnight to reduce morning cravings and to decrease time to achieve steady state drug levels.
Nicotine patch: dosing schedule
•Use the starting dose for 4-6 weeks•Taper in 7-14 mg steps every 2-6 weeks•Length of therapy varies based on patient response
•Withdrawal symptoms while tapering are usually mild if they exist at all
•Stay in contact with your patients to assess their response and assist with taper
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I keep my patients on their initially recommended dose right up to and following surgery to avoid withdrawal. After surgery, they can begin to taper as detailed on this slide. You want to make sure you stay in touch with your patients to assess, guide, encourage, and reassure.
Nicotine patch: duration of use•At least 3 months•Longer is better
Schnoll et al Annals of Internal Medicine, 2010
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We know that the longer patients use cessation medications, the better chance they have of staying quit. We recommend a period of at least 3 months but tell our patients that they may do better with six months of medication. We explain that being on nicotine replacement for a longer period of time does not “keep them addicted” but rather gives them a better chance of quitting for good.
Combination NRT:
•Preferred over long acting or immediate release alone
•Nicotine replacement patches: steady state absorption
•Gum, lozenges, inhalers: use for cravings•Longer duration (>8-10 weeks) of therapy may lead to improved smoking cessation rates
Cahill et al, JAMA, 2014
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Your patients will also have a better chance of quitting and staying quit when they use combination NRT: patches PLUS gum, lozenges or inhaler. Patches provide steady state absorption while short-acting options give an immediate release of nicotine during cravings.
Immediate-release NRT:Nicotine gum, lozenge, and inhaler
•Absorbed through the buccal mucosa•Affected by pH (avoid soft drinks)•Technique is important with gum/lozenges•Peak absorption in 15-20 minutes•No prescription necessary for gum and lozenges
USPSTF Treating Tobacco Use and Dependence: Clinical practice Guidelines update 2015UpToDate Pharmacotherapy for smoking cessation in adults: Summary and Recommendations
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With nicotine gum, smokers use the “Chew and Park” method: they chew for a few moments until they taste the nicotine then park it between their gumline and cheek. They repeat this cycle for about 30 minutes when the nicotine is gone. The gum comes in 2 and 4 mg dosages. The 4 mg dose is recommended for patients who smoke >25 cigarettes per day. Lozenges are used in a similar manner and we prescribe the 4 mg dose for those patients who smoke their first cigarette within 30 minutes of waking. They can use 1 piece every 1-2 hours as needed for cravings up to 24 pieces per day.
Immediate-release NRT:Nicotine inhaler:
•Requires a prescription•Smokers instructed to puff on the inhaler - "don't inhale into the lungs"•Recommended use is six to 16 cartridges a day for six to 12 weeks
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The nicotine inhaler may be a good option for your patient who finds pleasure in the handling aspect of smoking. Tell your patient NOT inhale but rather to puff on the inhaler
Immediate-release NRT
Nicotine nasal spray:•Requires a prescription•Absorbed through nasal mucosa•Recommended use is one spray each nostril 1-2 times per hour for ~3-6 months
•Side effects include nasal, sinus and throat irritation, watery eyes, sneezing, and coughing
USPSTF Treating Tobacco Use and Dependence: Clinical practice Guidelines update 2015UpToDate Pharmacotherapy for smoking cessation in adults: Summary and Recommendations
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Nicotine replacement is available in a nasal spray, but it is not preferred by many patients. I will be honest and say that I have yet to prescribe nicotine nasal spray.
Bupropion•Also known as Wellbutrin and Zyban, extended release form is bupropion is approved for smoking cessation
•Compared to placebo, bupropion increased the likelihood of smoking cessation.
•OK to take with SSRI's (often encountered)
UpToDate Pharmacotherapy for smoking cessation in adults: Summary and Recommendations
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Bupropion is believed to act by enhancing CNS noradrenergic and dopaminergic release. Licensed to aid in smoking cessation, the sustained release of bupropion known as Zyban is identical to the antidepressant Wellbutrin SR.
Bupropion: dosing
•Set target quit date one week from start of medication
•Start with 150 mg daily for 3 days and increase to 150 mg b.i.d. with at least 8 hours between doses
•Evening dose before 6 pm to avoid insomnia•Treat for at least 8-12 weeks•Severe liver disease requires dose adjustment
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Read slide. A lower dose of 150 mg daily as compared to 300 mg a day may be an option for smokers who did not tolerate side effects of full dose.
Bupropion: side effects
•Headache•Insomnia•Dry mouth•Anxiety/agitation•Decreased seizure threshold
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Patients who quit smoking commonly gain a modest amount of weight. And many use this as a reason to continue. A common side effect of bupropion is decreased appetite and taking it can actually offset some of the weight gain experienced by smokers who quit.
Varenicline
•Targets the nicotinic acetylcholine receptor in a unique fashion
•As an agonist it stimulates the receptor to decrease cravings and withdrawal symptoms
•As an antagonist, it blocks the receptor to decrease the reinforcement associated with smoking
USPSTF Treating Tobacco Use and Dependence: Clinical practice Guidelines update 2015UpToDate Pharmacotherapy for smoking cessation in adults: Summary and Recommendations
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Varenicline or Chantix works to decrease nicotine cravings and withdrawal symptoms and importantly, it also reduces the rewarding aspects of smoking. I tell my patients that Chantix will make it so that they don’t want to smoke as much, and when they do, they won’t get the good feeling they normal associate with smoking.
Varenicline: dosing
•Smokers are instructed to quit one week after starting varenicline to achieve stable blood levels.
•Prescribe a starter pack: 0.5 mg once daily for three days, then 0.5 mg twice daily for four days, followed by 1 mg twice daily for the remainder one month.
•Prescribe an additional two months of maintenance dosing (1 mg b.i.d) for a 12 week course.
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Patients pick a quit date one week after they start varenicline. Prescribe a starter pack PLUS an additional two months of maintenance dosing. Some patients may stop smoking as soon as they start varenicline and can use nicotine replacement therapy while they ramp up to the maintenance dose.
Varenicline: dosing (continued)
•Patients who have successfully quit at 12 weeks can be continued on varenicline for an additional 12 weeks.
•Excreted by the kidney; requires dose reduction in smokers with moderate renal insufficiency.
Tonstad et al, JAMA, 2006
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Research has found that people who have successfully quit smoking and are tolerating varenicline well at the three month mark, may increase their chances of remaining smoke-free at six months and the one year if they stay on it for a total of six months. The message here is again, the longer your patient is on the medication, the better chance they have of staying quit.
Varenicline: side effects
•Nausea•Insomnia•Abnormal or "vivid" dreams •Headache •Other GI effects
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Read the slide – talk about dreams – most common Nausea can be decreased when smokers take varenicline with full glass of water
Varenicline: warning
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In 2009, the FDA required varenicline to carry this black box warning describing risk of serious neuropsychiatric events, especially in patients with a history of mental illness. But in 2016, a study found the risk of these mental health side effects was lower than expected. The FDA determined that the benefits of smoking cessation outweighed the risk of side effects from varenicline and the black box warning was lifted. (Anthenelli et al, The Lancet, 2016)
Which is best?
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So, which cessation medication is best? A study published in the January, 2014 issue of JAMA found higher rates of smoking cessation associated with NRT and bupropion compared with placebo. Varenicline and combination NRT (i.e. patch plus gum) were most effective. None of the therapies was associated with an increased rate of serious adverse events.�
And research is ongoing...
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A more recent investigation published in 2016 found that in adult smokers motivated to quit, 12 weeks of treatment with the patch, varenicline, or combined nicotine replacement produced no significant differences in biochemically confirmed rates of smoking abstinence at 26 weeks. �
Charlie TableCHARLIE TABLE Relative Risk Abstinence Rate
Varenicline RR = 2.43 24%
Patch + Immediate Release Nicotine RR = 2.33 23%
Nicotine Patch RR = 1.75 18%
Nicotine Gum RR = 1.59 16%
Nicotine Lozenge RR = 1.59 16%
Nicotine Inhaler RR = 1.82 18%
Nicotine Nasal Spray RR = 1.93 19%
Bupropion RR = 1.71 17%
Nortriptyline RR = 1.71 17%
Clonidine RR = 1.74 17%
Davis, J. Perioperative Smoking Cessation: Evidence Based Perioperative Medicine 2018
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I borrowed this table from Dr. James Davis who is the director of the Duke Smoking Cessation Program. It nicely summarizes rates of abstinence and relative risk between smoking cessation medications. Varenicline has the highest abstinence rate followed closely by combination NRT. Relative risk was slightly higher for varenicline however. And as you can see, bupropion had similar abstinence rates to short acting nicotine replacement used alone. Nortriptyline and clonidine are considered second-line treatments for smoking cessation and neither are currently FDA approved.
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The role of electronic cigarettes in smoking cessation is controversial. Much attention has come from the study published in the New England Journal of Medicine’s February 14, 2019 edition reporting that E-cigarettes were more effective for smoking cessation compared to NRT when both were used in combination with behavioral support. The abstinence rate at one year was 18% in the E-cigarette group compared to 9.9% in the NRT group.
Electronic cigarettes for smoking cessation?
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While the current belief is that e-cigarettes are safer than traditional combustible cigarettes, controversy remains as to whether they should be advised as fist line treatment to assist with smoking cessation. The duration of e-cigarette treatment has yet to be defined. Further research on the health impacts of long term use is warranted. Studies are on-going.
What happened to our patient?
This Photo by Unknown Author is licensed under CC BY-NC-ND This Photo by Unknown Author is licensed under CC BY-ND
This Photo by Unknown Author is licensed under CC BY
This Photo by Unknown Author is licensed under CC BY-NC-ND
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What happened to Mr. Morris? After our discussion, we prescribed a varenicline starter pack as well as 2 months of maintenance therapy. He agreed to stop smoking that day and start his medication immediately. He will also get 21 mg NRT patches to use should he struggle with withdrawal symptoms while the varenicline “ramps up”. He will get NRT lozenges to use as needed for cravings. We advised him to call 1-800-QUIT-NOW help line and also provided him with our contact information. We called him one week after he started therapy to check on his progress.
Success for Mr. Morris…..• Doing well on varenicline
and nicotine lozenges• Quit smoking when we
saw him initially• Referred to the Smoking
Cessation Clinic: appt to coincide with post-op visit
• Tobacco-free one year later
• Wife quit smoking too!
Presenter
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At that point, he was doing well on the varenicline and had not needed to use the patches. He was using the NRT lozenges for cravings. He had not smoked since we saw him. We referred him to our institution’s Tobacco Cessation Clinic and arranged for his first visit to coincide with his Thoracic Surgery Clinic post-op appointment. Mr. Morris did well with surgery and was tobacco-free at his clinic visit one year later. His wife was pleased to tell us that she too had quit smoking.
In summary...
•Cigarette smoking is responsible for >80% of lung cancer deaths and puts our thoracic surgery patients at increased risk for post-op complications
•It is our responsibility to ask every patient if they smoke, advise them to quit, and help them achieve lasting tobacco cessation
•We have the unique opportunity to provide help to our patients when they need it most
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In closing, we know that smoking puts our thoracic surgery patients at increased risk for post-op pulmonary complications. **We need to ask every patient if they smoke, advise them to quit, and then help them achieve lasting smoking cessation. **We have the unique opportunity to provide help to our patients when they need it most.
Thank you
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Thank you very much
References1. Centers for Disease Control and Prevention Fact Sheet: Current Cigarette Smoking Among Adults in
the United States. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/2. U.S. Food and Drug Administration Lung Cancer and Smoking 12/2017. 3. Toll, B.A., Brandon, T.H., Gritz, E.R., Warren, G.W., &Herbst, R.S. (2013). Assessing Tobacco Use by
Cancer Patients and Facilitating Cessation: An American Association for Cancer Research Policy Statement. Clinical Cancer Research, 19(8) , 2004-2014
4. Jassem, J: Smoking after diagnosis of cancer. IASLC presentation 10/20175. Marino, K.A., Little, M.A., Bursac, Z. et al (2016) Operating on Patients Who Smoke: A Survey of
Thoracic Surgeons in the United States. The Annals of Thoracic Surgery. 102(3), 911-916. 6. Musallam, M., Rosendaal, F., Zaatari, G. et al (2013). Smoking and the Risk of Mortality and Vascular
and Respiratory Events in Patients Undergoing Major Surgery. JAMA Surgery, 148(8), 755-762. 7. Gronkjaer, M., Eliasen, M., Skov-Ettrup, L et al. (2014). Preoperative Smoking Status and
Postoperative Complications: A Systematic Review and Meta-analysis. Annals of Surgery 259(1). 52-71.8. Duffy, S.A., Louzon, S.A., Gritz, E.R. (2012). Why do cancer patients smoke and what can providers
do about it? Commun Oncology, 9(11): 344-352.
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Last, F. M., & Last, F. M. (Year Published). Article title. Journal Name,Volume(Issue), pp. Pages.
References9. Lugg, S.T., Tikka, T., Agostini, P.J., Kerry, A., Adams, K.,Kalkat, M.S., Steyn, R.S. Rajesh, P.B. Bishay, E., Thickett, D.R., & Naidu, B. (2017). Smoking and timing of cessation on postoperative pulmonary complications after curative-intent lung cancer surgery. Journal of Cardiothoracic Surgery, 12 (52) 10. Zaman, M., Bilal, H., Mahmood, S., & Tang, A (2012) ). Does getting smokers to stop smoking before lung resections reduce risk? Journal of Interactive Cardiovascular and Thoracic Surgery, 14(3), 320-32311. Pierre, S., Rivera, C., Maitre, B., Ruppert, A.M., Bouaziz, H., Wirth, N. Saboye, J., Sautet, A., alain, C.M. Tournier, J.J., Martinet, Y. Chaput, B., Bertrand, D. (2017). Guidelines of smoking management during the perioperative period. Anaesthesia Critical Care and Pain Medicine, 36 (3), 195-200.12. Hughes, J.R. (2003). Motivating and helping smokers to stop smoking. Journal of General Internal Medicine, 18(12), 1053-1057.13. United States Preventative Services Task Force: Treating Tobbaco Use and Dependence: Clinical
Practice Guideline update 2015
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Last, F. M., & Last, F. M. (Year Published). Article title. Journal Name,Volume(Issue), pp. Pages. � � � � � � �
14. Evidence Summary: Tobacco Smoking Cessation in Adults, Including Pregnant Women: Behavioral and Pharmacotherapy Interventions. U.S. Preventive Services Task Force. October 2015. http://www.uspreventiveservicestaskforce.org/Page/Document/behavioral-counseling-and-pharmacotherapy-interventions-for-/tobacco-use-in-adults-and-pregnant-women-counseling-and-interventions
15. Sanderson Cox L, et al. (2002). Tobacco use outcomes among patients with lung cancer treated for nicotine dependence. Journal of Clinical Oncology. 20: 3461-3469.16. Centers for Disease Control and Prevention Fact Sheet: Quitline FAQs for Health Care Providers, updated 12/201717. UpToDate Pharmacotherapy for smoking cessation in adults: Summary and Recommendations18. Schnoll, R., Patterson, F., Wileyto, P. et al. (2010). Effectiveness of Extended-Duration Transdermal
Nicotine Therapy: A Randomized Trial. Annals of Internal Medicine, 152(3):144-15119. Tonstad, S, Tonnesen P., Hajek, P., et al. (2006). Effect of maintenance therapy with varenicline on
smoking cessation: a randomized controlled trial. JAMA, 296(1), 64-71.20. Anthenelli, R.M., Benowitz, R.L., West, R. et al. (2016). Neuropsychiatric safety and efficacy of
varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial. The Lancet, 387(10037), 2507-2520.
21. Cahill, K., Stevens, S., Lancaster, T. (2014). Pharmacological Treatments for Smoking Cessation. JAMA, 311(2), 193-194
References
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22. Baker, T.B., Piper, M.E, Stein, J.H. et al (2016). Effects of Nicotine Patch vs Varenicline vs Combination Nicotine Replacement Therapy on Smoking Cessation at 26 weeks: A Randomized Clinical Trial. JAMA, 315(4). 371-379
23. Davis, J. (2018) Perioperative Smoking Cessation: Evidence Based Perioperative Medicine [powerpointslides]
24. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014
25. Hajek, P., Phillips-Waller, A., Przulj, D. et al (2019) . A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy. The New England Journal of Medicine, 380(7), 629-637.
References
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Presentation Notes
Last, F. M., & Last, F. M. (Year Published). Article title. Journal Name,Volume(Issue), pp. Pages.
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