A smoking-cessation program run by an oncology clinical nurse specialist at Duke Cancer Center Raleigh has doubled the quit rate since its implementation in 2015. At the 43rd Oncology Nursing Society Congress, Susan Bruce, MSN, RN, OCN, AOCNS, CTTS, a clinical nurse specialist at Duke Cancer Center Raleigh, in Raleigh, NC, presented her abstract, “A Clinical Nurse Specialist–Led Smoking Cessation Program.” She described how the program was developed, implemented, and evaluated for its effectiveness.
In her presentation, Bruce emphasized the important role of advanced practice nurses in supporting smoking-cessation efforts. Smoking cessation, a key to improving health and the quality of life, is perhaps even more critical in patients diagnosed with cancer, she said—due to the risks of smoking-related illnesses, secondary cancer development, and the potential impact on cancer treatment if smoking is continued following a cancer diagnosis.
The goal of Bruce’s smoking-cessation initiative was to develop a patient-centered smoking-cessation program within Duke Cancer Center that would address the problem of insufficient smoking-cessation resources for the Center’s patients.
As Bruce explained, “Our hospital-based cancer center did not have any smoking-cessation resources. I found one certified tobacco-treatment specialist at our main campus. To me, this was a missed opportunity, and I wanted to bring these much-needed services to our patients. Smoking-cessation efforts are essential—and, at times, required—for a patient to receive treatment of their cancer.” For example, Bruce pointed out, at Duke smoking cessation is required for patients who need to undergo thoracic surgery.
To implement the smoking-cessation program at Duke, Bruce told Cancer Network, she received comprehensive training at the Mayo Clinic, Rochester, Minn., to become a tobacco-cessation specialist. As part of her training, she learned how to develop evidence-based educational materials as well as a formal process for recruiting patients into the program and supporting their efforts to quit.
Duke’s smoking-cessation program required a multidisciplinary team approach. Currently in North Carolina, a Clinical Nurse Specialist (CNS) does not have prescriptive privileges, so collaboration with physicians was necessary to implement the CNS recommendations.
In the Duke program, following CNS assessment of candidates for participation (using tools including the Fagerstrӧm Test for Nicotine Dependence), an individually tailored smoking-cessation treatment plan is recommended. This may include the use of FDA-approved medications such as Zyban (bupropion hydrochloride, an antidepressant); Chantix (an oral agent that stops nicotine from attaching to α4β2 nicotinic acetylcholine receptor receptors in the brain); and nicotine patches, gum, lozenges, inhalers, or nasal sprays. Bruce said that, unfortunately, most of the medications recommended as aids to quitting are not covered by Medicare; however, some patients in her institution’s program qualified for certain pharmaceutical-assistance programs that paid for these products. “The FDA-approved treatments used vary based on patient need and insurance coverage,” Bruce said. “I work with a lot of Medicare patients who end up paying out-of-pocket for nicotine patches and short-acting nicotine products. If they can’t afford these nicotine-replacement products, I try to get free drug for them if they qualify.”
According to the American Cancer Society, it takes the average person 7 to 10 quit attempts to achieve full smoking cessation. Given this statistic, the program at Duke shows promising quit rate results, she told Cancer Network: The quit rates reported by the Duke smoking-cessation program have increased from 17% when it was launched in 2015 to 34% in 2017.
There are also plans to expand the smoking-cessation program at Duke. “Our plan for growth has been [to investigate] adding a half-day clinic [led by] a nurse practitioner or physician who will determine the treatment plan for [each] patient,” Bruce said. “My role as the clinical nurse specialist would be to provide behavioral counseling and all follow-up with the patient.”