Abstract
PURPOSE Smoking cessation after a diagnosis of lung, bladder, and upper aerodigestive tract cancer appears to improve survival, and support to quit would improve cessation. The aims of this study were to assess how often general practitioners provide active smoking cessation support for these patients and whether physician behavior is influenced by incentive payments.
METHODS Using electronic primary care records from the UK Clinical Practice Research Datalink, 12,393 patients with incident cases of cancer diagnosed between 1999 and 2013 were matched 1 to 1 to patients with incident cases of coronary heart disease (CHD) diagnosed during the same time. We assessed differences in the proportion for whom physicians updated smoking status, advised quitting, and prescribed cessation medications, as well as the proportion of patients who stopped smoking within a year of diagnosis. We further examined whether any differences arose because the physicians were offered incentives to address smoking in patients with CHD and not cancer.
RESULTS At diagnosis, 32.0% of patients with cancer and 18.2% of patients with CHD smoked tobacco. Patients with cancer were less likely than patients with CHD to have their general practitioners update smoking status (OR = 0.18; 95% CI, 0.17–0.19), advise quitting (OR = 0.38; 95% CI, 0.36–0.40), or prescribe medication (OR = 0.67; 95% CI, 0.63–0.73), and they were less likely to have stopped smoking (OR = 0.76; 95% CI, 0.69–0.84). One year later 61.7% of patients with cancer and 55.4% with CHD who were smoking at diagnosis were still smoking. Introducing incentive payments was associated with more frequent interventions, but not for patients with CHD specifically.
CONCLUSIONS General practitioners were less likely to support smoking cessation in patients with cancer than with CHD, and patients with cancer were less likely to stop smoking. This finding is not due to the difference in incentive payments.
Footnotes
Conflicts of interest: P.A. reports grants from the Medical Research Council (MRC), National Institute for Health Research (NIHR), Cancer Research UK (CRUK), Economic and Social Research Council, and UK Centre for Tobacco and Alcohol Studies during the conduct of this study; A.F. reports grants from the NIHR, MRC, and CRUK during the conduct of this study; R.R. reports that he was partly funded by the National Health Service (NHS) (Heart of England NHS Foundation Trust) during the conduct of this study. All other authors report none.
Author contributions: A.F., P.A., R.R., and L.S. developed the study protocol which was approved by all authors. C.K., J.O., and R.S. conducted the data processing and analysis. Drafting of the manuscript was led by A.F. and contributed to by all authors. All authors approved the final version of the manuscript. R.S. and J.O. had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Funding support: This study was funded by the NIHR School for Primary Care Research (project No. 224).
Disclaimer: The funder was not involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.
Supplementary materials: Available at http://www.AnnFamMed.org/content/15/5/443/suppl/DC1/.
- Received for publication October 4, 2016.
- Revision received January 27, 2017.
- Accepted for publication February 19, 2017.
- © 2017 Annals of Family Medicine, Inc.
