Date of Award

2018

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

College of Nursing

First Advisor

Kathleen Cartmell

Second Advisor

Ronald Acierno

Third Advisor

Martina Mueller

Abstract

The adverse effects of smoking have been widely promulgated for several decades through several research studies, culminating in the hallmark Surgeon General’s Report (United States Department of Health and Human Services [USDHHS], 2014). The 2014 Surgeon General’s Report (SGR) concluded that smoking leads to numerous adverse effects in patients with cancer, including poor wound healing, increased post-operative pain, increased side effects from cancer treatment, and increased cancer-specific and all-cause mortality (USDHHS, 2014). However, extant literature is less well defined regarding the effect smoking has on response to both cancer treatment and treatment-related toxicities (USDHHS, 2014). Despite the benefits of smoking cessation for all patients, there is also a paucity of data regarding the best way to most effectively deliver tobacco cessation services to patients with cancer in the United States (US). Additionally, in a healthcare environment that is increasingly challenged to provide financially feasible services, the ability to maintain integral resources to offer evidence-based, cost-effective tobacco cessation services to patients is also a key consideration. This compendium represents three manuscripts that contain distinct but related areas of research related to individuals with lung cancer who smoke. The first manuscript offers a literature review that outlines the interventions, outcomes and tobacco quit rates of programs delivering tobacco cessation programs for cancer patients in the United States (US). The second and third manuscripts detail quantitative studies that explore whether current and former smokers may require additional second- and third-line treatment as compared to the referent group of never smokers, and whether the groups of current and former smokers experience more treatment-related side effects as compared to never smokers. Lastly, we will provide a preliminary cost analysis in the group of current, former and never smokers who receive second-line and third-line chemotherapy. By 1) exploring how to best deliver tobacco cessation services to patients with cancer who smoke, 2) examining possible associations between tobacco use and treatment progression and treatment toxicities, and 3) reviewing preliminary costs of second-line and third-line chemotherapy across current, former, and never smokers, this compendium will help clarify current gaps in literature, synthesize research findings, and provide a preliminary basis on which specific areas for further research may be recommended.

Rights

All rights reserved. Copyright is held by the author.

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