Analysis Of Tobacco Use Status And Its Influencing Factors Among Patients With Smoking-related Cancers In Shandong Province

BackgroundThe incidence and mortality rate of cancer in China are high,and cancer has become a serious public health problem in our country.In addition,China is a big country of tobacco use,and the prevalence of tobacco not only increases the risk of cancer,but also brings a heavy economic burden of disease to society.Persistent cigarette smoking after diagnosis could reduce the effectiveness of treatment,increasing the risk of death and reducing the quality of life of patients.Quitting smoking is important for the prognostication of cancer patients,but there are still a large number of cancer patients who continue to smoke after diagnosis.There is still a lack of research on tobacco use of cancer patients in China.Understanding and intervening on smoking status of cancer patients is important to improve the quality of life of patients.ObjectiveBased on the health ecology model,this study aimed to analyze the tobacco use status and its influence factors at the time of diagnosis and after diagnosis of cancer patients in Shandong Province and explore patients’ needs of smoking cessation services to provide scientific evidence for smoking cessation interventions for cancer patients and the improvement of patients’ prognostic conditions.MethodsFrom July to August 2020,cluster sampling method was used to select subjects who met the inclusion criteria at Shandong Cancer Hospital and Tai’an Municipal Center Hospital,and explain the purpose of the study to participants and conduct face-to-face interviews.The survey mainly includes the sociodemographic characteristics of patients,disease information,self-efficacy,anxiety and depression symptom.In order to explore the facilitators and barriers of cancer patients’ smoking behavior and the patient’s needs of smoking cessation services,the purposive sampling method was used to select cancer patients who met the inclusion criteria as interviewees,and the interview was over until the data saturation(i.e.,no new topics emerged).The semi-structured interview was used to conduct face-to-face interviews with the subjects.The description analysis was used for basic information and tobacco use status of the participants.Using single-factor analysis and multi-factor analysis to analyze the factors influencing tobacco use of participants.The single-factor analysis mainly used Chi-square test was mainly used for single-factor analysis,and multinomial logistic regression and Poisson regression model were used for multi-factor analysis.The qualitative materials were collated and analyzed by the subject framework method.ResultsA total of 424 valid questionnaires were collected in this study.Of the participants,176 cancer patients smoked at the time of diagnosis,with a smoking rate of 41.51%at the time of diagnosis,and 31 cancer patients continued to smoke after diagnosis,accounting for 7.31%of all respondents and 17.61%of those who smoked at the time of diagnosis.The average age of starting smoking regularly of cancer patients with a history of smoking was 20.67±5.45,while the average total years of smoking was 36.58±11.43.86.24%of patients had more than 20 years of smoking history.The average daily amount of smoking was 22.61±11.46,and 44.95%patients had moderate or high levels of nicotine dependence.Based on the health ecology model,the influencing factors of tobacco use when diagnosis with cancer of patients were analyzed.And the results showed that the educational level and employment status were important upstream factors.As for mid-stream factors,pre-diagnosis drinking,self-efficacy and anxiety were associated with smoking status when cancer patients were diagnosed.Gender,age and lesion locations were the downstream factor that influence smoking behavior.Results of the analysis of the factors affecting smoking behavior after diagnosis of cancer patients smoking at the time of diagnosis showed that,as for upstream factors,although there were differences in smoking rates among patients with different characteristic groups,it was not statistically significant.In terms of mid-stream factors,the average daily smoking volume≤20 patients had a higher rate of persistent smoking after diagnosis.And about downstream factors,patients with late pathological stages were less likely to smoke after diagnosis than patients with earlier pathological stages.Qualitative studies have found that disease diagnosis,cancer patients’ own guilt,and support from clinical staffs and friends to quit smoking are facilitators for quitting smoking.The psychological stress,nicotine dependence,lack awareness of tobacco harm and surrounding environment were barriers of quitting smoking successfully.In terms of the demand for smoking cessation services,cancer patients have shown an interest in affordable smoking cessation clinics and drugs,proactive telephone counselling services and community smoking cessation groups.ConclusionThis study found that the rate of persistent smoking after diagnosis of cancer patients in Shandong Province is similar to that of foreign studies.Based on the health ecology model,the influencing factors of smoking behavior when diagnosed with cancer of patient included education level,employment status,pre-diagnosis drinking,self-efficacy,anxiety,gender and lesion locations.The factors affecting tobacco use after diagnosis of cancer patients who smoke at the time of diagnosis include the average daily smoking volume and pathological stage.Based on the results of the study,we propose the policy recommendations as follows:(1)Health committees at all levels should ensure that the smoking cessation outpatient program is implemented effectively.First,it should be ensured that there are professionally trained medical staff who could provide smoking cessation outpatient services for patients.Secondly,the higher-level medical institutions should coordinate with primary health care institutions to provide convenient smoking cessation services for patients.Thirdly,it is necessary to provide smoking cessation drug subsidies for patients with financial difficulties.(2)Considering incorporating smoking cessation counselling services into cancer patient care plans.Health care staff in the relevant oncology department can stress the importance of quitting smoking during each visit of patients to ensure that patients understand the risks and benefits associated with smoking.In addition,they should emphasize the negative impact of persistent smoking on the therapeutic effects and quality of life in the future.And medical staffs should provide personalized smoking cessation advice according to the patient’s own characteristics.(3)Public health agencies could provide proactive telephone counselling services.According to the hospital medical records,screening out cancer patients with a history of smoking,timely inquiring about their smoking situation,giving certain advice on quitting smoking,and do a good job of follow-up work to help patients overcome the withdrawal reaction faced in the process of quitting smoking.(4)The community-based advisory group on smoking cessation for cancer patients should be established,which could be Organized by the Community Health Service Center and guided by professionals from higher-level medical institutions.This measure would not only allow patients to learn smoking cessation techniques and boost their confidence in quitting smoking in the process of communicating with each other,but also help them reduce their psychological burden.