A qualitative study of attitudes and perceptions of smoking cessation medication among patients with cancer

Purpose: Among patients with cancer, tobacco use remains high. Nearly half who report smoking at diagnosis continue to smoke following diagnosis, and use of smoking cessation medication remains low. This study explores attitudes, barriers, and preferences for smoking cessation medication among patients enrolled in a tobacco treatment trial in the context of cancer care.

Methods: This is a secondary qualitative analysis of the Smokefree Support Study. Of 221 participants who completed the 6-month follow-up survey, n = 72 participants were randomly selected for an exit interview. Interviews were conducted using a semi-structured interview guide, recorded, transcribed, and individually coded using NVivo 11 until high interrater reliability was reached (Kappa > 0.86).

Results: Participants (55.6% female) were predominantly White (83.3%) and on average 60 years old. Many participants held negative beliefs about smoking cessation medications, primarily concerns about safety and side effects in the context of cancer treatment. Lack of understanding interactions with ongoing chemotherapy and access were the most common barriers reported by those who did not use cessation medication during the study. For those who did use medication during the study, positive outcomes included craving reduction, ease of use and access, and psychological benefits.

Conclusion: The findings suggest a knowledge gap in the safety and effectiveness of smoking cessation medications, specifically in relation to cancer care. Addressing this knowledge gap may increase medication uptake, adherence, and quit rates. Cancer care providers are seen as instrumental in emphasizing the importance and safety of smoking cessation medications as well as patient access concerns.

Implications: Tobacco use among patients with cancer remains high and has serious clinical implications. Tobacco cessation is associated with decreased treatment-related toxicity, decreased risk of second primary cancers, and increased survival rates. Smoking cessation medications are effective, yet patients with cancer have low usage rates. Elucidating reasons associated with smoking cessation medication nonadherence will assist cancer care providers in better addressing factors that increase adherence rates.