Smoking history and cessation discussions in cancer patients receiving definitive radiotherapy: Do we treat all patients equally?

INTRODUCTION: Tobacco is recognized as a causative agent for head and neck (H&N) and lung cancers, but not for cancers of the prostate or breast. Still, tobacco use during radiotherapy has been associated with poorer outcomes for all four of these commonly treated malignancies. We sought to evaluate if our providers record smoking history and discuss cessation as frequently for prostate and breast cancers as for H&N and lung cancers. METHODS: Initial consultation notes of 592 non-metastatic patients seen from January 2014 through June 2017 were reviewed using the electronic medical record. Descriptive statistics were used to evaluate smoking history and cessation discussions. The chi-squared test was used to compare frequencies. We chose two cancer sites commonly associated with tobacco use and causation (H&N and lung) and two sites not commonly associated (prostate and breast). RESULTS: Prostate cancer patients were less likely to have smoking history recorded (65%) than breast (91%), H&N (96%) or lung (97%) patients (p<0.0001). Breast and prostate cancer patients were less likely to be current smokers (10%) than H&N and lung cancer patients (29%) (p<0.0001). Smoking cessation discussions were less frequently documented in breast and prostate cancer patients (14%) than in H&N and lung cancer patients (55%) (p=0.0005). CONCLUSIONS: We document smoking history less frequently for prostate cancer patients than H&N, lung or breast cancer patients. Breast and prostate cancer patients have lower rates of current smoking than H&N and lung cancer patients. We document smoking cessation discussions less frequently in current smoking breast and prostate cancer patients than current smoking H&N and lung cancer patients. As all of these patients have been shown to experience poorer outcomes when smoking during radiotherapy, all should be asked about their smoking history.