To describe quitting experiences of cancer patients in a Cancer Center in Jordan; to study patients’ perceptions regarding the process of smoking cessation; and to provide insights about patients in this difficult setting in order to inform oncology practitioners with regards to how improve perceptions and skills related to quitting.
An Arabic cross-sectional questionnaire was developed to evaluate smoking and quitting behaviors in the context of cancer. The tool used as its framework the Theoretical Domains Framework to capture quitting perceptions of cancer patients who smoke, as well as social, environmental, and system-level factors that influence quitting. Eligible patients who were treated at the Center (both in-patient and out-patient settings) and who were current smokers or who smoked up to the time of cancer diagnosis were eligible. Patients were interviewed between July, 2018 and January 2020 using two versions of the questionnaire: an ‘ex-smokers’ version, and a ‘current smokers’ version.
Only a third of subjects (104/350) had been smoke-free for at least 30 days. Both smokers and ex-smokers generally felt that quitting was important, but mean importance and confidence scores (out of 10) were significantly lower in current smokers (8.2 versus 9.1, p-value=0.002; 6.4 versus 8.7, p-value=0.000). Roughly 31% of subjects believed smoking harms were exaggerated and that smoking was not an addiction. About 62% of subjects agreed quitting required skills, and 78.5% felt the steps to quit were clear, but across several listed strategies for quitting, use of these was limited (even in ex-smokers). Among current smokers, roughly a third exhibited forms of cessation fatigue.
Jordanian cancer patients who smoke present with limited knowledge about the quitting process. Even when some success is observed, low rates of utilization of specific quitting strategies were observed, highlighting the need for better counseling about quitting.
- • Quitting experiences and skills employed by Arab cancer patients are under-studied.
- • We evaluated a sample of cancer patients in a large Cancer Center in Jordan.
- • Useful quitting strategies are not frequently employed by patients.
- • About a third of current smokers exhibit some aspects of cessation fatigue.
- • Attitudinal challenges exist and highlight the need for intensive counseling.
Continued smoking after a cancer diagnosis impacts treatment efficacy, tolerability to medications, and patient quality of life; and increases the risks of recurrence or development of new primaries . Regardless of cancer site, patients who quit after a cancer diagnosis demonstrate higher survival rates . As a result of the irrefutable benefits of cessation across cancer care and survivorship, much effort is being made to better integrate smoking cessation services in oncology settings .
Supporting cancer patients who smoke is a challenging process. Despite the well-acknowledged importance of assisting cancer patients to quit, as well as the reported interest in quitting in cancer patients , many international studies indicate that quitting rates tend to be low and relapse rates high in the oncology setting . As such, efforts have been made to better understand cancer patients’ perceptions in the context of smoking cessation. For example, studies have indicated that confidence in ability to quit and belief that smoking contributed to the cancer’s occurrence or prognosis were associated with readiness to quit . Conversely, perceived difficulty to quit, distress, and hopelessness were associated with continued smoking or relapse .