Efficacy of Inpatient, Evidence-Based Tobacco Use Treatment of Patients With Bladder Cancer After Radical Cystectomy

Purpose

Despite a 3-fold increase in risks of bladder cancer (BC) among current smokers, smoking cessation therapy for patients undergoing treatment is significantly underutilized. Inpatient admission after surgery provides a teachable moment to pursue tobacco treatment. We conducted a 12-month prospective quality improvement initiative to increase tobacco treatment program (TTP) consultations with BC patients who smoke and underwent radical cystectomy (RC).

Materials and Methods

From 6/2022 to 6/2023, patients admitted after RC for BC who were identified to be current smokers were referred to our institution's inpatient TTP. A baseline standardized assessment of tobacco dependence was conducted postoperatively, and nicotine replacement therapy (NRT) was prescribed both inpatient and upon discharge. Study endpoints included the percentage of patients receiving inpatient TTP consultation, inpatient and 1-month NRT prescription fill rates, tobacco usage, cessation rates, quit attempts, and patient and provider satisfaction. Postintervention outcomes were compared to historical controls.

Results

Of the 16 inpatients (of 63 RCs) who smoked and received a TTP referral, 15 accepted. Referrals to TTP increased from 20% at baseline to 100% after implementation of the intervention (P = .01). NRT was prescribed for 40% of inpatients, and 60% of patients filled NRT after discharge. At 1-month follow-up, a significant decrease occurred in cigarette use (12.6 cigarettes/day to 6.8 cigarettes/day; P = .001). The majority, 86%, reported attempts to quit, and 29% reported that they successfully quit smoking. Patients reported high levels of stress reduction, confidence to quit, desire to quit, and willingness to use NRT. Most (83%) providers were very satisfied with the TTP and felt recommendations were easy to implement.

Conclusions

This study successfully increased the use of inpatient TTP in patients with BC who smoked and were undergoing RC. The positive outcomes, including high acceptability among patients, increased rates of TTP consultations, reduced cigarette usage postintervention, and notable satisfaction among healthcare providers, suggest that these strategies can be readily adopted by urologic care teams.