Behavioral economics strategies can help patients quit smoking after a cancer diagnosis

Researchers from Penn Medicine and the Children’s Hospital of Philadelphia find ‘nudges’ from electronic health records could improve the implementation of tobacco use treatment.

Researchers from the Perelman School of Medicine and the Children’s Hospital of Philadelphia (CHOP) have found that cancer patients who continued to smoke after their diagnosis were significantly more likely to receive treatment for tobacco use when “nudges” to provide tobacco treatment were directed at clinicians through the electronic health record. The findings strengthen the case for using behavioral economics, or targeting predictable patterns in human decision-making to overcome barriers to changes in behavior, to improve outcomes for patients treated for cancer.

Person breaking a cigarette in half.
Image: iStock/Daria Kulkova

The study is published in the Journal of Clinical Oncology.

More than 50% of patients who smoke prior to their cancer diagnosis continue to smoke after they are diagnosed. This can worsen quality of life and accelerate tumor growth. Routine, evidence-based tobacco use treatment (TUT)—usually involving a referral to a smoking cessation clinic for counseling and potentially using medication to help address tobacco use—reduces the risk of death caused by cancer and other health issues. Despite its benefits, only about half of cancer centers identify patient tobacco use and even fewer engage patients directly in adopting a TUT strategy.

To help increase the use of TUT among cancer patients, researchers wanted to explore the use of strategies informed by behavioral economics to improve TUT uptake among patients and help clinicians improve their willingness to engage in TUT for their patients.

“Oncologists are faced with the challenge of responding to each patient’s individual cancer, so we wanted to see if we could develop a strategy for making their lives as easy as possible by providing simple, timely nudges to help patients engage in tobacco use treatment options,” says first author Brian Jenssen, a researcher and primary care pediatrician with the Division of General Pediatrics at CHOP, a faculty member with PolicyLab and Clinical Futures at CHOP, a senior fellow at the Leonard Davis Institute, and a member of the Abramson Cancer Center’s Tobacco and Environmental Carcinogenesis Program. “Clinicians can help their patients find ways of improving their health by helping them quit smoking in a nonjudgmental way.”

“This study shows that a behavioral economics ‘nudge’ strategy can increase tobacco use treatment in the oncology setting, which we hope will help more patients with cancer control their tobacco dependence and enjoy better cancer care outcomes,” says senior author Frank T. Leone, director of the Comprehensive Smoking Treatment Program at Penn Medicine, a professor of pulmonary medicine in the Perelman School of Medicine, and a member of the Tobacco and Environmental Carcinogenesis Program at the Abramson Cancer Center. “We look forward to continuing to build on this research and further increase engagement with tobacco use treatment in the oncology setting.”

Read more at Penn Medicine News.