Lisa Sanderson Cox

Coding Manual for Cancer Registry Registrars

Background: Smoking and obesity are leading causes of preventable morbidity and mortality, often co-occurring and synergistically increasing risks for cardiovascular disease and diabetes. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are effective for managing type 2 diabetes, obesity, and cardiovascular disease, and emerging evidence suggests potential benefit for smoking cessation. However, the prevalence of GLP-1 RA indications and prescriptions among adults who smoke is unknown. Objective: To compare the frequency of GLP-1 RA indications and prescriptions among adults who do and do not smoke within a large Midwest health system. Methods: Electronic health record data identified adults (≥18 years) with outpatient primary care visits from September 2023–2024. Patients were categorized as current smokers or non-smokers. We assessed indications for GLP-1 RAs—type 2 diabetes, weight management (BMI ≥30 or 27– 29.9 with comorbidity), and secondary prevention of cardiovascular disease and examined prescription rates among those with at least one indication. Results: Of 59,981 patients, 4,843 (8.1%) were current smokers. Compared to non-smokers, adults who smoke were more likely to have an indication for GLP-1 RAs (66.1% vs. 62.6%; p p <0.001). This pattern was consistent across all indications. Conclusion: Adults who smoke more frequently meet clinical criteria for GLP-1 RAs yet are less likely to be prescribed these therapies. Enhancing access to GLP-1 RAs for individuals who smoke could address critical metabolic and smoking-related health challenges, particularly given their potential role in supporting smoking cessation.

Objectives Menthol flavoring is a critical public health issue, but prior work has largely represented the voices of White adults who smoke (AWS) menthol cigarettes who comprise a small subset of AWS menthol cigarettes in the US. This study compared perceptions of a hypothetical MC/FC ban among Black and White AWS menthol cigarettes. Methods Participants were a convenience sample of 2,113 Black and 1,087 White AWS menthol cigarettes collected through Amazon Mechanical Turk between July 2023 and January 2024. Participants reported opinions about a MC/FC ban, likely public health outcomes, and hypothetical impact of the ban on their smoking behavior. Stepwise logistic regression modeled factors associated with ban opposition/ambivalence. Results Over one-third of menthol cigarette users supported a MC/FC ban (Black, 37.2% vs White, 34.5%, p=.13], but Black AWS were more likely to endorse public health benefits of a ban assessed via agreement with 5 statements of FDA rationale [3.0 (SD=1.7) versus 2.4 (SD=1.8), p<.001]. Smoking more cigarettes per day, belief that menthol cigarettes are more addictive/harder to quit, and intent to continue using nicotine under a ban increased odd of opposition/ambivalence. Conclusions Compared to White AWS, Black AWS were more likely to believe that a MC/FC ban would benefit public health and showed no statistical difference in overall support for a ban. Targeted outreach to those who consume more menthol products and those who do not intend to quit nicotine could increase ban support among menthol users. What is the current understanding of this subject?Knowledge of the public’s perception of a MC/FC ban is largely informed by White menthol cigarette users. Given that Blacks represent the majority of AWS menthol cigarettes in the US, the paucity of data from Black voices engenders a critical gap in research used to inform health policy. What does this report add to the literature?Compared to White AWS, Black AWS were more likely to believe that a MC/FC ban would benefit public health and showed no statistical difference in overall support for a ban. To our knowledge, this study comprises the largest convenience sample of perceptions and perceived impact of a federal MC/FC product standard among Black AWS menthol cigarettes in the US and provides valuable evidence to inform policy action in these areas. What are the implications for public health practice?Findings support ongoing efforts to advance a MC/FC product standard and suggest that targeted outreach to those who consume more menthol products and those who do not intend to quit nicotine could increase ban support among menthol users.

Introduction: As many as 40% of adults who smoke (AWS) use cannabis, yet little is known about how cigarette-cannabis (CIG-CAN) use impacts change in cigarette and other tobacco product (OTP) use during a quit attempt. Methods: Secondary data analysis of a smoking cessation randomized clinical trial (RCT) that enrolled 392 Black adults who wanted to quit cigarettes and were provided 18 weeks of standard or adapted pharmacotherapy. Participants self-reported cigarettes, cannabis, and OTP at W0, 2, 6, 12, 18, and 26. Longitudinal modeling of group, time, and group by time effects compared change in cigarettes, cannabis, and OTP between those who did and did not use cannabis. Results: Nearly half (47.2%,185/392) were CIG-CAN users. Cannabis types were joints (78.4%) and blunts (51.9%). Significant reduction in CPD over time (p = .02) did not differ by group (p = .18). OTP had significant group, group by time interaction and time effect (p < .001), however, OTP use is small and had minimal effect on consumption. CIG-CAN increased cannabis use through week 26 (p < .001). When CPD decreased, there was a compensatory effect on OTP (< .0001), but not cannabis (p = .37). Conclusion: Prevalence of cannabis use was high among Black adults attempting to quit cigarette smoking in an RCT. OTP use was minimal, but CIG-CAN maintained higher OTP and increased consumption of cannabis while having similar reductions in CPD. Findings require replication in a prospectively designed study but suggest a pattern of compensation, primarily with cannabis, among CIG-CAN that may limit potential health benefit of cigarette reduction and could compromise future attempts at cessation. Trial registration: NCT03897439

Background. Individuals undergoing cancer treatment have better outcomes when they discontinue tobacco use. Few cancer centers systematically provide evidence-based cessation services. As part of a national quality improvement initiative (Cancer Center Cessation Initiative, (C3i)), we collaborated with our cancer registry to develop and implement two tobacco treatment metrics for tracking the provision of behavioral support and pharmacotherapy. Methods. Post-development, the tobacco treatment metrics were integrated into the registry for all future patients. We used means and frequencies to summarize tobacco treatment for cases treated between 2017-2019, coinciding with the timeframe of C3i participation. Results. Of 17,735 cancer cases reviewed, both measures were captured on 17,654 (99.5%) of patients, with 3,091 (17.4%) identified as users of tobacco. Across the 3 years, 557 (18%) of individuals who used tobacco received either tobacco cessation pharmacotherapy or behavioral support; with 478 (15.5%) receiving behavioral counseling, 352 (11.4%) receiving pharmacotherapy, and 273 (8.8%) receiving both—considered gold standard care. Tobacco treatment varied substantially across cancer types. The odds of receiving gold standard care were 2.37 times greater in 2019 compared to 2017. (OR=2.37, 95% CI=1.63–3.46, p<0.0001). Conclusions. The new metrics demonstrated high completion rates and their potential to track quality improvement efforts over time. They identified suboptimal treatment reach, but a potential increase in treatment over time and greater treatment among tobacco-related versus non-tobacco-related cancers. Impact. Continued tobacco use worsens cancer care outcomes. Integrating measures into cancer registries is a viable option for tracking tobacco treatment and cessation in the context of cancer care.

Coding Manual for Cancer Registry Registrars

Coding Manual for Cancer Registry Registrars

Background:Individuals undergoing cancer treatment have better outcomes when they discontinue tobacco use. Few cancer centers systematically provide evidence-based cessation services. As part of a national quality improvement initiative [Cancer Center Cessation Initiative (C3i)], we collaborated with our cancer registry to develop and implement two tobacco treatment metrics for tracking the provision of behavioral support and pharmacotherapy.Methods:Post-development, the tobacco treatment metrics were integrated into the registry for all future patients. We used means and frequencies to summarize tobacco treatment for cases treated between 2017 and 2019, coinciding with the timeframe of C3i participation.Results:Of 17,735 cancer cases reviewed, both measures were captured on 17,654 (99.5%) of patients, with 3,091 (17.4%) identified as users of tobacco. Across the 3 years, 557 (18%) of individuals who used tobacco received either tobacco cessation pharmacotherapy or behavioral support; with 478 (15.5%) receiving behavioral counseling, 352 (11.4%) receiving pharmacotherapy, and 273 (8.8%) receiving both—considered gold standard care. Tobacco treatment varied substantially across cancer types. The odds of receiving gold standard care were 2.37 times greater in 2019 compared with 2017. (OR, 2.37; 95% confidence interval, 1.63–3.46; P < 0.0001).Conclusions:The new metrics demonstrated high completion rates and their potential to track quality improvement efforts over time. They identified suboptimal treatment reach, but a potential increase in treatment over time and greater treatment among tobacco-related versus nontobacco-related cancers.Impact:Continued tobacco use worsens cancer care outcomes. Integrating measures into cancer registries is a viable option for tracking tobacco treatment and cessation in the context of cancer care.

Coding Manual for Cancer Registry Registrars