Hospital quit-smoking efforts make no difference: Quebec study

Counselling and treatment on smoking cessation will help smokers who are hospitalized at a cardiopulmonary hospital centre quit their habits. Right?

Wrong.

A new Canadian study that asked that question is one of those relatively rare clinical trials in which the conclusions seem self-evidently obvious but the data turn up unexpected results.

Contrary to the researchers' hypothesis, all the smoking cessation work put in by the Laval hospital's physicians -- an involved, five-step intervention that takes the study's authors most of a small-type journal page to describe -- had no discernible effect on patients' likelihood to butt out.

DISCOURAGING DATA
The study (full text requires subscription) was published by a team of Quebec City-based Laval University researchers in this month's issue of the journal Nicotine & Tobacco Research.

Faced with the evidence, the authors were forced to admit defeat. They wrote:

"In this randomized trial, a smoking cessation intervention of moderate intensity delivered in a tertiary cardiopulmonary center did not increase the smoking cessation rate at 1-year follow-up."

The slight variations between the two arms of the study that the researchers managed to tease out of the data were dismissed as "small and clinically irrelevant."

The simplest explanation for the results seems to be that there simply wasn't enough medium-term follow-up (longer than one month after the initial visit) to get patients to stick with their decision to quit.

That conclusion is more than just a disappointment to hospital staff physicians, who have hoped for years that their access to patients during hospitalizations represented a window of opportunity to get their anti-smoking message across. To a large degree, the Laval study's failure -- it was so clearly unsuccessful that the trial was abandoned early -- amounts to a repudiation of that practice.

ALL IS NOT LOST
In spite of the gloomy data, the paper ends with two hopeful notes.

The study's one-year cessation rate was an impressive 30%, which is more than twice the 13% rate seen in a 2002 Cochrane Collaboration meta-analysis; the Laval researchers chalk up their higher rate to the fact that their study's locale was the Quebec Heart and Lung Institute, where physicians are likely to include smoking cessation in normal care of patients with cardiopulmonary problems. The standard care, therefore, seems to be helpful.

The other glimmer of hope is, ironically, the fact that few physicians incorporated nicotine replacement therapy (NRT) into their smoking cessation treatment; only 18 of 99 patients randomized to receive cessation treatment got NRT. Doctors were reluctant to use NRT meds like the nicotine patch because many of the patients in the trial had heart conditions that might have been adversely affected by some of the side effects of the patch. Nevertheless, the fact remains that this study did not rule out the potential effectiveness of NRT.

That's not exactly a major success, but compared to the rest of the study's results? It'll have to do.

Check out our website: www.nationalreviewofmedicine.com