03/27/2017

NCCN has published updates to the NCCN Guidelines® for Smoking Cessation

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) for Smoking Cessation. These NCCN Guidelines^® are currently available as Version 1.2017. 

• Management of former smokers and recent quitters (>30 days since last smoked) (SC-3)
  • For those with ≥1 risk factor/high risk for relapse, “consider NRT” has been changed to “consider pharmacotherapy as clinically indicated to maintain abstinence.”
  • The following footnote has been added: "When considering pharmacotherapy maintenance options for patients who have been nicotine free for an extended period of time (eg, 30 days or longer), carefully consider the potential effects of re-introducing nicotine through NRT or advocating for the use of combination NRT."
• General Approach to Smoking Cessation for Patients with Cancer and Survivors (SC-4/SC-5)
  • The recommended schedule for assessment/follow-up has been revised to occur “within 3 wk after therapy begins (within 1 wk preferred), and at 12 wk.”
  • For those that remain smoke free after 12 wk, the following recommendation has been added: “Extend duration of pharmacotherapy as clinically indicated (ie, > 6 months)."
  • Additional reassessment of smoking status is recommended at the end of therapy (if past 12 wk), and at 6 and 12 mo after therapy.
  • Clarified where bupropion is listed that sustained release bupropion is recommended. (Also on SC-F)

• Principles of Alternative Approaches to Smoking Cessation (SC-A)
  • The following has been added to the third bullet: “For patients using alternative approaches, including electronic cigarettes, continue to provide support during quit attempts.”
• Smoking Associated-Risks for Patients with Cancer (SC-B)
  • The following recommendations have been added for providers:
    • Discuss smoking cessation with all patients who smoke. Patient satisfaction is enhanced when smoking cessation is offered by providers.
    • Encourage smoking cessation among all members of the household for the benefit of the patient.
• Smoking cessation resources for patients and health professionals have been reorganized. (SC-C)
• Principles of Smoking Cessation and Cancer Surgery (SC-D)
  • Noted that there is no evidence to support delaying a quit attempt at any time prior to surgery.
• Principles of Behavioral Strategies (SC-E)
  • Revisions have been made to the motivational counseling section.
• Principles of Pharmacotherapy (SC-F)
  • Added recommendation to evaluate the use of the current preferred primary therapy before continuing or switching to another option for patients who continue to smoke or relapse following primary therapy.
  • Standard dose information for combination NRT has been revised to include the following:
    • Begin with 21 mg patch + short-acting NRT
    • If 21 mg patch is not effective, consider using more than one patch to ncrease the dose to 35 or 42 mg
    • Short-acting NRT as needed, every 1–2 hours for cravings
  • The following footnote has been added to combination NRT: “Gradually decrease dose over 10 weeks or more. Dose reduction may not be appropriate for patients with limited life expectancy."

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Drugs & Biologics Compendium (NCCN Compendium^®), the NCCN Biomarkers Compendium^®, the NCCN Chemotherapy Order Templates (NCCN Templates^®), and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.