b'smoking cessation referrals in the context of an acute illness, only 42% followed up compared to 68% per-cent of referrals made by a primary care provider. 1Thepresenceofanacuteillnessinisolation failed to impact program success, the study notes. However,whilesurgeon-initiatedreferralswere meager in number, the engagement rate approached that of primary care. This finding suggests that sur-geonsplayapowerfulroleininfluencingpatient behavior that may be harnessed to augment success of existing cessation programs.Abstinence Difficult to AchieveBut while VA surgeons might be able to get patients started on the path to quitting, long-term abstinence is difficult to achieve.Another late 2021 study appearing in the journal Chest involved a VHA dataset of patients with clinical Stage ISource: VA: SmokefreeVET Partner Toolkitnon-small cell lung cancer (NSCLC) undergoing surgi- Screening (VA-PALS) is a collaboration between the cal treatment between 2006 and 2016. Persistent smok- VAOfficeofRuralHealth,Bristol-MyersSquibb ing was defined as continuing to smoke one year afterFoundation, and the International Early Lung Cancer surgery; that information was used to describe the rela- Action Program to increase veterans access to lung tionship between persistent smoking and disease-freecancer screening. If found early, lung cancer has an survival and overall survival. 2 80% cure rate.Of the 7,489 patients undergoing surgical treatmentHowever, only a small portion of patients who agree for clinical Stage I NSCLC, 60.9% were smoking atto be screened receive treatment for smoking cessa-the time of surgery and 58.0% continued to smoke attion. A study published last year in the Journal of one year after surgery, according to the authors. AmongGeneral Internal Medicine looking at patients who the 39.1% patients who were not smoking at the time ofwere screened between 2014 and 2018 found that surgical treatment, 19.6% relapsed and were smokingonly 18.3% received medication or counseling, and at one year after surgery, the authors add. only 1% received a combination of both. Of those Resultsindicatethatpersistentsmokingatonereceiving medication, only 1 in 4 received one of the year after surgery was associated with significantlymost effective medications. 3Overall, only 5,400 of shorter overall survival (adjusted hazard ratio [aHR],the 47,609 current smokers screened (11.3%) were 1.291; 95% CI, 1.197-1.392; p0.001) but was notsuccessful in quitting.associated with inferior disease-free survival (aHR,1Maloney CJ, Kurtz J, Heim MK, Maloney JD, Taylor LJ. Role of 0.989; 95% CI, 0.884-1.106; P=0.84). procedural intervention and acute illness in veterans affairs smoking PersistentsmokingfollowingsurgeryforstageIcessation program referrals: A retrospective study. Tob Prev Cessat. NSCLCiscommonandisassociatedwithinfe- 2021;7:3. Published 2021 Jan 11. doi:10.18332/tpc/130776rioroverallsurvival,theresearchersconcluded.2Heiden BT, Eaton DB Jr, Chang SH, Yan Y, Schoen MW, Chen LS, Smock N, Patel MR, Kreisel D, Nava RG, Meyers BF, Kozower BD, Providers should continue to assess smoking habitsPuri V. The Impact of Persistent Smoking After Surgery on Long-in the post-operative period given its disproportion- term Outcomes After Stage I Non-Small Cell Lung Cancer Resec-ate impact on long-term outcomes after potentiallytion. Chest. 2021 Dec 14:S0012-3692(21)05082-0. doi: 10.1016/j.curative treatment for early-stage lung cancer. chest.2021.12.634. Epub ahead of print. PMID: 34919892.Because veterans are at a higher risk of developing3Heffner JL, Coggeshall S, Wheat CL, Krebs P, Feemster LC, Klein DE, Nici L, Johnson H, Zeliadt SB. Receipt of Tobacco Treatment and One-lung cancer, VA has placed an increasing emphasis onYear Smoking Cessation Rates Following Lung Cancer Screening in lung cancer screening for patients who smoke. Thethe Veterans Health Administration. J Gen Intern Med. 2021 Jul 19. doi: VA Partnership to Increase Access to Lung Cancer10.1007/s11606-021-07011-0. Epub ahead of print. PMID: 34282533.113'