Ep. 54 Smoking Cessation for the Urologist with Dr. Christian Fankhauser and Dr. Richard Matulewicz

In this episode of BackTable Urology, Dr. Aditya Bagrodia discusses methods and benefits of smoking cessation in urologic oncology patients with Dr. Christian Fankhauser from Luzerner Kantonsspital and Dr. Richard Matulewicz from Memorial Sloan Kettering.

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SHOW NOTES

First, the doctors discuss the role of urologists in taking charge of smoking cessation. Because smoking cessation directly minimizes surgical complication and increases longevity in urologic oncology patients. It is beneficial to have other medical professionals, such as physicians in other specialties (e.g. cardiology) and PAs, working to encourage smoking cessation as well.

Next, they discuss the initial intake of a smoking patient. Screening patients for smoking is not happening as commonly as it should. Additionally, it is important to use non-judgmental phrasing and tone in order to make the patient feel comfortable with sharing information. When screening for smoking, the 5A Model can be used: ask, advise, assess, assist, and arrange smoking cessation therapy. However, this method can take up a lot of time during the clinic visit. Thus, pre-visit questionnaires are efficient. When counseling a patient to quit smoking, it is best to set a quit date within 2-3 weeks before surgery. Some evidence-based benefits to smoking cessation include: inhibition of bladder cancer progression, increases in longevity, minimizing perioperative complications, prevention of erectile dysfunction and infertility, and the promotion of wound healing. Dr. Bagrodia also mentions that bladder treatment outcomes from adjuvant chemotherapy and intravesical therapy will improve with cessation. Some common cessation techniques are nicotine replacement therapy and stress reduction techniques.

The urologist can take the lead on smoking cessation or refer the patient to a counselor. In Europe, Dr. Fankhauser sends the patient to their general practitioner to initiate cessation therapy, while Dr. Matulewicz encourages urologists to learn how to document cessation encouragement as a separate billable service. Finally, the doctors share resources for urologists wanting to help their patients quit smoking. All three urologists agree that there should be more formal education initiatives about cessation for medical students and residents and that society guidelines should emphasize the importance of smoking cessation more strongly. Dr. Matulewicz encourages his patients to call the number 1-800-QUIT-NOW- to connect to state health departments, which provide nicotine replacement medications and trained counselors. Finally, Dr. Fankhauser discusses his smoking cessation research and emphasizes that it’s never too late for patients to stop smoking.