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Erin Balogh, Margie Patlak, and Sharyl J. Nass, Rapporteurs National Cancer Policy Forum Board on Health Care Services
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The workshop that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineer- ing, and the Institute of Medicine. This activity was supported by Contract Nos. HHSN261200900003C and 200-2005- 13434 TO #1 between the National Academy of Sciences and the National Cancer Institute and the Centers for Disease Control and Prevention, respectively. In addition, the National Cancer Policy Forum is supported by the American Association for Cancer Research, the American Cancer Society, the American Society of Clinical Oncology, the Association of American Cancer Institutes, Bristol-Myers Squibb, C-Change, the CEO Roundtable on Cancer, GlaxoSmithKline, Novartis Oncology, the Oncology Nursing Society, and Sanofi-Aventis. The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity. International Standard Book Number-13: 978-0-309-26401-3 International Standard Book Number-10: 0-309-26401-4 Additional copies of this workshop summary are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624- 6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2013 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Cover credit: Design by Casey Weeks. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2013. Reducing tobacco-related cancer incidence and mortality: Workshop summary. Washington, DC: The National Academies Press.
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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a man- date that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the N ational Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org
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WORKSHOP PLANNING COMMITTEE1 ROY S. HERBST (Chair), Chief of Medical Oncology, Yale Cancer Center and Associate Director for Translational Research, Smilow Cancer Hospital at Yale, New Haven, CT CAROLYN DRESLER, Tobacco Control Medical Director, Arkansas Department of Health, Board of Directors, International Association for the Study of Lung Cancer, and Chair, Tobacco Control Subcommittee, American Society of Clinical Oncology Cancer Prevention Committee, Little Rock, AR ELLEN R. GRITZ, Professor and Olla S. Stribling Distinguished Chair for Cancer Research, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston THOMAS J. KEAN, President and Chief Executive Officer, C-Change, Washington, DC MATTHEW MYERS, President, Campaign for Tobacco-Free Kids, Washington, DC BRENDA NEVIDJON, Clinical Professor and Specialty Director, Nursing & Healthcare Leadership, Duke University School of Nursing, Durham, NC, and Past President, Oncology Nursing Society BENJAMIN TOLL, Assistant Professor of Psychiatry, Yale University School of Medicine, Yale Comprehensive Cancer Center, Program Director, Smoking Cessation Service, Smilow Cancer Hospital at Yale, New Haven, CT Project Staff ERIN BALOGH, Study Director PAMELA LIGHTER, Research Assistant NIHARIKA SATHE, Research Assistant (until March 2012) MICHAEL PARK, Senior Program Assistant SHARYL J. NASS, Director, National Cancer Policy Forum ROGER HERDMAN, Director, Board on Health Care Services 1 Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution. v
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NATIONAL CANCER POLICY FORUM1 JOHN MENDELSOHN (Chair), Director, Khalifa Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston PATRICIA A. GANZ (Vice-Chair), Distinguished University Professor, University of California, Los Angeles, Schools of Medicine & Public Health, and Director, Cancer Prevention & Control Research, Jonsson Comprehensive Cancer Center AMY P. ABERNETHY, Associate Professor of Medicine, Duke University School of Medicine, and Director, Duke Cancer Care Research Program, Durham, NC RAFAEL G. AMADO, Senior Vice President & Head of R&D, GlaxoSmithKline-Oncology, Collegeville, PA FRED APPELBAUM, Director, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA PETER B. BACH, Attending Physician, Memorial Sloan-Kettering Cancer Center, New York, NY EDWARD BENZ, JR., President, Dana-Farber Cancer Institute, and Director, Harvard Cancer Center, Harvard School of Medicine, Boston, MA MONICA BERTAGNOLLI, Professor of Surgery, Harvard University Medical School, Boston, MA OTIS BRAWLEY, Chief Medical Officer and Executive Vice President, American Cancer Society, Atlanta, GA MICHAEL A. CALIGIURI, Director, Ohio State Comprehensive Cancer Center, Columbus, OH RENZO CANETTA, Vice President, Oncology Global Clinical Research, Bristol-Myers Squibb, Wallingford, CT MICHAELE CHAMBLEE CHRISTIAN, Retired, Washington, DC WILLIAM DALTON, CEO, M2Gen Personalized Medicine Institute, Moffitt Cancer Center, Tampa, FL, and Chair, American Association for Cancer Research Science Policy & Legislative Affairs Committee 1 Institute of Medicine forums and roundtables do not issue, review, or approve indi- vidual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution. vi
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WENDY DEMARK-WAHNEFRIED, Associate Director for Cancer Prevention and Control, University of Alabama at Birmingham Comprehensive Cancer Center ROBERT ERWIN, President, Marti Nelson Cancer Foundation, Davis, CA ROY S. HERBST, Chief of Medical Oncology, Yale Cancer Center, New Haven, CT THOMAS J. KEAN, President and Chief Executive Officer, C-Change, Washington, DC DOUGLAS R. LOWY, Deputy Director, National Cancer Institute, Bethesda, MD MICHELLE M. Le BEAU, Arthur and Marian Edelstein Professor of Medicine and Director, Comprehensive Cancer Center, University of Chicago, IL, and President, Association of American Cancer Institutes DANIEL R. MASYS, Affiliate Professor, Biomedical Informatics, University of Washington, Seattle MARTIN J. MURPHY, Chief Executive Officer, CEO Roundtable on Cancer, Durham, NC BRENDA NEVIDJON, Clinical Professor and Specialty Director, Nursing & Healthcare Leadership, Duke University School of Nursing, Durham, NC, and Past President, Oncology Nursing Society STEVEN PIANTADOSI, Director, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA LISA C. RICHARDSON, Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA DEBASISH ROYCHOWDHURY, Senior Vice President, Global Oncology, Sanofi Oncology, Cambridge, MA YA-CHEN TINA SHIH, Director, Program in the Economics of Cancer, University of Chicago, IL ELLEN SIGAL, Chairperson and Founder, Friends of Cancer Research, Washington, DC STEVEN STEIN, Senior Vice President, U.S. Clinical Development and Medical Affairs, Novartis Oncology, East Hanover, NJ JOHN A. WAGNER, Vice President, Clinical Pharmacology, Merck and Company, Inc., Rahway, NJ vii
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RALPH R. WEICHSELBAUM, Chair, Radiation and Cellular Oncology, and Director, Ludwig Center for Metastasis Research, The University of Chicago Medical Center, IL JANET WOODCOCK, Director, Center for Drug Evaluation and Research, Food and Drug Administration, Rockville, MD National Cancer Policy Forum Staff SHARYL J. NASS, Director LAURA LEVIT, Program Officer ERIN BALOGH, Associate Program Officer PAMELA LIGHTER, Research Assistant MICHAEL PARK, Senior Program Assistant PATRICK BURKE, Financial Associate SHARON B. MURPHY, Scholar in Residence ROGER HERDMAN, Director, Board on Health Care Services viii
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Reviewers This workshop summary has been reviewed in draft form by individu- als chosen for their diverse perspectives and technical expertise, in accor- dance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary: LINDA BAILEY, President and CEO, North American Quitline Consortium MICHAEL C. FIORE, Professor of Medicine and Director, Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health THOMAS J. GLYNN, Director, Cancer Science and Trends, International Cancer Control, American Cancer Society DANNY McGOLDRICK, Vice President for Research, Campaign for Tobacco-Free Kids ix
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x REVIEWERS GRAHAM WARREN, Assistant Professor, Department of Radiation Medicine, Department of Pharmacology and Therapeutics, Roswell Park Cancer Institute Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the work- shop summary before its release. The review of this report was overseen by Susan J. Curry, University of Iowa College of Public Health. Appointed by the Institute of Medicine, she was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the rapporteurs and the institution.
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Contents INTRODUCTION, 1 CHANGING DEMOGRAPHICS OF TOBACCO USE, 5 CHANGING PATTERNS OF TOBACCO USE, 10 TOBACCO USE AND CANCER, 13 How Smoking Causes Cancer, 13 Impact of Smoking on Cancer Incidence and Treatment Outcomes, 15 TOBACCO DEPENDENCE, 17 TOBACCO CESSATION PROGRAMS, 21 Overview of Tobacco Cessation Therapy, 21 Use of Tobacco Cessation Therapy, 26 Models for Clinician Referrals, 27 Tobacco Cessation Therapy for Cancer Patients, 29 Training Practitioners, 31 OVERVIEW OF TOBACCO CONTROL POLICY, 33 ANTISMOKING LAWS AND REGULATIONS, 39 Family Smoking Prevention and Tobacco Control Act, 39 Patient Protection and Affordable Care Act, 42 Point-of-Sale Restrictions, 43 Smoke-Free Environments, 43 Tobacco Taxes, 45 Proposed Laws and Policies, 47 xi
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xii CONTENTS SUCCESSFUL STATE AND LOCAL GOVERNMENT ANTISMOKING EFFORTS, 48 New York State and New York City, 48 Massachusetts, 49 California, 52 EDUCATION, OUTREACH, AND MESSAGING, 53 Educational Efforts, 53 Media Campaigns, 57 Cigarette Packaging Warning Labels, 59 Message Content, Framing, and Placement, 61 ANTISMOKING ADVOCACY, 65 FINANCIAL AND LEGAL CHALLENGES, 67 Funding for Tobacco Cessation Programs, 70 Legal Challenges, 71 RESEARCH AND INFRASTRUCTURE NEEDS, 72 CONCLUDING REMARKS, 75 REFERENCES, 75 APPENDIXES A Workshop Agenda 87 B Speaker, Moderator, and Panelist Biographies 93
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Boxes, Figures, and Tables BOXES 1 Quitlines, 22 2 Major Tobacco Control Activities at the U.S. Department of Health and Human Services (HHS), 34 3 Successful Media Campaigns, 58 FIGURES 1 Percentage of high school students who reported current cigarette use, 1991–2011, 8 2 Trends in per capita consumption of various tobacco products— United States, 1880–2005, 10 3 Link between cigarette smoking and cancer through carcinogens in tobacco smoke, 14 4 Effectiveness of and estimated abstinence rates for interventions delivered by various numbers of clinician types, 28 5 Long-term impact of comprehensive tobacco control in California, 38 6 State and local smoke-free restaurant and bar laws have expanded rapidly in the United States, 2002–2012, 45 7 Real cigarette prices and per capita consumption, United States, 1970–2000, 46 xiii
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xiv BOXES, FIGURES, AND TABLES 8 Impact of tobacco taxes and smoke-free laws on adult and youth smoking prevalence in New York City, 2002–2007, 49 9 The tobacco industry outspends state tobacco prevention efforts by 23 to 1, 69 10 U.S. cancer deaths versus federal research funding per death, 74 TABLES 1 Tailoring Pharmacotherapy for Tobacco Cessation Therapy, 22 2 The 5 A’s Model for Treating Tobacco Dependence, 24