eBulletin Newsletter

NCCN Flash Updates: NCCN Guidelines Updated for Smoking Cessation

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®), and the NCCN Drugs & Biologics Compendium (NCCN Compendium^®) for Smoking Cessation. These NCCN Guidelines^® are currently available as Version 1.2023.

Link directly to the Updates section of the NCCN Guidelines: Smoking Cessation

General:

• The term "marijuana" has been replaced with "cannabis" throughout the guidelines.

Intro

• New paragraph added: As a generalization, the principles for treating nicotine use disorder of any nicotine-containing products are similar. Therefore, the NCCN Guidelines for Smoking Cessation are directly applicable to not only cigarettes, but also smokeless tobacco and vaping.
• Clinical Recommendations, first bullet:
  • First sub-bullet revised: The two most effective pharmacotherapy agents approaches are combination nicotine replacement therapy (NRT) and/or varenicline.
  • Second sub-bullet revised: Behavior therapy with multiple counseling sessions is most effective, and at least . At a minimum, of brief counseling is highly recommended needed. Quitlines are a source of brief behavioral counseling for quitting smoking and may be used as an adjunct, have added value, especially in lower-resource settings.

SC-1

• Initial Evaluation, new bullet added: Have you ever or do you currently use other tobacco-containing products (eg, pipes, cigars, e-cigarettes, smokeless tobacco)?
• Footnote b revised: Recommendations in this guideline apply to cessation of all combustible tobacco products, which pose the greatest risk to people with cancer The Smoking Cessation algorithms can be applied for any other tobacco product. Patients with cancer should be encouraged to achieve and maintain abstinence from all combustible tobacco products (eg, cigarettes, cigars, hookah) and smokeless tobacco products. For information about e-cigarettes, see Principles of Alternative Approaches to Treatment of Smoking (SC-A).
• New footnotes added:
  • Footnote c: General Principles of the Smoking Cessation Guidelines.
  • Footnote g: Patients who use multiple tobacco products may be more resistant to quitting.

SC-2

• Evaluation, first bullet, Nicotine dependence use:
  • First sub-bullet revised: How much do you currently smoke or use nicotine products (eg, cigarettes, pipes, cigars, e-cigarettes, smokeless tobacco)...
  • Third sub-bullet revised: How soon do you smoke or use nicotine products after you wake up in the morning?
• Second bullet, fifth sub-bullet revised: Why were previous quit attempts unsuccessful? (eg, side effects, cost, continued cravings, did not work, inadequate behavioral support).
• Footnote removed: For lung cancer screening recommendations, see NCCN Guidelines for Lung Cancer Screening.
• New footnote k added: Smoking by other household members is an important predictor for not remaining abstinent, and individuals in the patient's household should be encouraged to abstain from smoking to benefit the patient.
• Footnotes revised:
  • Footnoteh: Time to first cigarette is used to select the strength of the nicotine gum and lozenge (2 mg, 4 mg)is utilized to determine short-acting NRT dose. Discussion.
  • Footnote i: Document type medication name, strength, dose, and duration of use for medications used during previous quit attempts...

SC-3

• Status: Pathways for Quit within prior 30 days and Ready to quit have been separated.
  • Following Ready to quit and Not ready to quit pathways, new bullet added: Discuss the impact of continued smoking on cancer treatment outcomes and complications from chemotherapy, radiation, and surgery.

SC-4

• Evaluation of Relapse Risk, Risk factors for smoking relapse, eighth bullet revised: Drug/alcohol use or abuse (eg, marijuana cannabis, opioids, stimulants).
• Far right, following Smoke free, option revised: Reevaluate risk of relapse at each visit.

SC-5

• Assessment/Follow-Up, second bullet revised: At Following 12 wks of therapy.

SC-6

• Assessment/Follow-Up, first bullet revised: Within 3 wks (1 wk preferred) and

SC-A

• Electronic Cigarettes ("E-Cigarettes") or Vaping:
  • Second bullet revised: The use of e-cigarettes is sometimes often referred to as vaping or juuling.
  • Fourth bullet revised: For patients who choose to use e-cigarettes exclusively for smoking cessation, despite recommendations to use evidence-based pharmacotherapies, encourage abstinence from smoking and incorporate behavioral counseling.
    • First sub-bullet revised: For dual users patients who use both e-cigarettes and combustible tobacco, complete smoking cessation is recommended. Dual use is strongly discouraged as it continues to pose a risk of smoking-related diseases...

SC-C 1 of 2

• General Resources for Patients, new resource added: Pharmacies Providing Cessation Services: https://www.QuitSmokingPharmacies.com.

SC-E (1 of 3)

• First bullet revised: Pharmacotherapy is most effective when combined with behavior therapy. Brief counseling is better than no counseling.
  • First sub-bullet revised: While implementing evidence-based smoking cessation remains the responsibility of all health professionals, Ppopulation-level studies of smoking treatment modalities indicate that counseling by a smoking cessation specialist plus medication results in a significant improvement in cessation rates relative to no counseling or medication...
• Second bullet revised: Through behavior therapy, people who smoke learn coping skills and receive support and education. Behavior therapy, tailored to the patient’s nicotine dependence use and previous quit attempts, provides strategies for:

SC-E (2 of 3)

• Behavior Therapy/Counseling Recommendations, second bullet, second sub-bullet, new tertiary bullet added: Quitlines are a source of brief behavioral counseling for quitting smoking and may have added value, especially in lower-resource settings.

SC-F (1 of 3)

• Second bullet, first sub-bullet revised: Follow-up is recommended (in-person or by phone/telehealth) within 23 weeks (1 week preferred) after starting pharmacotherapy, but can be extended to within 3 weeks adjusted to coordinate with regularly scheduled oncology appointments as needed. Additional periodic follow-up during therapy (at a minimum of 12-week intervals), and after completion of therapy, is recommended.
• Fifth bullet revised: When considering pharmacotherapy options, consider cultural and contextual factors including cost, ability to pay, and insurance coverage, ability to adhere to the treatment regimen, and patient preference.
• Footnote d revised: Bupropion (long-acting) should be avoided for in patients with seizure risk, including those with brain metastases or primary brain tumors due to seizure risk.

SC-F (2 of 3)

• Standard Dose/Administration, Varenicline, first bullet revised: Initiate dosing 1-65 wks prior to quitting.

SC-F (3 of 3)

• Adverse Effects and Contraindications:
  • Combination NRT, second bullet revised: Patients commonly underdose when using combination NRT. Nicotine overdose Significant nicotine toxicity is rare, but possible and usually short-lived.
  • Varenicline, third bullet revised: Use with caution for in patients with a history of seizure disorder or at risk for seizures.
  • Bupropion:
    • New bullet added: Bupropion should be avoided in patients with seizure risk, including those with brain metastases or primary brain tumors
    • Third bullet revised: Bupropion is contraindicated for patients with seizure disorder, those taking monoamine oxidase inhibitors (MAOIs) inhibitors (increased risk of hypertensive reactions), current diagnosis or history of anorexia or bulimia, or abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs those with closed-angle glaucoma.

ABBR-1

• New section added: Abbreviations.

 

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^®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.

To view the NCCN Guidelines for Patients^®, please visit NCCN.org/patientguidelines.

Free NCCN Guidelines apps for iPhone, iPad, and Android devices are now available! Visit NCCN.org/apps.

About NCCN Flash Updates™

NCCN Flash Updates™ is a subscription service from NCCN that provides timely notification of updated and new information appearing in the NCCN Guidelines, the NCCN Compendium^®, and other NCCN Content.

Subscribe to NCCN Flash Updates™

Third Party Content: The NCCN Content may contain content (such as figures, tables or illustrations) that NCCN licenses from third parties as displayed on NCCN Third Party Content site: https://private.filesanywhere.com/fs/v.aspx?v=8a6d65cfa19ea4bda0a3&C=6241. Licensee shall be solely responsible for obtaining permissions from each such third party to use any such Third Party Content in the Permitted Works. 

Access information on permissions and licensing of NCCN Content

Users may unsubscribe from Flash Updates at any time by contacting us. NOTE: The subscription fee for NCCN Flash Updates™ is non-refundable.