Underuse and underreporting of smoking cessation for smokers with a new urologic cancer diagnosis

Urothelial carcinoma of the bladder (UCB) or upper urinary tract (UCUT) and renal cell carcinoma (RCC) are smoking-related genitourinary (GU) malignancies. A new diagnosis of smoking-related GU cancer is an opportunity when smoking cessation interventions may have increased effectiveness. Underuse or underreporting of cessation tools in this setting represents potential for quality improvement. We estimated the use of smoking cessation in new smoking-related GU cancer visits based on billing claims.

From MarketScan data, over 34 million enrollees aged 18 to 65 years, calendar years 2007 to 2011, were screened for billing codes for index UCB/UCUT or RCC and tobacco use disorder. Qualifying individuals were assessed for claims-based pharmacologic or counseling smoking cessation interventions in the 12 months following diagnosis using Current Procedural Terminology (CPT) codes and International Classification of Diseases Ninth Revision (ICD-9) codes. Multivariable logistic regression identified factors associated with smoking cessation intervention.

From over 111,453 incident cancers, 5,777 smokers with tobacco-related GU malignancy were identified by billing claims (40% UCB, 46% RCC, 4.2% UCUT, and 9.8% multiple cancers). Claims for intervention were rare (5.3%). Among intervention recipients, 240 (80%) had UCB and 92% had claims for either counseling or medications, only 8% had both. Most claims-based interventions (61%) were within 3 months after GU cancer diagnosis. On multivariable analysis UCB was associated increased odds of claims-based intervention (odds ratio [OR] = 6.27; 95% CI: 4.57-8.60) compared with UCUT and RCC. Other significant factors included more comorbidities (Charlson score = 1, OR = 1.50, 95% CI: 1.06-2.13; Charlson score≥2, OR = 1.89, 95% CI: 1.19-3.02 compared with Charlson score = 0) and diagnosis in the latter half of the study period (OR = 1.30, 95% CI: 1.02-1.67 compared with earlier years).

Although a new diagnosis of a smoking-related GU malignancy diagnosis offers greater opportunity for provider-driven smoking cessation, timely multimodal claims-based cessation interventions are underreported or underused.