Leveraging the Teachable Moment: Identifying Opportunities to Address Chronic Opioid Use, Cigarette Smoking, and Poor Sleep Among Cancer Survivors

Abstract

Cancer survivors are a large and growing population. Even after completion of active treatment, survivors remain at increased risk for recurrence, secondary malignancies, and worse quality of life, necessitating interventions to mitigate modifiable behaviors associated with these adverse outcomes. Tobacco use, chronic opioid use, and poor sleep are strongly associated with reduced quality and quantity of life for cancer survivors. There is a crucial need to better understand the mechanisms that facilitate behavior change in these risk factors among cancer survivors, to explore how oncology clinicians can best support their patients, and to identify barriers to change during the post-treatment survivorship period. This dissertation is comprised of three chapters, each of which is a stand-alone manuscript intended for peer-reviewed publication. In Chapter 1, I characterize rates and patterns of oncology clinician-delivered brief smoking cessation intervention and identify areas for improvement in providing equitable care. In Chapter 2, I use a mixed-methods approach to understand facilitators and barriers to reducing prescription opioid use among post-treatment cancer survivors to inform future intervention efforts. In Chapter 3, I characterize subjective sleep quality and its correlates among patients with comorbid cancer and depression, highlight the prevalence of insomnia among this population, and build the case for integrating evidence-based sleep assessment and treatment into depression care for patients with cancer. Together, these papers aim to establish a program of research focused on enhancing the assessment and treatment of key health risk behaviors among cancer survivors.