Cigarette Smoking and Lung Cancer in Australia - Research Paper Example

Cigarette Smoking and Lung Cancer in Australia Student’s Name: Subject: Professor: University/Institution: Location: Date: Table of Contents Contents Introduction 2 Article Summary, Limitations and Level of Evidence 3 List of articles 3 Hierarchy of evidence 4 Article 1 4 Critique 5 Article 2 6 Critique 7 Article 3 8 Critique 9 Article 4 9 Critique 10 Conclusions 12 References 13 Introduction Lung cancer is a significant public health concern. Not only is it ranked fifth amongst the most commonly diagnosed invasive cancers in Australia, it also causes the highest number of cancer deaths (8,114) in both males and females (AIHW & Cancer Australia 2011). Lung cancer account for over 9% lung cancer cases and 19% of cancer deaths in Australia (National Lung cancer program, 2011). Alarmingly, 80% to 90% of lung cancer cases in developed nations are attributed to tobacco smoking (Jemal, Bray, Center, Ferlay, Ward, & Forman 2011). In fact, in Australia, tobacco smoking is the sole largest cause of lung cancer (AIHW & Cancer Australia 2011). Research indicates that tobacco smoking accounts for 90% and 65% of lung cancers in males and females, respectively (Brhane, Liu, & Hung, R. J. 2015). The poor survival outcome is, at least in part, attributable to the relatively high percentage of cases (approximately 80%) that are diagnosed in an advanced phase (National lung cancer program, 2011). Given the grim nature of the statistics presented above, the need for research in this area is clear. Thus the following paper examines the redefined question “What is the correlation between cigarette smoking and lung cancer in Australia?” Article Summary, Limitations and Level of Evidence The current review’s objective is to offer a summary, analysis and critique of four scholarly articles that are pertinent to the issue of cigarette smoking and lung cancer. The articles will be critiqued in terms of their contribution, limitation and applicability with respect to the practice area. To be considered highly valuable and applicable to the area of concern, each article must focus on cigarette smoking and lung cancer. The National Health and Medical Research Council (2010) offer guidance on how to place values on the evidence within an article. This will be used in determining the ranking, relevance and quality of each article. List of articles 1. Hymowitz, N. (2012). Cigarette smoking and lung cancer: pediatric roots.  2. Pesch, B.,Gustavsson, P., Kendzia, B., Jöckel, K. H., Johnsen, G., Pohlabeln, H., &Brüning, T. (2012). ‘Cigarette smoking and lung cancer-relative risk estimates for the major histological types from a pooled analysis of case-control studies.’  3. Parsons A., Begh, R., Daley, A., &Aveyard, P. (2010). ‘Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: systematic review of observational studies with meta-analysis.’ 4. Park, S.,Park, E. H., Jee, S. H., Shin, H. R., Shin, A., Jung, K. W.,…& Boffetta, P. (2014). The attributable fraction of tobacco smoking on cancer using population-based nationwide cancer incidence and mortality data in Korea. Hierarchy of evidence Article Nature of research Level of evidence Cigarette smoking and lung cancer: pediatric roots. Quantitative IIb: Observation study Cigarette smoking and lung cancer- relative risk estimates for major histological types from a pooled analysis of case-control studies. Quantitative III: a pooled analysis of case-control studies. Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: a systematic review of observational studies with meta-analysis. Quantitative Ia: a systematic review of observational studies with meta-analysis. Attributable fraction of tobacco smoking on cancer using population-based nationwide cancer incidence and mortality data in Korea. Quantitative Ia: systematic review and meta-analysis of a cross-sectional study. Article 1 The scholarly article was written by Norman Hymowitz (2012), and is a level IIb: an observational study that is quantitative in nature. Hymowitz sought to establish that earlyonset of cigarette smokingincreases the occurrence of lung cancer in adulthood and may therefore be an autonomous risk factor. Consequently the researcher analyzed studies that had evidence linking the incidence of lung cancer to tobacco usage. The researcher also reviewed articles indicating that cigarette smoking at an early age augments risk of lung cancer rates. Furthermore, the researcher examined articles that had evidence associating declining usage of tobacco to reduced incidences of lung cancer. As a result of the articles examined, Hymowitz concluded that there may be a crucial epoch when lung tissue is specifically vulnerable to carcinogenesis induced by cigarette smoking. The reviewed studies suggested that the early onset of smoking is an autonomous risk factor for lung cancer. However, Hymowitz noted that some cohort studies did not support the early onset of smoking asan autonomous risk factor for lung cancer. The researcher identified molecular biology and epidemiology of lung cancer as areas requiring further research. Hymowitz concluded that it is imperative to prevent the onset of smoking at an early age by identifying susceptible youth and aiding those youths who are smoking to quit. The researcher encourages adoption of the World Health Organization Framework Convention on Tobacco Control (2005) recommendations for countries so as to reduce lung cancer death rates. Critique The critiqueof article 1 is based on a CASP cohort study checklist; that beingan alternative type of observational study.A cohort study checklist was used as the article is an observational study. The review is focused in terms of the outcome considered, and it also tries to detect a harmful effect in a clear manner. The use of cohort method is appropriate for addressing the study’s research question as the cohortis representative of the population under study. The researchers have also utilized objective and similar measurements for all subjects in the cohort to precisely measure a clearly defined exposure. The measures employed by the researchers have been validated. The follow-up of subjects in the cohort is long and has sufficiently revealed the effects of the disease. The study outcomes are applicable to the Australian population. The researchers did not, however, state the precision of the results as there are no confidence intervals for the review results. Article 2 Article 2, written by Pesch et al. (2012), is a level III: pooled meta-analysis of case-control studies. The authors sought to address the effect of smoking cessation after diagnosis of early stage lung cancer on prognosis. Controls were matched to the cases and were drawn from either the hospitals or the general population. Data on smoking and lung cancer subtypes was obtained from a SYNERGY database that had eight case-control studies of European descent in eleven countries and a Canadian study. The collective dataset contained 13,169 cases and 16,010 controls that had been enrolled from fifteen study centers between the mid-1990s and mid-2000s. Information on smoking was gathered via interviews with the subjects. WHO guidelines were utilised in the classification of subtypes of lung cancer by pathologists linked to the participating hospitals. The ethics committee of the individual studies and IARC’s Institutional Review Board approved the study. Risks associated with smoking were approximated by a combination of all lung cancers (N=13,163) and for every major cancer subtype. The main cancer subtypes estimated are an adenocarcinoma of the lung (N=3,397), small cell lung cancer (N=5,310) and squamous cell cancer of the lung (N=2,201). STAT software was used for all calculations. Data gathered on cigarette smoking was inclusive of initiation age, quitting age for former smokers, and cigarettes smoked in a calendar year. Odds ratios and confidence intervals of 95% were approximated with conditional regression logistic models. The researchers concluded that adenocarcinoma of the lung was the most common subtype among women and nonsmokers. Increased cigarette smoking was associated a higher percentage of squamous cell cancer of the lung and small cell lung cancer relativeto adenocarcinoma of the lung. Smoking cessation was linked to reduced cancer risk not only in the short-term, but also in the long-term. However, the risks in ex-heavy smokers did not ultimately return to the baseline risk level of nonsmokers. Critique The critique of article 2 is based on a CASP case-control checklist as it is a pooled analysis of case-control studies. The study question is focused in terms of risk factors; population studied, and the harmful effect detected. A meta-analysis of case controls is the appropriate method for the study as it addresses the research question. The cases have been selected via a reliable system (SYNERGY database), are precisely defined and are sufficient for the study. The cases and controls are geographically representative of the population under study. The two decades study timeframe is relevant to the disease. The controls’ non-response from respondents is low. The controls are sufficient, matched to the cases and are population-based. The researchers have utilized objective and similar measurements (trend tests) for both cases and controls to measure precisely a clearly defined exposure. The measures employed by the researchers have been validated. There is a strong association between exposure and outcome as evidenced by the odds ratio. The precision of the lung cancers’ risk estimates is high as evidenced by the sizes of the p-values and confidence intervals in the review. The results obtained from the study can be applied in Australia. The researchers took into account the potentially confounding factor of age in the design. However, environmental, genetic and socio-economic factors were not considered. Article 3 Authored by Parsons et al. (2010), the article is a level Ia: a systematic review of observational studies with meta-analysis. The researchers sought to establish the impact of smoking cessation after diagnosis of early stage lung cancer on prognosis. The researchers independently carried out a systematic review to identify studies to be utilised in the research and extracted information. This review aimed to identify and record studies concerning the effect of smoking cessation after diagnosis of lung cancer on prognostic outcomes without regarding tumor histology. Estimates were amalgamated by utilizing a random effects model. Life tables were utilised in modeling of five-year survival for both early and limited non-small lung cancer phases. The life tables employed death rates of not only continuing smokers, but also those of quitters. The researchers established that quitting smoking during the early stage of lung cancer is associated with a decreased incidence of lung cancer deaths. Life table modeling also indicated that the most significant benefit of quitting smoking was a decreased probability of cancer progression as opposed to a decline in cardiorespiratory deaths. Researchers concluded that smoking cessation treatment for early stage lung cancer patients that have been incapable of quitting might have a significant role in secondary prevention. Such a programme ought to be founded on evidence that smoking cessation is fundamentally linked to enhanced outcomes and that smoking cessation interventions in this category are cost efficient.  Critique The critique of article 3 is based on a CASP systematic review checklist as the study is a systematic review of observational studies with meta-analysis. The reviewis focused in terms of the outcome considered. The articles chosen have addressed the review’s question, are pertinent and important to the research. The merging of the results in the reviewis reasonable as results from various studies are similar. The researchers have addressed any variations in the results forstudies covering the same population. The study results can be used in Australia to reduce lung cancer death rates. However, the researchers have not stated the accuracy of the study results as the confidence intervals for the study results are not stated. Article 4 Authored by Park et al. (2014), the article is a level Ia: systematic review and meta-analysis of a cross-sectional study. The researchers sought to establish the percentage of the Korean population affected by cancers related to tobacco smoking. Population-attributable fractions were projected based on second-hand and ever smokers’ data of the Korean adult population in the late 1980s. Former and current smokers were categorized as ever smokers for research purposes. Importantly, those who were exposed to cigarette smoke at home or work were classified as passive smokers. The researchers made an assumption of a latency epoch of approximately two decades between exposure to smoking and occurrence of cancer. Prevalence rates of adult smoking from the Korea National Health Survey conducted in the 1980s were used for the study. Second-hand smoking and current smoking prevalence data between the late 2000s and early 2010s was used to extrapolate the 1980s prevalence of passive smoking via fitting a log-linear regression model. A total of 19 studies were utilised for the meta-analysis. The researchers performed the meta-analysis to approximate the pooled relative risks and 0.05 significance levels, based on both the fixed and random-effects model. The researchers concluded that one in three cancer deaths and two in three lung cancer deaths among Korean men could have been averted in the late 2000s had there been no smokers. Moreover, one in four lung cancer cases among non-smoking Korean females could have been prevented if there were no smokers. Further development and implementation of tobacco smoking control programs in Korea so as to decrease the cancer burden that is associated with smoking cigarettes was recommended. Critique The critique of article 4 is based on a CASP systematic review checklist as the study is a systematic review and meta-analysis of a cross-sectional study. The reviewis focused in terms of the outcome considered. The articles have explicitly addressed the review’s question and are considered relevant and significant. The combination of the results in the review is reasonable as the results are similar from study to study. Any variations in the results are discussed and importantly, the study’s results can be used in Australia to reduce lung cancer death rates. However, the researcher has not stated the accuracy of the studies because neither the confidence interval nor the p-value for the selected studies has been shown in the study. Relevance to Public Health Nursing Practice The four articles reviewed are pertinent to public health nursing practice given that they seek to establish that cigarette smoking and exposure to second-hand smoke causes lung cancer. The articles also reveal that smoking cessation results in decreasedlung cancer deaths. Rice, Hartmann-Boyce and Stead (2013) established the prospective benefits of nursing interventions offered by nurses to patients who are smokers. The research reveals that the smoking cessation advice or counseling offered by nurses to their patients is aneffectivecigarette smoking intervention. A challenge remains, however, in incorporating smoking cessation interventions to standard practice, so as to offer all patients a chance to be queried on their tobacco usage,and be offered advice to quit,together withsupport and follow-up. Furthermore, Stead et al. (2012) stipulates that nicotine replacement therapy enhances the rate of quitting when utilised withcounseling for behavioral change. It ought to be regarded as asignificant adjunct, but not as a substitute for nursing interventions. Conclusions The current review offers a summary, analysis and critique of four scholarly articles that are central to the issue of cigarette smoking and lung cancer. The articleshavebeen critiqued in terms of their contribution, limitation and applicability with respect to the public health nursing practice. From the articles reviewed, it can be concluded that cigarette smoking and exposure to second-hand smoke causes lung cancer. The articles further reveal that smoking cessation results in decreased lung cancer deaths. Moreover, public health nurses can utilize nursing interventions such as smoking cessation counseling or advice to reducethe incidence of lung cancer deaths. References Australia Government (2011). Report on lung cancer in Australia literature review and consultation on factors impacting on lung cancer outcomes. Commonwealth of Australia AIHW (2012).Cancer incidence projections, Australia 2011 to 2020.Cancer series no. 66. Cat. no. CAN 62. Canberra: AIHW. Brhane, Y., Liu, G. and Hung, R. J. (2015), Cannabis smoking and lung cancer risk: Pooled analysis in the International Lung Cancer Consortium. Int. J. Cancer, 136: 894–903. Hymowitz, N. (2012). Cigarette smoking and lung cancer: pediatric roots. Lung Cancer International, 2012. Jemal, A., Bray, F., Center, M. M., Ferlay, J., Ward, E., & Forman, D. (2011). Global cancer statistics. CA: a cancer journal for clinicians, 61(2), 69-90. National Health and Medical Research Council (NHMRC) (2010): Australian Guidelines for the Prevention and Control of Infection in Healthcare. Canberra: Australian Government Publishing Service. Park, S.,Park, E. H., Jee, S. H., Shin, H. R., Shin, A., Jung, K. W., ...& Boffetta, P. (2014). An attributable portion of tobacco smoking on cancer using population-based nationwide cancer incidence and mortality data in Korea.BMC Cancer, 14(1), Parsons, A., Begh, R., Daley, A., &Aveyard, P. (2010). Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: a systematic review of observational studies with meta-analysis. Bmj, 340. Pesch, B.,Gustavsson, P., Kendzia, B., Jöckel, K. H., Johnsen, G., Pohlabeln, H., & Brüning, T. (2012). Lung cancer and Cigarette Smoking-relative risk estimates for the major histological types from a pooled analysis of case–control studies. International journal of cancer, 131(5), 1210-1219. Rice VH, Stead LF, Hartmann-Boyce J,Nursing interventions for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD001188. DOI: 10.1002/14651858.CD001188.pub4. Stead LF, Hartmann-Boyce J, Perera R, Bullen C, Mant D, Cahill K, etal.Nicotined therapy replacement for smoking cessation. Cochranne Database of Systematic Reviews 2012, Issue 11. [DOI: 10.1002/14651858.CD000146.pub4] Read More