An Unfortunate Trifecta
Normally, if you win a trifecta it’s a good thing (especially if you’re betting on the races at Keeneland), but in this case, not so much: Based on national data, Kentucky has one of the highest rates of smoking, persistent poverty, and cancer (both incidence and mortality). Given this, the BIRDS Lab is well positioned to investigate the interplay among smoking cessation (or the lack thereof), social determinants of health, and cancer survivorship. Additionally, the BIRDS Lab focuses on underserved cancer survivors in Kentucky, often found in the rural and Appalachian parts of our state. Our main goals are to 1) identify the key variables that promote adjustment after a cancer diagnosis and 2) equitably facilitate smoking cessation among cancer survivors. Below is a summary of some of the BIRDS Lab studies.
Cancer And Tobacco Study (CATS)
In this NCI funded study, we were interested in identifying the factors that contribute to a cancer diagnosis being a true “teachable moment” for smoking cessation. More specifically, we were trying to uncover which affective and cognitive variables play a role in the quit attempts, lapses, and relapses that occur in the context of a new head, neck, or cervical cancer diagnosis. To do so, we recruited recently diagnosed cancer survivors who reported smoking into a 30-day intensive longitudinal study and asked them to report on their thoughts, feelings, social interactions, and smoking (and quitting) behavior. The most important study result is that most cancer survivors who smoke continue to smoke throughout cancer treatment, despite strong intentions and multiple attempts to quit for good. Better distress management and social support are needed in the context of cancer care to support smoking cessation and positive adjustment overall. The publications from this study are available here and here.
Cancer and the Kentucky Experience (CAKE)
In this concurrent mixed-methods study, we explored the quality of life and tobacco use of cervical cancer survivors and their primary support person (i.e., whomever the survivor considered her “go to” person for support). The focus on cervical cancer survivors was intentional as cervical cancer is a smoking-related cancer and these women have some of the highest rates of persistent smoking post-diagnosis. In this study, we were interested in characterizing (for one of the first times) the smoking behavior of this group and identifying barriers to and facilitators to their smoking cessation. We collaborated with Kentucky Cancer Link, a non-profit organization that provides assistance to low-income and under-insured cancer survivors across the state, and the Kentucky Cancer Registry to conduct this study in an attempt to reach underserved women. We learned a lot with this study, perhaps most importantly that the causal link between smoking and cervical cancer outcomes is not well known (outside of academic/medical circles) and that social variables (including income, education, norms, and perceived support and constraints) play a key role in smoking after cervical cancer diagnosis. The publications from this study are available here and here.
Markey Cancer Center Assessment, Referral, Engagement, and Support (CARES) Tobacco Program
Originally funded by a NCI CCSG Administrative Supplement, the Markey CARES Tobacco Program implements the highest quality tobacco cessation treatment via two pathways: 1) widespread provider education, and for some individuals, free enrollment in an accredited, online tobacco treatment specialist training program and 2) evidence-based patient care that involves population-based assessment, proactive offers of tobacco cessation assistance, systematic follow-up, and integrated support consistent with the conceptual model of the 5 As (Ask, Advise, Assess, Assist, and Arrange) and AAC (Ask, Advise, Connect) models. This comprehensive plan to address the high burden of tobacco use in Markey cancer patients through a 2-pronged approach considerably strengthened Markey’s commitment to reduce cancer morbidity and mortality in KY via both educational and treatment avenues. The publications from this study are available here and here.
Let's TALK Study
As a dissertation project, Dr. Tia (Borger) Weber led a mixed-methods longitudinal study where we explored the rationale behind some cancer patients' desire to quit tobacco on their own. Specifically, we were interested in why some cancer patients want to quit tobacco without assistance and we wanted to understand how this preference impacts their tobacco use over time. To do so, we recruited cancer patients through Markey Cancer Center and then asked them to complete 3 surveys and 2 interviews over the course of two months. The quantitative and qualitative data were integrated during analysis and converged to show self-reliance is a strong motivator for the preference to try and quit without use of any treatment. While some study participants were successful and fulfilled their intentions, the vast majority were not, again underscoring the need to facilitate uptake of evidence-based smoking cessation treatments as part of cancer care delivery. One of the 3 publications from this study is available here.
Survivorship Care Study
For the first time, there exist National Standards for Cancer Survivorship Care. The BIRDS Lab is helping with a project co-led by Drs. Jessica Burris and Laurie McLouth that aims to assess the alignment between the National Standards and what Markey Cancer Center provides to its patient population. To do so, we will enrolled 20 cancer program administrators, oncology providers, supportive care specialists, and community members plus 150 cancer survivors and 75 cancer caregivers into a mixed-methods, cross-sectional study and are using the data collected to inform implementation mapping and quality improvement planning. This study was funded by the NCI and several publications will be out shortly!
Multilevel Intervention for Tracking and Reducing Alcohol Consumption in Survivors (MI-TRACS)
Like tobacco use, alcohol use can negatively impact outcomes after a cancer diagnosis. Yet, the cancer care system does not routinely screen for alcohol use, provide brief intervention to patients on this topic, or refer to treatment cancer survivors who engage in hazardous alcohol use. The SBIRT model is an evidence-based approach to assessing and managing alcohol use in the context of standard care delivery, one that could work well in a cancer setting. However, it remains to be seen if that is true. Luckily, Drs. Burris, Laurie McLouth and Carolyn Lauckner received a NCI R01 grant award to implement and test the SBIRT model in the Markey Cancer Center, embarking on a five year effectiveness trial that began in August 2026. The BIRDS Lab will be involved in study implementation and scholarly dissemination.