By Lexington Souers

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Thousands of sick and dying Kentuckians come to the UK Chandler Hospital every year in hopes of getting the best cancer-related health care in the state.

Kentucky has some of the highest rates of smoking in the country — 26 percent of Kentuckians smoke tobacco compared to 18 percent nationally. UK’s Chandler Hospital and UK HealthCare system are dedicated to the treatment and prevention of tobacco related diseases and disabilities.

Janie Heath, dean and warwick professor of Nursing at UK’s College of Nursing, says that UK’s location makes it a prominent leader in tobacco diseases and health care. Located in the heart of Kentucky,  it is a hub for rural counties, as well as the state’s only designated cancer institute.

Of all patients who were discharged by UK HealthCare in 2014, 41 percent reported using tobacco in the past 30 days, according to Heath.

“It’s no surprise we see the sickest of the sickest,” Heath said. “When you look at the numbers, you can follow the trail of people that come through our doors and are tobacco dependent or addicted.”

The National Institutes of Health estimate that lung cancer care cost the United States $13.1 billion in 2014. Smoking is the leading cause of lung cancer, with about 80 percent of lung cancer deaths thought to be caused by smoking.

Lung cancer causes more deaths than colorectal, breast and prostate cancers combined. According to lung.org, an estimated 158,040 Americans are expected to die from lung cancer in 2015,  which accounts for about 27 percent of all cancer deaths.

UK HealthCare offers specialty services in pulmonary and cardiac care, two of the biggest health areas affected by tobacco use. The hospital also sees strong connections between tobacco use and bladder, colon, oral, lung, pancreatic and breast cancer.

The hospital’s campus has been smoke free since 2009, and provided nurses with the training needed to work with patients who were interested in quitting.

Audrey Darville, a certified tobacco treatment specialist, was hired as a result of this change. She is specially trained in tobacco abuse counseling and her status as a registered nurse allows her to provide counseling and advise on medications.

“Medications aren’t prescribed all of the time, so healthcare practitioners may not know if there have been any changes with how they should be used,” Darville said. “Not all health care providers are comfortable so they refer patients to me.”

Currently there is nurse-led protocol that helps identify patients who are ready to quit and offer nicotine replacement while the patient is still staying at Chandler Hospital. Darville said this helps the patient feel more comfortable, especially since most smokers will try to quit smoking several times before they are successful.

Chandler Hospital and UK HealthCare also focused on preventing tobacco abuse and researching which communities are more likely to become tobacco dependent.

Amanda Fallin, an assistant research professor at the College of Nursing, studies tobacco treatment and policy in vulnerable populations. Currently she is researching the affects of tobacco addiction on women who have experienced other addictions, and said she hopes this will change policy in the future.

Fallin said that Kentucky’s history as a tobacco state hasn’t really changed how people use the former cash crop, but it may explain why Kentucky doesn’t spend the Center for Disease Control and Prevention’s recommended amount on tobacco abuse prevention.

“I think it’s because we are a tobacco growing state,” Fallin said. “That may limit policy makers.”

The next step in treating tobacco use is targeting the pockets of high risk communities, something that both Darville and Fallin are working towards. Both support outreach and research programs that target areas where tobacco use is prominent.

Heath said she would like to see the state initiate an institute for preventative health, and to invest more in prevention.

“There will be no vibrant population until prevention is a priority,” Heath said. “Prevention starts at the top. It would be great if we had leadership that saw we needed to stop fixing and start preventing.”

Heath said she feels that the tobacco industry and lawmakers still have strong ties. She said regulating tobacco isn’t about shutting down farms — or the farmers who have created communities around tobacco growth — but instead finding other opportunities for the former economic engine of the state.

Heath said it would take several generations, better health education in schools and social change to end tobacco abuse.

“We’re not going to see that happen — in your lifetime or mine,” Heath said. “But it will be a glorious day.”

As far as Chandler Hospital is concerned, the end of tobacco abuse wouldn’t really affect day to day life.

“We would still have diseases and surgeries, but there would be a reduction of the big bad things,” Darville said. “Think how wonderful it would be to treat less lung cancer.”

Chandler Hospital see 375 new patients each year, with more than 2,000 visits annually and more than 200 outpatients each month.