Tobacco smoking affects the development, treatment response, prognosis, and recurrence of a variety of cancers.1-4 In addition, it affects non-cancer cardio-respiratory outcomes.1,3,5 In the general cancer patient population, about 50% of patients report a smoking history.1 Although many patients quit smoking before they are diagnosed with cancer, about 20% of patients smoke within the year they are diagnosed with cancer.1 Recent data by this study group has shown that up to half of cancer patients at our regional cancer centre who smoke in the peri-diagnosis period continue to smoke afterwards.6
Prior studies3,4,7 found that most oncologists ask about smoking status only on the 1st assessment. Many cancer care providers report inadequate time and lack of skills to counsel effectively. Assessment and discussion of smoking status by physicians has been identified as a cause of discomfort and stigma among cancer patients who smoke.8 Here, a cross-sectional survey of cancer patients was conducted across multiple disease sites and smoking statuses to assess the frequency of smoking assessment and the associated attitudes and preferences with respect to the screening of smoking status and discussion of smoking cessation.
It was identified that current smokers at diagnosis had their smoking status assessed more frequently than never or ex-smokers, but <50% of patients were being screened at ≥50% of their follow-up visits. Almost all patients (98%), regardless of smoking status, felt that it was important for their oncologist to be aware of their smoking status, and 95% wanted this information available at their 1st visit. Although current smokers were less likely to feel comfortable, compared to never or ex-smokers, with informing their oncologists of their smoking status at diagnosis (88% versus 98%, respectively; p<0.001), 96% were comfortable with being assessed. Although only half felt that smoking status should be assessed at all visits, among current smokers at diagnosis, lung cancer patients were 2–3 times more agreeable to being assessed at every visit, compared to patients with head and neck or non-tobacco related cancers. In general, patients felt that smoking status should be obtained by their oncologist (88%), as compared to other methods, including through allied health members, questionnaires, and electronic surveys (<50%); most patients (76%) felt that smoking cessation discussions should be initiated on the 1st visit.
Taken together, these survey results suggest that the vast majority of patients were comfortable with having their smoking status assessed, felt that this information was important, and were agreeable to having discussions initiated around tobacco cessation on the 1st visit by their oncologists, despite it being a potentially overwhelming time period. Currently, routine standardised screening, assessment, and treatment of tobacco use have not been consistently performed across all cancer centres.9 The peri-diagnosis period during the initial cancer visits for a patient can provide a window of opportunity and offers a teachable moment to discuss behavioural changes in patients, including tobacco cessation to optimise treatment response, reduce side effects, and improve prognosis. Pilot programmes, including one at our cancer centre, have shown that patients who are routinely screened are receptive to engaging in tobacco cessation programmes.9,10 However, further methods to implement routine care pathways, which include systematic screening, strong recommendation to stop by the oncologist with access to medication, and counselling by other members of the team, are necessary for whole patient care. Counselling should include the harms of continued smoking and the benefits of stopping on side effects and treatment response. Future research on optimal treatment regimens and implementation strategies to make tobacco addiction treatment routine in cancer centres is warranted.