Smoking cessation: what is the oncologist’s role?

Risk Factors

By Michael Woodhead

2 May 2018

Most oncologists want to offer smoking cessation support for their patients but have neither the time nor expertise to provide interventions in their own clinics, a national survey reveals.

And a substantial number of oncologists also have doubts about the benefits of smoking cessation for patients with advanced cancers and limited lifespan, according to responses provided by 189 members of the Medical Oncology Group of Australia and 106 radiation oncologists.

Researchers from the University of Newcastle and the Hunter Cancer Research Alliance found that 97% of oncologists routinely asked patients about smoking at the initial consultation.

However after recording details of smoking history and current consumption of tobacco, many oncologists took little further action beyond asking the patient if they intended to quit (63%) and advising cessation (70%).

About 17% of medical oncologists discussed medication options for smoking cessation and 15% referred patients to support services such as Quitline. Only 2-3% of oncologists actively managed the patient’s smoking cessation themselves.

“We found that almost all oncologists bring smoking up in their first consultation with a patient, but only half of them regularly ask about smoking in follow-up consultations. Few (<20%) regularly provide support in the form of referrals and pharmacotherapy,” said study authors Dr Fiona Day and Professor Christine Paul.

In their responses, many oncologists said there was little time in a complex oncology consultation and they expected smoking cessation interventions to be provided in the community by the patient’s GP or a dedicated smoking cessation service.

Almost half the respondents said smoking cessation interventions could be left until after the patient had completed their cancer treatment, as they would need to cope with the anxiety and stress of their diagnosis and side effects of treatments.

“I believe the primary focus of my patient contact time is cancer treatment and there is not enough time during the consultation to talk about where pts can seek help from,” commented one oncologist.

“Additionally many patient are overwhelmed by change in their routine brought about by cancer treatment and I don’t feel they are ready to either talk or attempt smoking cessation during treatment.”

And almost one in four medical oncologists said they would only see smoking cessation as valuable for patients with curable disease.

“Almost 100% of my pts have incurable cancer with limited life spans. I don’t believe they necessarily need to cease smoking and I think it impacts negatively on their quality of life (anxiety/distress),” commented one.

However Professor David Currow, Chief Cancer Officer and CEO of the Cancer Institute NSW said smoking cessation was important because it could affect treatment efficacy , complications and overall survival.

“ We now know that quitting smoking even after a cancer diagnosis can have a huge impact on treatment,” said Professor Currow. “Smoking cessation is now an essential part of cancer care. The Cancer Institute NSW is working closely with cancer services across NSW on a project to embed smoking cessation brief interventions into all cancer services.”

The researchers suggest a team approach to cessation care where oncologists may be the first to engage with the patient about the need for quitting, e.g. providing motivational advice and information about the benefits, and putting together an agreed plan with the patient on the best referral and support strategy.

The findings are published in the Asia Pacific Journal of Clinical Oncology.

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