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April 25, 2018

Quitting smoking: It takes a team

Why quitting smoking after a cancer diagnosis makes sense

More and more, evidence shows that quitting smoking can improve outcomes in patients undergoing cancer treatment. Quitting smoking after a cancer diagnosis improves the chance of recovery after surgery, increases the effectiveness of chemotherapy and radiation treatment, and reduces the likelihood that the cancer will return.

But in the midst of a life-altering diagnosis, the thought of quitting can be overwhelming. That’s why staff and physicians at Juravinski Cancer Centre (JCC) have developed a program aimed at making quitting smoking easier for patients and their families.

“It’s important for patients to know that we’re here to support them,” says Cheryl Reid, lung disease site co-chair and smoking cessation champion at JCC. “Their chance of success is greatly increased when they have the right supports in place.”

Empowering patients to quit smoking with the right tools

At JCC, “the right supports” means empowering every member of a patient’s healthcare team to have conversations about quitting or cutting back tobacco use. All staff, including healthcare aides, primary care nurses, oncologist and pharmacists, are well-equipped to have the conversation. This collaborative effort is earning results.

Since 2016, the number of patients who have been screened for and who have accepted support for quitting or cutting back has dramatically increased. Last year, more than 80 per cent of patients were screened for tobacco use. That’s 10 per cent above the provincial target and up 60 per cent from 2016. Of those patients, more than 22 per cent accepted a referral for smoking cessation support, exceeding the provincial target of 20 per cent.

“In the past, there was a perception that patients weren’t interested in having the conversation, so we wouldn’t initiate,” says Anatoli Chkaroubo, a pharmacist at JCC. “We’ve changed that by approaching the subject systematically.”

“We try to emphasize that it’s never too late to quit.”

The strength of the program is the consistency of support and communication across care providers, where smoking cessation is a step-by-step journey.

First, patients are asked about their tobacco use as part of their initial health assessment as an outpatient at the Centre. This crucial first step is initiated by a healthcare aide on the patient’s arrival. If a patient indicates that they’ve smoked in the last six months, next steps are triggered. These include a more detailed assessment by a primary care nurse and onocologist. Very often it results in a referral to the JCC outpatient pharmacy. There, a pharmacist completes the assessment and works with the patient to decide on a treatment plan. This may include behavioral strategies, medications to help the patient reduce or quit, or nicotine replacement therapy, such as a patch or gum. A free trial of nicotine replacement therapy may be provided to eligible patients on site, and they’ll be given information about additional resourcesin the community.

Extending our reach beyond hospital walls

Collaboration with Hamilton’s Public Health team and Smoker’s Helpline ensures alignment to local and provincial standards and resources.

This concerted, collaborative approach ensures that no opportunity is missed to have a conversation about quitting smoking.

“Patients feel empowered because it’s something they can control amidst a time of great uncertainty, and they know they have support in doing that,” says Anatoli.

Sometimes, support means simply offering a patient a nicotine replacement while they’re receiving chemotherapy and unable to go outside to have a cigarette. Whether or not a patient is prepared to quit smoking, the team strives to work alongside the individual to develop strategies tailored to their individual needs.

“We try to emphasize that it’s never too late to quit,” says Riley Crotta, manager of the integrated cancer screening program. “But, regardless of their goals, our goal is to help patients feel comfortable throughout their journey with us.”

For more information about smoking cessation and cancer, visit

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