Smoking Cessation Counseling Jerry Maniate MD, M.Ed(C), FRCPC

What is the one thing you want to learn about in this session?

What you can do in 3 minutes

We will give you the knowledge and tools

We will give you the knowledge and tools

to help patients quit smoking

to help patients quit smoking

Impact of tobacco dependence

Impact of

tobacco dependence Is an addiction

tobacco dependence

Clinical interventions for users Willing to quit

Clinical interventions for users

Clinical interventions for users Willing to quit Not

Clinical interventions for users

In Canada Decrease in Smoking rates Quantity smoked Daily smokers

Decrease in

Smoking rates

Quantity smoked

Daily smokers

In Canada 19% of the population

19% of the population

In Canada 5 million Canadians

5 million Canadians

Tobacco Related Cancer Deaths 18,000

New lung cancer cases 85%

Cornwall, ON Population 45,000

Cornwall, ON

Treatment complications Second primary tumors Other medical conditions Complications & morbidity Smoking & Oncology Patients

Treatment complications

Second primary tumors

Other medical conditions

Complications & morbidity

PMRT + Smoking Ever-smokers were at increased risk of lung cancer vs. nonsmokers after PMRT Smoking and PMRT were associated with increased risk for all histologic types of lung cancer Kaufman E et al., J Clin Oncol 26: 392 - 398, 2008

Ever-smokers were at increased risk of lung cancer vs. nonsmokers after PMRT

Smoking and PMRT were associated with increased risk for all histologic types of lung cancer

Smoking Cessation & Lung Cancer Patients General improvement in respiratory capabilities Less dyspnea and coughing Less sputum

Smoking Cessation & Lung Cancer Patients Sense of smell and taste Appetite Sleep Less fatigue Mood Self-worth

Barriers to treating tobacco dependence

“ I can’t help patients stop.”

“ Not enough time.”

“ Patients don’t want to hear about it.”

“ Patients don’t want to hear about it.”

“ Smoking cessation interventions during physician visits were associated with increased patient satisfaction with their care among those who smoke.” Mayo Clin Proc. 2001;76:138-143 “ Patients don’t want to hear about it.”

80% Would like to quit

80%

5% do

5%

A) The amount of nicotine the product contains B) The product brand C) The speed at which nicotine enters the brain and the brain releases dopamine D) The frequency a person uses the product E) The amount of product a person consumes What main factor determines the addictiveness of a nicotine product?

A) The amount of nicotine the product contains

B) The product brand

C) The speed at which nicotine enters the brain and the brain releases dopamine

D) The frequency a person uses the product

E) The amount of product a person consumes

A) The amount of nicotine the product contains B) The product brand C) The speed at which nicotine enters the brain and the brain releases dopamine D) The frequency a person uses the product E) The amount of product a person consumes What main factor determines the addictiveness of a nicotine product?

A) The amount of nicotine the product contains

B) The product brand

C) The speed at which nicotine enters the brain and the brain releases dopamine

D) The frequency a person uses the product

E) The amount of product a person consumes

Chronic Medical Condition

 4  2 -nicotinic acetylcholine receptors reinforce effects

 4  2 -nicotinic acetylcholine receptors reinforce effects

Increased tolerance

Increased tolerance

“ Smoking is an addiction; not simply a habit. Nicotine dependency is a medical condition which makes quitting difficult. Smokers who are truly motivated to quit deserve support and the tools to be successful.” Dr. Andrew Pipe

“ Smoking is an addiction; not simply a habit. Nicotine dependency is a medical condition which makes quitting difficult. Smokers who are truly motivated to quit deserve support and the tools to be successful.”

Dr. Andrew Pipe

“ I can’t help patients stop.”

“ I can’t help patients stop.” US Public Health Service Clinical Practice Guideline (June 2000) OMA / CTI educational information Review in CMAJ (November 2007) Information from CAMH Nicotine Dependence Clinic

Brief Clinical Intervention 5 A’s 5 R’s Interventions Resources

5 A’s

5 R’s

Interventions

Resources

Ask about tobacco use Advise about importance of cessation Assess their readiness to quit Assist by providing information such as Smokers Helpline Arrange through Smoking Cessation Clinic