As survival from cancer has improved over time, the potential impact of cigarette smoking on cancer patients and survivors is of increasing relevance. In addition to increased risk of chronic disease such as cardiovascular and respiratory disease, continued smoking after a cancer diagnosis increases the risk of second primary cancer, cancer recurrence and is a cause of treatment complications. As well the profound adverse impact of continued smoking on health outcomes in cancer patients, continued smoking among people with cancer incurs significant cost to the health system.

2. Pathways to Smoking Care
Implementation Project
(P-SCIP)
Christine Paul, Megan Freund, Ann Dadich, Emma Sherwood,
Natalie Taylor, Fiona Day, Bettina Meiser, Megan Varlow, Rina Hui,
Tim Shaw, Jane Young, John Wiggers

3. “For cancer patients… smoking status is a powerful clinical risk indicator that
merits the full attention of the health care team and the patient”(US Surgeon
General)
Smoking rates after diagnosis range from 20% - 50%1
Rates of assistance are low2
39% of oncologists provided cessation support (US data)
Majority believed cessation support was someone else’s role
Quitting soon after diagnosis:
 Gain of 1.6 years median survival time over eight years3
 Decreased risk of recurrence or new primary4
 Decreased risk of treatment side effects5
1. NCI 2013 2. Warren 2013 2. Weber et al 2014. 3. Walter et al 2014, Parsons 2010. 4. Rugg et al 1990

4. To explore:
Capacity of NSW hospitals to implement key aspects of system-
wide smoking cessation advice
Proportion of oncology patients who report receiving smoking
cessation care
Proportion of oncology medical and nursing staff who routinely
deliver cessation care to patients
To pilot test the feasibility of a smoking cessation implementation
strategy

5. Three successive project stages to address aims
Stage 1 (complete)
State-wide survey of key informants
Stage 2 (ongoing)
Survey of cancer care staff and cancer patients*
Stage 3 (ongoing)
Pilot program to test feasibility of an implementation
intervention
Stage 1
Stage 2
Stage 3
* Patient data not presented

6. Electronic survey invitation sent to key informants
across NSW e.g. Director Cancer Services (n=68)
Examined capacity of hospitals to:
consistently record patient smoking information
Share smoking related information across cancer care
providers
automate referrals for smoking care
provide pharmacotherapy

7. 34 respondents, 42 unique hospitals nominated (86 total)
Item – individual hospitals N (%)
Policy for smoking cessation ?
- specific to cancer patients?
19 (45%)
0 (0%)
Routinely record smoking status?
- At admission
- By doctor / nurse
16 (38%)
12 (29%)
Routinely record smoking cessation care provided?
- By doctor/nurse
- At admission
14 (33%)
3 (7%)
How is NRT made available to inpatients?
- Unsure
- Hospital pharmacy
17 (41%)
10 (24%)
How is NRT made available to outpatients?
- Unsure
- Referral letter to GP
25 (60%)
4 (10%)

8. 0
5
10
15
20
Quit counselling
services for staff
Resources
specifically for
cancer patients
Staff access to
free/cost price
NRT
Inservice
plans/strategic
documents
Training to
provide
cessation care
for general
patients
Most common strategies implemented (34 sites)
0
5
10
15
20
Automated referral
to QL or other
Patient file field
where cessation
care provided can
be easily seen
Staff incentives Incorporating
cessation care
practices into staff
appraisal
Least common strategies implemented (n=34)

9. All staff involved with care of cancer patients
Survey items:
Delivery and recording of smoking cessation care
Support strategies to facilitate cessation care
Beliefs regarding cessation care for cancer patients
92 surveys completed across 2/6 sites (1 site complete)
17 doctors (18.5%), 51 nurses (55.4%), 24 other (26.1%)
Medical oncology, radiation oncology,
surgical oncology, and allied health

10. Delivery and recording of care
Survey Question Patient setting Result
What proportion of patients do you
ask/confirm smoking status?
Inpatient (n=63) 47.6% (n=30) Half or less
Outpatient (n=66) 66.7% (n=44) Half or less
For patients that smoke, what proportion
did you advise to quit?
Inpatient 55.6% (n=35) Half or less
Outpatient 65.2% (n=43) Half or less
Support strategies to facilitate care
Survey Question Result
Does your hospital have a policy on smoking cessation care for cancer
patients?
26.1% (n=24) Yes
Are there reminders or prompts for clinical staff to ask about smoking
status?
23.9% (n=22) Yes
Beliefs regarding care
Survey Question Result
Asking about smoking jeopardises my relationship with the patient 6.5% (n=6) Strongly agree/agree
Is it appropriate to provide cessation care for patients with tobacco-related
cancer?
85.9% (n=79) Strongly agree/agree

12. Stage 1
Low preparedness / room for improvement
Stage 2
Staff reasonably willing but system weak
Need for range of strategies – no silver bullet
Stage 3
Complexity of system: need for department-specific tailoring

13. We gratefully acknowledge the funding and
infrastructure support provided by:
Cancer Institute NSW
The University of Newcastle
Hunter Medical Research Institute
Hunter New England Population Health
We also would like to thank the study
participants

14. Adult outpatients attending medical, radiation or
surgical oncology clinics
Any cancer type
English speaking
Previously attended clinic
Survey items relating to:
Receipt of smoking cessation care
Beliefs regarding appropriateness of cessation care

15. 163 participants across 2 sites
97 (59.5%) medical oncology, 43 (26.4%) radiation oncology, 23
(14.1%) surgical oncology
86 male (52.8%), mean age 61.4 years
18 (11%) current smokers, 82 (50.3%) former smokers, 62 (38%)
never smokers
Patients:
Believe that cancer patients should be asked about smoking
(92%) and that smokers should be advised to quit (90.1%)
However…
23.3% patients were not asked about their smoking
38.9% of current smokers (n=18) were not offered help to quit
smoking

16. Receipt of Smoking Care
Survey Question Result
Did any of your doctors or nurses as whether you smoke tobacco? 23.3% (n=38) No, Unsure
FOR CURRENT SMOKERS ONLY (n=18):
Were you offered help to quit smoking by people involved in you cancer
care?
38.9% (n=7) Not offered help
Beliefs regarding care
Survey Question Result
Health professionals in cancer care should ask people who have cancer if
they smoke
92% (n=149) Strongly agree/agree
Health professionals in cancer care should advise people who have cancer
and are smokers to quit smoking
90.1% (n=146) Strongly
agree/agree
There is no point quitting smoking if you have cancer 11.1% (n=18) Strongly agree/agree
People who have cancer should not be asked to quit smoking because they
have enough to deal with
12.3% (n=20) Strongly agree/agree