Lisa Di Prospero, Regional Co-lead of Smoking Cessation at Toronto’s Odette Cancer Centre, discusses how the Centre integrates smoking cessation into cancer care.
Can you tell me about the Odette Cancer Centre?
Odette Cancer Centre is a comprehensive cancer centre in Toronto. We include all facets of the journey of the patient, from initial consultation to surgery, chemotherapy, and radiation oncology. We also have a patient and family support program.
How does the Odette Cancer Centre integrate smoking cessation into cancer care?
Our program, which started in 2012, is based on an interprofessional model where all health-care providers are trained to provide brief interventions. It’s based on the five As of smoking cessation. That means we ask the patient their smoking status. Then we advise the patient on the benefits of quitting and assess their readiness and willingness to quit. If the patient is ready, we assist by referring them to resources, such as the Smokers’ Helpline, and arrange for them to receive support to quit and follow-up via external providers. The approach is decentralized so every health-care provider at every point of care can ask the questions and start the process with the patient.
What does the evidence say about integrating smoking cessation with cancer care?
The evidence shows us two things:
Firstly, it shows us that the most influential advice comes from the health-care provider at the point of care.
Secondly, it shows us that smoking cessation positively affects treatment outcomes.
Why isn’t smoking cessation traditionally incorporated into cancer care?
It’s probably because there were myths that smoking was a habit rather than an addiction. It’s also a difficult conversation to have, especially when patients are going through something as difficult as cancer. Some may assume that adding another thing for the patient to think about, such as smoking cessation, just adds to the patient’s anxiety and stress.
What do you tell patients who say: “Listen, leave me alone. I have cancer. Let me smoke.”
If patients aren’t feeling ready for the conversation, we acknowledge this. We strive to provide a supportive and neutral environment, in any circumstance. We offer materials tailored to patients who don’t want to quit [see below for the Odette Cancer Centre’s Smoking Cessation Resources]. If they choose to decline these materials, we leave things open-ended. It is our responsibility to open the door and to be there to discuss the potential benefits of quitting. Ultimately, though, the decision to be open to cessation or not, is theirs. From our experience, patients who are not interested in quitting will still engage in a conversation about smoking.
Is this a novel approach?
Traditionally, regional cancer programs have individual counsellors who are trained in smoking cessation. Here, we have created a collaborative approach to smoking cessation. Every member of the patient’s health-care team has been trained to provide brief intervention.
The Odette Cancer Centre’s Smoking Cessation Resources
Resources for patients who have signaled an interest in quitting:
- Quitting smoking: An interactive e-Learning module [Sunnybrook Health Sciences Centre]
- For smokers who want to quit [Canadian Cancer Society]
- Are you interested in quitting smoking? Pathfinder [Sunnybrook Health Sciences Centre]
- The benefits of quitting smoking for patients with cancer [Cancer Care Ontario]
Resources for patients who are ambiguous and might revisit the option to quit:
- For smokers who don’t want to quit [Canadian Cancer Society]