Post-cancer smoking cessation and the role of GPs

While some clinicians consider helping people to quit smoking as primarily the domain of general practice, calling on GPs to prioritise smoking cessation over the many other activities during the initial diagnostic and treatment period for those with cancer is challenging.
 
However, the support provided by GPs for these patients, a time when the motivation to quit may increase, could be instrumental in facilitating quitting.
 
Smoking is the most prominent modifiable risk factor for the development of cancer, and future projections suggest that the number of smoking-related cancer deaths in Australia will exceed 250,000 between 2020–44.
 
GPs will care for many patients living with lung and other cancers who continue to smoke after diagnosis and during treatment.
 
For all clinicians in the treatment team, providing smoking cessation care for patients living with cancer is an important management priority. This is because smoking cessation can improve prognosis and continued smoking after diagnosis is associated with adverse health outcomes.
 
According to the US Surgeon General’s report, in cancer patients and survivors, there is sufficient evidence to infer a causal relationship between cigarette smoking and increased mortality, both all cause and cancer-specific. The report reaches the same conclusion in cancer patients and survivors about cigarette smoking and the increased risk for second primary cancer, such as lung cancer.
 
Additionally, the evidence is suggestive but not sufficient to infer a causal relationship between cigarette smoking and poorer response to treatment, and increased treatment-related toxicity in cancer patients and survivors.
 
In relation to cancer treatments, pre-operative smoking is linked to greater risk of post-operative complications for surgical oncology patients, such as delayed wound healing and anastomotic leaks.
 
Compared with continued smoking, smoking cessation after a cancer diagnosis reduces all-cause mortality, with survival benefit seen across many different cancer types, including those not commonly considered as smoking associated, such as breast and prostate carcinoma.
 
The Clinical Oncology Society of Australia (COSA) calls for smoking cessation treatment to be offered as a standard part of cancer care, recommending that evidence-based smoking cessation treatment be systematically provided to all patients with cancer.
 
COSA seeks to embed smoking cessation care in Australian oncology health services, supporting a best practice approach that includes behavioural intervention plus pharmacotherapy as clinically appropriate. 
 
GPs are considered vital in facilitating successful quitting. The COSA Position Statement, ‘recommends that coordination of smoking cessation care is important within the context of multidisciplinary team care’.
 
Evidence-based smoking cessation care consists of brief advice from a health professional about the benefits of quitting, in combination with multi-session behavioural intervention and pharmacotherapy as clinically appropriate.
 
Comprehensive behavioural support, such as that provided by Quitlines, includes individually tailored smoking cessation counselling, across multiple sessions, using established behaviour change techniques. 
 
Pharmacotherapy is used to minimise withdrawal symptoms and decrease cravings.
 
The choice of pharmacotherapy must be guided by clinical suitability and patient preference;  further guidance may be found in the RACGP Supporting smoking cessation: A guide for health professionals.
 
Clinicians providing smoking cessation care can visit quitcentre.org.au to find RACGP-accredited training, clinical tools and resources, along with a recorded webinar by radiation oncologist Dr Graham Warren on ‘Supporting Smoking Cessation Care in Oncology Settings’.
 
The National Best Practice Support Service for Nicotine and Smoking Cessation (‘Quit Centre’) is supported by funding from the Australian Government Department of Health and Aged Care under the Alcohol, Tobacco and Other Drugs Program.
 
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