Implementing smoking cessation within cancer treatment centres and potential economic impacts

Background: Although the health benefits of smoking cessation in newly diagnosed cancer patients are well established, systematic efforts to help cancer patients stop smoking have rarely been implemented in cancer centres. Methods: Starting in 2012, the 14 regional cancer centres overseen by Cancer Care Ontario in the province of Ontario, Canada began to screen ambulatory cancer patients for their smoking status, to provide smokers with advice on the health benefits of quitting and to offer referral to smoking cessation services. Multiple initiatives were undertaken to educate healthcare providers and patients on the health benefits of cessation. Critical to the success of the initiative was strong leadership from Cancer Care Ontario executives and regional vice presidents, advice from an advisory committee of smoking cessation experts, engagement of regional champions and support from a provincial secretariat. The quarterly review of performance metrics was an important driver of change. Results: Most cancer centres now screen in excess of 75% of ambulatory patients but rates for the acceptance of a referral to smoking cessation services remain low (less than 25%). Introduction of an opt-out referral process appears to increase referral acceptance. Economic analyses suggest that smoking cessation is cost-effective in a cancer centre environment. Conclusions: Although there are barriers to the implementation of smoking cessation in cancer centres, it is possible to change the culture to one in which smoking cessation is considered part of high-quality treatment.