• 2,300 women
    women were determined to be at high risk for breast cancer by the High Risk Screening Program in Ontario in 2015
  • 86%
    of cancer patients saw a registered dietitian at a regional cancer centre within 14 days of referral in 2016
  • 71%
    of stage III colon cancer patients received chemotherapy within 60 days of after surgery in 2014
  • 86%
    of all cancer surgery patients received their consult within the recommended wait time in 2016, and 87% received their surgery within the recommend wait time
  • Over 43,000
    patients were discussed at comprehensive multidisciplinary cancer conferences (MCCs) in fiscal year 2016/2017
  • About 13%
    of patients who undergo lung, prostate and colorectal surgery have an unplanned hospital visit following surgery
  • 79%
    of breast cancer patients had a guideline-recommended mammogram in the first follow-up year
  • 74%
    of colorectal cancer patients diagnosed in 2013 had a surveillance colonoscopy within 18 months of surgery
  • Over 100
    patient and family advisors, who vary by their type of cancer and experiences, represent diverse regions and work with Cancer Care Ontario to ensure a person-centred cancer system
  • 383,023
    unique patients were screened for symptom severity using Your Symptoms Matter – General Symptoms (YSM-General) in 2016
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Smoking Cessation in Regional Cancer Programs


Key Findings

The number of new ambulatory cancer patients reported as having been screened for tobacco use in regional cancer centres across Ontario has increased. Screening rates have increased from 42% in April 2015 to 62% in December 2016, which represents approximately 1,000 more new patients screened in December 2016 than in April 2015.

Measure Desired Direction As of this Report
Reported tobacco screening in new ambulatory cancer patients  Black Arrow Up  Grey Arrow Up
See Methodology and Approach to find out how the ratings are calculated.

What is Cancer Care Ontario’s Smoking Cessation Program in Regional Cancer Programs?

  • Cancer Care Ontario’s Smoking Cessation program was implemented in 2013 and is a provincial effort to ensure that new cancer patients seen in Regional Cancer Centres (RCCs) are screened for tobacco use and, if appropriate, are referred to smoking cessation services available at or through the Regional Cancer Programs (RCPs).
  • The program's vision is to ensure that a smoking cessation intervention is systematically offered to every new ambulatory (non-hospitalized) cancer patient. The goal is to make smoking cessation an important and routine part of cancer treatment. To fully realize this, a shift in the culture around smoking cessation is required at the RCCs.
  • The provincial program has focused on standardizing various smoking cessation practices across Ontario. It has developed information for patients and providers on the health benefits of smoking cessation and resources to support smoking cessation. The program also provides a platform for RCPs to share both their successes and challenges.

What are the roles of Cancer Care Ontario and the Regional Cancer Centres?

  • Cancer Care Ontario monitors screening and smoking cessation activities within the RCCs, which means that smoking cessation services outside the RCC but within the RCP are not reported (i.e. services provided at a hospital, the RCC’s satellite site(s) or community partners). The RCCs are required to submit monthly data on a minimum set of performance metrics measuring smoking cessation activity at their facility.
  • RCCs have trained their frontline staff on the importance of screening patients for tobacco use, held grand rounds with physicians and other healthcare providers on the benefits of cessation for cancer treatments, developed smoking cessation resources and updated documentation practices.
  • Cancer Care Ontario has organized a network of Regional Smoking Cessation Champions who convene monthly to share successes and challenges with each other and with Cancer Care Ontario on relevant topics such as the latest research, strategies to raise awareness, building technological capacity, pharmacotherapy options and comparing quarterly performances.
  • Among a series of measures, implementation of each RCC’s smoking cessation program is currently reflected by the indicator Tobacco Screening among New Ambulatory Cancer Patients. This indicator was first reported by 5 RCCs in October 2013, and by April 2015, all RCCs were reporting on this metric. With improvements in data quality and submission processes, the Smoking Cessation program joined Cancer Care Ontario’s regular Quarterly Performance Reviews in April 2015 with its first performance indicator, tobacco screening.
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What do the results show?

There has been a consistent increase in the number of new cancer patients reported as having been screened for tobacco use across Ontario over the past two years (Figure 1).

  • Approximately a thousand more new patients were screened in December 2016 than in April 2015. This translates to an increase in reported tobacco screening from 42% in April 2015 to 62% in December 2016, which approaches the current provincial tobacco screening target of 70% (Figure 1).
  • This increase is partly the result of Cancer Care Ontario’s efforts to support RCCs in identifying tobacco users among the 5,500 new ambulatory cancer patients registered each month across Ontario and connecting them with appropriate smoking cessation services.

The overall provincial increase in tobacco screening rates is based on the increase seen in many RCCs across the province between 2015 and 2016 (Figure 2).

  • The tobacco screening rate for most of 2015 was 45% and this increased to 60% in 2016. Between these 2 years, 4 of the 14 RCCs showed substantial increases (more than 50%) in reported tobacco screening rates:
    • The large increases for Hamilton, Kingston and Sudbury, which initially had lower rates, may be explained by the smoking cessation program’s focus on helping the lower-performing sites identify potential issues in documentation or data submission processes.
    • The increase in the tobacco screening rate at Princess Margaret Hospital in Toronto may be attributed to a change in their patient interaction processes.
  • Many of the remaining RCCs experienced more modest increases or no changes in their tobacco screening rates between 2015 and 2016.

Why is smoking cessation important for cancer patients?

  • For cancer patients who smoke, evidence suggests that the risk of dying could be lowered by 30 to 40% by quitting smoking at the time of diagnosis.1
  • Smoking cessation has been shown to improve cancer prognosis, prevent development of second primary cancers, and reduce all-cause and cancer-specific mortality. In addition, quitting smoking may decrease the possibility of cancer recurrence, decrease toxicity from radiation therapy and provide greater response to systemic therapy treatment.1
  • Tobacco use screening offers health care providers a teachable moment to educate patients on how smoking cessation can improve their cancer treatment outcomes. People with cancer who are identified as tobacco users are advised on the benefits of cessation specific to their cancer treatment, and offered referrals to cessation services either within the cancer centre (e.g. cessation counselling) or in the community (e.g. Smokers’ Helpline, public health units).

What are the next steps?

  • In 2016, the program at Cancer Care Ontario received funding from the Canadian Partnership Against Cancer to review the program’s implementation strategy. This funding has allowed the provincial program’s representatives to visit the RCCs in person and evaluate how the RCCs’ programs are being run across the province. Based on this evaluation, the goal is to update the project’s framework and data requirements, and develop content to support RCC champions in communicating with their teams and patients about the importance of smoking cessation after a cancer diagnosis.
  • Moving forward, a goal of the provincial program is to extend the initiative beyond the RCCs to the entire RCP, including smoking cessation activities occurring in hospitals, RCCs’ satellite locations and community partners.

Find out more

For more details on the tobacco screening initiative described above or on helping tobacco users to quit, please email Cancer Care Ontario’s Smoking Cessation Program at smokingcessation@cancercare.on.ca or visit:

View Notes

  1. U.S Department of Health and Human Services. The Health Consequences of Smoking – 50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centres for Disease Control and Prevention, National Centre for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.