Smoking Cessation in Regional Cancer Programs
Measure: Reported tobacco screening among new ambulatory cancer patients
As of this Report:
The proportion of new ambulatory cancer patients reported as having been screened for tobacco use in Regional Cancer Centres (RCCs) across Ontario increased from 59% in 2016 to 67% in 2017. However, the percentage of tobacco users accepting a smoking cessation referral was stable at 21% in both 2016 and 2017.
What is Cancer Care Ontario’s Smoking Cessation Program in Regional Cancer Programs?
- Cancer Care Ontario’s Smoking Cessation Program was implemented in 2013. The program is a provincial effort to ensure that new cancer patients seen in RCCs are screened for tobacco use and, if appropriate, referred to smoking cessation services available at or through 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 RCCs.
- The provincial program has focused on standardizing various smoking cessation practices across Ontario. It has developed information products 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 their challenges and successes.
Measure: Reported acceptance of smoking cessation referral among tobacco users
As of this Report:
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 are not reported if they occur outside the RCC but within the RCP (e.g., 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 front-line 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 of their cessation programs, building technological capacity, pharmacotherapy options and comparing quarterly performances.
- Cancer Care Ontario has also developed content to support Regional Smoking Cessation Champions in communicating with their teams and patients about the importance of smoking cessation after a cancer diagnosis. This includes materials such as print resources and videos for both patients and providers.
- The performance of each RCC’s smoking cessation program is currently reflected by the indicators “tobacco screening among new ambulatory cancer patients” and “accepted a smoking cessation referral among tobacco users.” Following improvements in data quality and submission processes, the Smoking Cessation Program joined Cancer Care Ontario’s regular Quarterly Performance Reviews with inclusion of the “tobacco screening among new ambulatory cancer patients” indicator in April 2015, and the “accepted a smoking cessation referral among tobacco users” indicator in April 2016.
What do the results show?
There has been an increase in the proportion of new cancer patients reported as having been screened for tobacco use across Ontario over the past 2 years (Figure 1).
- Reported tobacco screening rates increased from 54% in January 2016 to 61% in December 2017, 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 approximately 5,200 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 2016 and 2017 (Figure 2).
- The provincial tobacco screening rate in 2016 was 59%, and this increased to 67% in 2017. Four of the 14 RCCs had notable improvements (more than 25% compared to the previous year) in their reported tobacco screening rates, including 1 RCC with a substantial increase (more than 50% compared to the previous year).
- The largest relative increase was observed at Juravinski Cancer Centre in Hamilton.
- Other notable increases were observed at the Odette Cancer Centre in Toronto, Stronach RCC in Newmarket, and Simcoe-Muskoka RCC in Barrie.
- Two cancer centres had notable declines (more than 25% compared to the previous year) in tobacco screening rates: Princess Margaret in Toronto and London RCP in London.
- The remaining RCCs experienced modest increases or no changes in their tobacco screening rates between 2016 and 2017.
Despite variation between RCCs across the province, the provincial rate of reported acceptance of smoking cessation referral remained consistent between 2016 and 2017, and near the provincial target (Figure 3).
- The reported acceptance of smoking cessation referral rate was 21% in 2016 and 2017. Two of the 14 RCCs had substantial increases (more than 50% compared to the previous year), and 1 had a notable improvement (more than 25% compared to the previous year) in the accepted referral rate.
- The largest relative increase was observed at Carlo Fidani RCC in Mississauga and at Stronach RCC in Newmarket.
- A notable increase was also observed at the Windsor RCC.
- A substantial decrease in accepted referral rates was observed at McLaughlin Durham RCC in Durham (more than 50% compared to the previous year).
- To help improve the rate of reported accepted referrals, the Smoking Cessation Program has strongly recommended cancer centres adopt an opt-out approach as of April 1, 2018. This approach involves automatically referring tobacco users to smoking cessation services as part of their cancer treatment.
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% if they quit smoking at the time of diagnosis .
- 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 .
- Tobacco use screening offers healthcare providers a teachable moment to educate patients on how quitting smoking 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 they are offered referrals to cessation services either within the cancer centre (e.g., cessation counselling) or in the community (e.g., the Smokers’ Helpline or public health units).
What are the next steps?
- In 2016 and 2017, Cancer Care Ontario received funding from the Canadian Partnership Against Cancer to review the Smoking Cessation Program’s implementation strategy. This funding supported an environmental scan of implementation practices (including regional site visits) to inform a refinement of the program’s framework and data requirements, and to inform implementation of a communications and knowledge translation strategy.
- Moving forward, a goal of the provincial program is to extend the initiative beyond each RCC to their entire RCP. This includes smoking cessation activities occurring in hospitals, RCC satellite locations and community partners. Future work also includes exploring opportunities to measure tobacco quit outcomes among cancer patients who smoked tobacco when they registered at the cancer centre.
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 firstname.lastname@example.org . You can also visit the following online resources:
- Cancer Care Ontario’s “The benefits of quitting smoking for people with cancer,” a resource for cancer patients, available at https://www.cancercareontario.ca/sites/ccocancercare/files/assets/PrevQuitSmokingBrochure.pdf
- Smokers’ Helpline at smokershelpline.ca/
- Smoke-Free Ontario Act at mhp.gov.on.ca/en/smoke-free/