Health benefits of smoking cessation are significant. Potential benefits include improved treatment outcomes, reduced risk of disease recurrence, and lower risk of secondary cancers. Even after a cancer diagnosis, a patient’s prognosis can be improved if quit attempts are made.
The National Comprehensive Cancer Network (NCCN) presented its NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Smoking Cessation at the NCCN 20th Annual Conference: Advancing the Standard of Cancer Care.1 Peter G. Shields, MD, The Ohio State University Comprehensive Cancer Center—Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC—James), served as chair of the NCCN Guidelines Panel for Smoking Cessation. These new guidelines focus on smoking cessation recommendations for patients with cancer. After a cancer diagnosis, patients may be more likely to believe any benefits to quitting smoking have passed. They need to be reassured that it is never too late to quit smoking.
The guidelines recommend a multifaceted approach that includes evidence-based pharmacotherapy, behavior therapy, and close follow-up with retreatment, as needed. It also recognizes that smoking and nicotine addition is a chronic relapsing disorder, and relapse should be expected. Some patients may need to make several attempts before achieving long-term smoking cessation. Nurses should be prepared to support and encourage these patients to make another quit attempt.
Any member of the health care team (eg, physician, nurse, medical assistant, health educator, other dedicated staff member) can perform the initial evaluation. The discussion of smoking status should be a part of the initial comprehensive patient history and documented in the patient’s health record. Smoking status can be assessed with two simple questions: Have you ever smoked cigarettes? Do you currently smoke, or have you smoked, cigarettes in the last 30 days?
A current or recent smoker should be asked if they are ready to make a quit attempt in the next 30 days. If yes, the patient’s nicotine dependency should be assessed in terms of how many cigarettes does the patient smoke per day, how soon after waking up does the patient smoke the first cigarette of the day, and does the patient use other types of tobacco or nicotine products.
Some current smokers may have made quit attempts in the past. Prior attempts to quit and why those attempts were unsuccessful, as well as how long the patient was able to maintain abstinence should be included in the health record. These factors may impact smoking cessation plan and the type of support a patient may need in his or her next quit attempt.
However, some patients may not be ready to make a quit attempt. Nurses should encourage the patient who is not ready to quit to discuss their feelings about quitting in an empathetic manner. The guidelines suggest leaving the conversation as an open-ended discussion by setting a future quit date or considering the use of pharmacotherapy to reduce the number of cigarettes smoked per day with a goal of making a quit attempt in the future.