Pre-Implementation Module – Why This Matters

Why This Matters: Tobacco Use During Cancer Care

Tobacco use is rarely addressed during cancer treatment despite evidence that continued use is associated with many negative cancer outcomes, including poor wound healing, complications, cancer recurrence, new cancers, and higher death rates. Quitting tobacco use can benefit patients in all stages of cancer care and help people live longer (U.S. National Cancer Institute, 2022). Tobacco cessation also improves other adverse health outcomes, including cardiovascular diseases, chronic obstructive pulmonary disease (COPD), and reproductive health outcomes (Office of the Surgeon General, 2020).

Many factors contribute to the undertreatment of tobacco use. Some of these are challenges in all care contexts, such as lack of clinician time, lack of clinician confidence, lack of efficient and sustainable workflows, and pessimism regarding patient receptivity or tobacco treatment effectiveness. Others are heightened in the context of cancer, such as stigma, fatalism, patient stress, and treatment toxicity. The Health Experiences Research Network’s Smoking and Cancer catalyst film shares patients’ experiences with smoking and tobacco cessation in the complex context of cancer care, which can inform the implementation of quality, patient-centered tobacco treatment services.

Tobacco use is a chronic, relapsing condition. Although many patients quit using tobacco soon after learning of their cancer diagnoses, about half continue to use tobacco after diagnosis, and many who quit at diagnosis eventually relapse to tobacco use (U.S. National Cancer Institute, 2022). Treating tobacco effectively requires system changes to support chronic or repeated cycles of tobacco treatment care.

Case studies in this guide provide examples of ways cancer programs met these challenges and successfully affected systems changes to integrate tobacco treatment in cancer care. Although no program convinces 100% of their patients to quit using tobacco, these programs help many patients with cancer quit and reduce their harm from tobacco use (D’Angelo et al., 2022; Ramsey et al., 2022).