More than 30% of patients with cancer who used tobacco stopped or reduced their use after participating in an oncology nurse–led tobacco cessation program, Rochelle J. Lonn, RN, DNP, NE-BC, OCN®, reported in an article for the February 2024 issue of the Clinical Journal of Oncology Nursing. The author projected that the quit and reduction rates would have a per lifetime savings of $102,600 and a per premature death cost avoidance of $511,200.

As advocates and leaders, “advanced practice nurses serve a critical role in health care as drivers for quality improvement through the implementation of evidence-based practice,” Lonn said. “Specific to this population of patients with cancer, the nurse practitioner (NP)–led smoking cessation program created a pathway to address smoking as a leading cause of preventable death.”

Lonn presented a business case that demonstrated that hiring an NP to lead a smoking cessation program resulted in a positive net revenue, despite salary and benefit costs. After receiving organizational approval, the team built a program around the American Society of Clinical Oncology’s 5 A's of Tobacco Cessation:

  • Ask
  • Advise
  • Assess
  • Assist
  • Arrange

An oncology nurse navigator (ONN) meets with all patients newly diagnosed with cancer for an initial new patient orientation, Lonn said. The ONN refers any patients who report being a current or former smoker to the NP for smoking cessation management. Former smokers receive support because of the potential for relapse with the stress of a new diagnosis. Current smokers who are not ready to quit received reinforced education about smoking cessation and risks associated with continued tobacco use in patients with cancer, and the ONN follows up about their interest in the program one month later. 

The NP provides targeted smoking cessation management using the 5 A’s to develop an individualized quit plan for each patient. In the plan, the NP identifies a time frame and milestones for quitting, offers pharmacotherapy, and refers patients to a social worker or other resources to support smoking cessation, Lonn said

For their pilot program, 66 patients completed the intervention. Nine of them stopped smoking and 11 reduced their use of cigarettes, Lonn said.

“Equipping oncology care clinicians with evidence-based smoking cessation practices serves as a foundation for the interprofessional team and cancer program services to support the provision of quality care that is close to home for communities,” Lonn concluded. “This project supports advanced practice nurses serving an effective role with cancer prevention and screening.”

Lonn’s program demonstrates the far-reaching effects of nurse advocacy on an ONS health policy priority: cancer prevention through tobacco cessation. Learn more about a nurse’s role in advocacy in ONS’s e-cigarettes and vaping position statement and endorsed ISNCC tobacco position statement, then get the tools you need create real change in your community in ONS’s Tobacco, E-Cigarettes, and Vaping Learning Library.