Nurses Must Take the Lead in Tobacco Cessation

November 26, 2021

By Anne Lawton, BSN, RN, NCTTP

Associated with more than a dozen different cancers, tobacco use is the leading cause of cancer and cancer deaths in the United States. The Centers for Disease Control and Prevention (CDC) estimated that 40% of all cancers are linked to tobacco use, and it’s responsible for 30% of cancer deaths in the United States and 22% around the world.

But we have an opportunity to transform those statistics. Even after a cancer diagnosis, smoking cessation improves outcomes and survival, lowers risk for future cancers, and may even improve mortality from other causes. As the most trusted and respected members of the healthcare team, nurses have an important role in tobacco cessation. We must use our training and skills to treat tobacco addiction and use our voices to promote a culture responsive and open to tobacco cessation. 

Why Patients Need to Quit

According to CDC, 9%–18% of U.S. cancer survivors continue to smoke after their diagnosis. Research has shown us that continuing to smoke can negatively impact cancer treatment and survival.

Continued use of tobacco after a cancer diagnosis can decrease treatment effectiveness, increase possible side effects, and raise risk for a second cancer or cancer recurrence. Incorporating tobacco cessation into cancer treatment improves prognosis and reduces treatment costs. Patients must be educated about how tobacco cessation will benefit their overall cancer care and advised that it is not too late to quit despite their cancer diagnosis.

Oncology Nurses Can Help Patients Quit

Nurses are in a perfect position to take on tobacco cessation. Not only do we spend a great deal of time with patients, we also know which patients are the most vulnerable.

Tobacco cessation is within our scope of practice, and lack of tobacco treatment training should not be considered an insurmountable barrier. Providing education and adopting evidenced based guidelines will empower nurses to be proactive in assisting patients to quit tobacco.

In a 2019 study, Sheeran et al. found that "interventions delivered solely by nurses proved more effective than interventions from other sources." Education should also emphasize that tobacco use is a chronic/relapsing disease and that it may take several attempts before someone is tobacco free.

Advocating for an inclusive electronic health record and using it to capacity are vital. Most systems adequately identify patients who require interventions, but clinicians have not dedicated attention to treatment assistance and follow-up. Nurses need to ask about tobacco use at every visit, assess patients’ readiness to quit, advise them to stop smoking, assist in cessation, and arrange follow-up. Systemic follow-up is vital and addresses the reality of tobacco dependence as a treatable, chronic, relapsing condition. 

And We Can Overcome the Systemic Problems

Finally, we need to use our voices to promote a culture responsive and open to tobacco cessation in our practice, healthcare group, and community. “Adopting a cohesive policy of providing smoke-free facilities, supporting tobacco treatment among staff, and tobacco treatment as a standard of clinical care for all patients who smoke should be advocated by institutional leadership as well as with all members of a clinical management team” Rojewski et al. wrote.

Now is the time for nurses to use their skills and voices. November is Lung Cancer Awareness Month and also marks the Great American Smoke Out on November 18, 2021. Use those as a starting point for conversations with your patients and community, and fully embrace tobacco cessation as part of your mission for the overall well-being of our patients.


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