Oncology APRNs Are Change Agents for Tobacco Cessation
Whether by cigarette, pipe, cigar, or vaping device, tobacco use is a major risk factor (https://doi.org/10.1016/j.jtocrr.2021.100182) for the development of many cancers; increases cancer mortality, risk of recurrence, and second primary cancers; adversely affects treatment outcomes for surgery, radiation, and chemotherapy; and affects other chronic health conditions. Initiating smoking cessation at the time of a lung cancer diagnosis (https://doi.org/10.1016/j.jtocrr.2021.100182) improves overall survival by 30%–40%, yet 40%–50% of smokers continue to use tobacco after diagnosis.
Oncology advanced practice RNs (APRNs) have a critical opportunity to improve access and adherence to tobacco cessation treatment (https://dx.doi.org/10.1016/j.jtcvs.2017.07.086) for many reasons: providing higher quality care, improving clinical outcomes, and contributing to positive financial outcomes.
Patients With Cancer Are Motivated to Quit
Medical professionals often report that their patients aren’t interested in stopping their use of tobacco, but evidence suggests otherwise: Patients with cancer are actually more motivated to quit than the general population (https://doi.org/10.1159/000489266), although they struggle to find a successful strategy. Oncology providers report discussing medications for tobacco cessation with only 40% of smokers. Compared to advice alone, providing cessation medications increases the success rate for quit attempts by 39% (https://doi.org/10.1159/000489266) and providing behavioral support improves success by 69% (https://doi.org/10.1159/000489266). Yet providers report facing obstacles (https://doi.org/10.1177/26334895221112153) such as knowledge, relative priority and time, and access to resources.
Influence Outcomes in Tobacco Cessation
In clinical practice, oncology APRNs can lead by example by implementing the five A’s:
- Ask all patients about their use of tobacco.
- Advise users to quit.
- Assess their readiness for a quit attempt.
- Assist patients with quitting.
- Arrange a follow up.
To make a broader difference at the institutional level, oncology APRNs can:
- Establish cessation intervention standards.
- Participate in efforts to develop a tobacco cessation program.
- Educate patients and colleagues about community-based cessation programs.
Bringing together stakeholders with expertise and interest in tobacco cessation is particularly important, such as oncology APRNs, staff nurses, physicians, respiratory therapists, information technology specialists, and community partners.
Tobacco cessation is a part of cancer screening programs, and your organization may already have many resources. Oncology APRN-focused educational programs can also increase your knowledge of tobacco dependence and evidence-based interventions and improve your confidence and skills in motivational interviewing and behavioral support.
See the sidebar for educational, implementation, and health policy resources.
Make Tobacco Cessation Part of Your Standard Practice
Professional organizations such as ONS (https://www.ons.org/make-difference/ons-center-advocacy-and-health-policy/position-statements/isncc-tobacco-position) and the American Society of Clinical Oncology (https://old-prod.asco.org/news-initiatives/current-initiatives/prevention-survivorship/tobacco-cessation-control), National Comprehensive Cancer Network (https://www.nccn.org/), and Joint Commission (https://www.jointcommission.org/measurement/measures/tobacco-treatment/) recommend tobacco cessation strategies.
Meaningful use documentation requires institutions with electronic health records (EHRs) to assess tobacco use in every patient, including smoking status, tobacco history, interest in smoking cessation counseling, and previous counseling. Despite that requirement, providers have very little guidance on how to implement and document cessation counseling (https://doi.org/10.1188/18.CJON.259-261).
Providers can use EHRs to augment their tobacco cessation activities (https://doi.org/10.3389/fpubh.2020.00221) by reminding patients to record their tobacco use, providing patient education for quitting, prescribing tobacco cessation medications, and automatically referring patients to quit programs. Some U.S. states also offer incentives for billing for tobacco cessation counseling, so check your local guidelines.
As part of cancer program quality improvement, tobacco cessation efforts contribute to cancer program accreditation activities for cancer survivors and must be routinely integrated into cancer care.