Smoking cessation for cancer patients through the lens of cancer specialists: challenges & solutions

Abstract Background The benefits of smoking cessation (SC) for cancer patients are widely recognised. However, there has been a limited emphasis on SC in this context and it continues to be a challenge for cancer patients. As part of a larger feasibility study aiming to develop a structured SC pathway for cancer patients in Ireland, this qualitative study explored the SC practices, experiences and opinions of oncology healthcare professionals (HCPs). Methods Semi-structured interviews were conducted with 18 HCPs from lung, breast, cervical, head and neck and general oncology, across 4 specialist adult cancer hospitals in Ireland. Interview transcripts were analysed using thematic analysis. Results Four key themes emerged: (1) Frequently ask and advise but infrequently assist: most HCPs ask about smoking and many advise about available supports, but few refer patients to SC services. Where offered, referrals were to hospital SC services and/or nicotine replacement therapy was prescribed; no HCP prescribed varenicline or bupropion. Barriers included lack of time, ill-defined referral pathways and lack of knowledge. (2) Increased willingness but differing ability to quit: most patients were interested in quitting post diagnosis and had varying support needs, linked to cancer stage, social circumstances and stress levels. (3) Need for an integrated or parallel service: all HCPs suggested that a structured and defined referral pathway will facilitate SC. (4) Motivational counselling and pharmacotherapy combination: many HCPs suggested face to face as the best mode of intervention initially, with regular follow ups and ongoing support virtually, started pre-treatment, with an empathetic and empowering approach with provision of both motivational counselling and SC pharmacotherapy. Conclusions Smoking post cancer diagnosis has serious implications for cancer treatment and prognosis but is frequently overlooked. These findings will inform the design of a SC pathway for cancer patients. Key messages • Despite increased willingness to quit, there is inadequate and inconsistent SC support provision for cancer patients. • Tailored SC support should be an integral part of comprehensive cancer care.


Background:
The benefits of smoking cessation (SC) for cancer patients are widely recognised. However, there has been a limited emphasis on SC in this context and it continues to be a challenge for cancer patients. As part of a larger feasibility study aiming to develop a structured SC pathway for cancer patients in Ireland, this qualitative study explored the SC practices, experiences and opinions of oncology healthcare professionals (HCPs).

Methods:
Semi-structured interviews were conducted with 18 HCPs from lung, breast, cervical, head and neck and general oncology, across 4 specialist adult cancer hospitals in Ireland. Interview transcripts were analysed using thematic analysis.

Results:
Four key themes emerged: (1) Frequently ask and advise but infrequently assist: most HCPs ask about smoking and many advise about available supports, but few refer patients to SC services. Where offered, referrals were to hospital SC services and/or nicotine replacement therapy was prescribed; no HCP prescribed varenicline or bupropion. Barriers included lack of time, ill-defined referral pathways and lack of knowledge.
(2) Increased willingness but differing ability to quit: most patients were interested in quitting post diagnosis and had varying support needs, linked to cancer stage, social circumstances and stress levels.
(3) Need for an integrated or parallel service: all HCPs suggested that a structured and defined referral pathway will facilitate SC.
(4) Motivational counselling and pharmacotherapy combination: many HCPs suggested face to face as the best mode of intervention initially, with regular follow ups and ongoing support virtually, started pre-treatment, with an empathetic and empowering approach with provision of both motivational counselling and SC pharmacotherapy.

Conclusions:
Smoking post cancer diagnosis has serious implications for cancer treatment and prognosis but is frequently overlooked. These findings will inform the design of a SC pathway for cancer patients. Key messages: Despite increased willingness to quit, there is inadequate and inconsistent SC support provision for cancer patients. Tailored SC support should be an integral part of comprehensive cancer care.

Background:
Health education for promoting healthy lifestyle from early ages is considered to be important. However, this issue has not been thoroughly examined in Georgia. The research, undertaken on adolescents, aimed to analyse adolescents' lifestyle, awareness and attitudes towards healthy lifestyle.

Methods:
The study applied a mixed methods design and included both, qualitative and quantitative research methods. 145 students aged 17 to 23 years participated in the research. In order to evaluate the adolescent's perceptions and attitudes, qualitative individual interviews with university students were conducted. For the quantitative method, a self-administered questionnaire assessing the level of adolescents' awareness and attitudes towards healthy lifestyle was developed.

Results:
This section presents preliminary findings of the study. We found that more than 67% of adolescents were aware on the importance of healthy lifestyle. However, most of the participants did not transfer their knowledge into practice. The participants found it challenging to maintain healthy eating habits due to increased costs of healthy, organic food. The study also confirmed the need for integrated work of public, governmental, and non-governmental organizations to initiate and implement health promotion programs for children and adolescents.

Conclusions:
Overall, the study found that even though adolescents are aware about the importance of the healthy lifestyle, it is challenging for them to maintain it. In order to change adolescents' attitudes towards unhealthy behaviour, it is necessary to carry out targeted interventions.

Key messages:
Health education is a necessary component for healthy lifestyle. Healthy lifestyle requires careful study of the issue and making evidence-based conclusions.