SIDEBAR: Ask Patients about Their Smoking Status  

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Some providers were very sensitive to the stigma that cancer patients may feel with regard to their smoking, and others may not have as much sensitivity as needed.

—Vani Nath Simmons, PhD

“Receiving a cancer diagnosis represents a ‘teachable moment’ for delivering smoking cessation and relapse prevention interventions,” concluded a study in the journal Cancer1 about smoking relapse in patients with thoracic cancer or head and neck cancer. Previous research by two of the study’s authors, Vani Nath Simmons, PhD, and Thomas H. Brandon, PhD, of the Health Outcomes and Behavior Department at H. Lee Moffitt Cancer Center in Tampa, Florida, and their colleagues at the University of South Florida, showed that oncologists and other health-care professionals may not be fully capitalizing on that teachable moment.

Patient-Provider Disconnect

In-depth interviews with 20 patients with lung and head and neck cancer and 11 health-care providers2 “found a bit of a disconnect between patients and providers with regard to the type of risk information” being communicated, Dr. Simmons told The ASCO Post.  

“We found that patients reported that their providers may mention that there are some long-term risks associated with smoking, such as the chance of cancer recurrence, but the message that was not getting out was that there are more acute, immediate effects for cancer patients who continue to smoke,” he said. “For example, patients may have greater risk of treatment complications or their treatment may be less effective. They may have greater side effects or poorer wound healing. Those are just some examples of some of the more immediate consequences that patients face.”

A later study asked 81 patients with thoracic cancer and 87 with head and neck cancer to assess whether oncology health-care providers were following Public Health Service guidelines to use the “5A’s” model of brief smoking cessation intervention: “(1) ask all patients whether they use tobacco, (2) advise all smokers to quit, (3) assess smokers’ willingness to quit, (4) assist smokers with quitting, and (5) arrange follow-up contact to prevent relapse.”3

“We found that providers were doing a good job in terms of asking about tobacco use, and advising smokers to quit. However, only half were assessing somebody’s willingness to quit, and in terms of actually assisting in the quit attempt and arranging for some sort of follow-up, that is where things seemed to really fall off. So there is definitely a lot of room for improvement,” Dr. Simmons stated.

“Overall, patients reported that physicians implemented the 5A’s to a greater degree than staff,” according to the study report. “Patients were more likely to report that physicians asked their smoking status, advised them to quit, and assisted them in quitting by writing them a prescription,” the report continued.

Provider’s Role

“In speaking to providers, one of the issues was that they feel that they are not prepared, that it is somebody else’s role, perhaps, to deal with the smoking,” Dr. Simmons continued. “There is definitely a need for more research in this area, because we did find a lot of variability in terms of how providers talked about smoking with their patients. Some providers were very sensitive to the stigma that cancer patients may feel with regard to their smoking, and others may not have as much sensitivity as needed for that topic.”

Dr. Brandon, who serves on the American Association for Cancer Research Tobacco and Cancer Subcommittee, said, “We are working on a policy statement right now regarding the importance of assessing and treating tobacco dependence in patients with cancer.” He said that he expects that statement to be published within the next few months. ■


1. Simmons VN, Litvin EB, Jacobsen PB, et al: Predictors of smoking relapse in patients with thoracic cancer or head and neck cancer. Cancer. December 20, 2012 (early release online).

2. Simmons, VN, Litvin EB, Patel RD, et al: Patient-provider communication and perspectives on smoking cessation and relapse in the oncology setting. Patient Educ Couns 77:398-403, 2009.

3. Simmons, VN, Litvin EB, Unrod M, Brandon TH: Oncology healthcare providers’ implementation of the 5A’s model of brief intervention for smoking cessation: Patients’ perceptions. Patient Educ Couns 86:414-419, 2012.

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