That smoking causes lung cancer is the most clearly, and most correctly-understood information about cancer development held by the Australian community. That smoking cessation reduces risk of lung cancer is likewise both correct and widely understood. Paradoxically, the business of promoting and achieving smoking cessation by cancer patients is not focused on the prevention of lung cancer, and certainly not an issue for lung cancer patients specifically. The central matter is not the carcinogenicity of tobacco smoke, but its toxicity: its impact as a general poison. Cancer patients who smoke – irrespective of the malignancy or tumour type which has been diagnosed – survive less well than their counterparts who don’t smoke. This dichotomy may be at least partially reduced if cancer patients stop smoking. In 2016, an all-day Cancer Institute NSW symposium provided participants – virtually all of whom were responsible for the provision of clinical care – with unequivocal evidence that smoking cessation by cancer patients was markedly beneficial. This science was not disputed, but subsequent discussion established that responsibility for smoking cessation in the context of multidisciplinary team (MDT)-based cancer care was problematic, both in terms of responsibility and funding.
This scenario, when brought to the attention of COSA Council prompted establishment of a multidisciplinary Working Group. The Group was charged with developing a publication which might bring clarity to the scenario mentioned above and, in response, have provided a COSA publication entitled Smoking Cessation in Cancer Patients: Embedding Smoking Cessation Care in Australian Oncology Health Services. This publication specifies that the provision of individualised and comprehensive smoking cessation care in clinical practice requires a collaborative approach and all members of the oncology MDT should have an agreed role and be able to deliver smoking cessation brief advice. It is essential that there are clear referral pathways to smoking cessation behavioural intervention services in every oncology health service, such as Quitline, or where possible a trained smoking cessation specialist within the service. The general practitioner is also a vital partner in providing smoking cessation care to cancer patients, which includes the delivery of brief advice and providing ongoing follow up.