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Tobacco Treatment Specialists Across Healthcare: Spotlight on Cancer Care

This occasional series highlights some of the practice areas where tobacco treatment specialists (TTS) work and offers tips for treating tobacco use within a specific population. In this post we explore why tobacco cessation services are an essential component of cancer care and offer tips for tailoring your message to this complex population.

Tobacco use is a major modifiable risk factor for cancer, and a large body of evidence shows that quitting or reducing smoking during cancer treatment improves outcomes. Despite these facts, many cancer centers still aren’t integrating smoking cessation as a routine part of cancer care. In fact, only 50% of oncologists advise their patients to quit smoking, and even fewer connect patients with services to help them quit.

Megan Keith, LCSW, MSW

The National Cancer Institute (NCI) recently released its Tobacco Control Monograph 23—Treating Smoking in Cancer Patients: An Essential Component of Cancer Care. It asserts that “quitting smoking is among the most effective treatment options for improving the likelihood of survival, quality of life, and overall health of people with cancer who smoke.”

We spoke with two tobacco treatment specialists who work regularly with cancer patients through the Duke Smoking Cessation Program. Kelly Young, a physician assistant, and Megan Keith, a licensed clinical social worker, shared their expertise and tips for tailoring smoking cessation care to this complex population.

Kelly Young, PA-C

Both Megan and Kelly acknowledge that it can be challenging to work with patients facing a new cancer diagnosis. They have many appointments and medical obligations, and it can be overwhelming for them to think about quitting smoking.

"For patients undergoing active treatment, I focus on how to navigate this very stressful time of life while taking away one of their primary coping strategies—smoking. Acknowledging this is big,” said Megan, who has lost several family members to tobacco-related cancers and feels a personal connection to this population.

A lot of cancer patients have shame about smoking. Addressing that this stigma exists and that I’m here to help and not judge is important. – Megan Keith, LCSW, TTS

“I try to focus on benefits of quitting smoking now with a cancer diagnosis,” said Kelly, who noted several benefits laid out in the National Cancer Institute (NCI)’s recently released Tobacco Control Monograph 23—Treating Smoking in Cancer Patients: An Essential Component of Cancer Care.

The report highlights the following benefits of quitting smoking after a cancer diagnosis:

  • Reduced all-cause mortality and cancer-specific mortality

  • Decreased risk of cancer recurrence and developing a secondary primary cancer

  • Less adverse treatment outcomes, including improved response to chemo and radiation, less medication side effects, improved healing after surgery, and post-operative pulmonary complications

  • Decreased overall healthcare costs

Kelly also noted that it’s vital to work closely with the patient’s oncology team because of the complexity of these patients’ medical care. “Providers are dealing with so many things. It is helpful for me to come in as a specialist and take smoking cessation off of their plate. Teams are always so receptive to that collaboration.”

In a cancer care setting, sometimes patients are referred by an oncologist or a surgeon and aren’t necessarily ready or motivated to quit. Megan’s advice for approaching these challenging cases: “Many of our patients are being talked at a lot. They don’t have a lot of choices or input. I see my primary role as a listener, to hear where they are at and where they want to go.”

Building a relationship with these patients is key, Megan adds. “Sometimes as tobacco treatment specialists we get caught up in the assessment and treatment plan, but it really is most important to have a relationship with your patient. When you hit a wall or patients aren’t making progress, if you come back to the relationship and focus on that, things can come to light that you missed before.”

Kelly and Megan find a lot of meaning in helping patients navigate the complexities of their cancer care.

“It’s really rewarding when patients sometimes feel like it’s an impossible task to quit, and you can come along beside them, helping them breakdown the process into small, easy steps, and they make progress,” Kelly said.

Ready for more evidence-based tobacco treatment knowledge? Don’t miss our upcoming comprehensive TTS Training, November 7-15, 2022. Click here to register!

About The Author Rachael Joyner is a family nurse practitioner with the Duke Smoking Cessation Program. She holds a National Certificate in Tobacco Treatment Practice and received her Doctorate in Nursing Practice from the University of Florida. She loves working collaboratively with patients to help them become tobacco free.


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