Patients Prefer Smoking Status Assessment by Oncologists

Patients newly diagnosed with cancer appreciate being asked about their smoking status and many think it should be assessed at each and every oncology clinic visit, Canadian researchers reported at the American Society of Clinical Oncology 2018 Cancer Survivorship Symposium in Orlando, Florida.

“Most cancer patients felt that assessment of smoking status was important, were comfortable being assessed and preferred being assessed directly by their oncologist,” reported lead study author Lawson Eng, MD, of the Princess Margaret Cancer Centre in Toronto, Ontario, Canada, and coauthors.

Patients who continue to smoke tobacco after they are diagnosed with cancer tend to have poorer prognosis than patients who quit smoking. In a survey of 501 newly diagnosed patients who were treated at the Princess Margaret Cancer Centre, the researchers asked about the patients’ smoking history, screening rates, and attitudes and preferences regarding clinicians’ assessment of their smoking status.

Of the 501 patients, 115 (23%) were smokers at the time of diagnosis and 53% had tobacco-associated lung or head and neck cancers. Ninety-five percent reported that smoking status should be assessed at the first oncology clinic visit and more than half (58%) stated that it should be reassessed at each visit. Yet only 40% reported being asked about their smoking status during their first clinic visit and only 12% had been asked their smoking status at each clinic appointment. Patients who were current smokers more often reported being asked about their smoking status at every visit or at most clinic visits, compared with former or never-smokers (36% vs 20%).

Most (87%) patients surveyed thought it important for clinicians to discuss smoking cessation options at the first clinic visit. Survey responses showed a clear patient preference for discussing smoking status and cessation with their oncologist (88%) in person rather than on paper.

Patients with lung cancer were more likely to report that they should be asked about their smoking status at every clinic visit than patients with non–smoking-associated cancers (multivariate adjusted odds ratio, 2.63; 95% CI, 1.0–6.8; P = .05). Older patients, patients undergoing curative therapy, and patients who smoked less were more amenable to undergoing smoking assessments at each clinic visit. Patients also expressed concern about exposure to secondhand smoke.