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Evolution of a Systematic Approach to Smoking Cessation in Ontario’s Regional Cancer Centres
Authors:Erin Cameron  Vicki Lee  Sargam Rana  Mohammad Haque  Naomi Schwartz  Sahara Khan  Rebecca Truscott  Linda Rabeneck
Affiliation:1.Prevention & Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada; (V.L.); (S.R.); (M.H.); (N.S.); (S.K.); (R.T.); (L.R.);2.Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;3.Department of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada
Abstract:Smoking cessation after a cancer diagnosis can significantly improve a person’s prognosis, treatment efficacy and safety, and quality of life. In 2012, Cancer Care Ontario (now part of Ontario Health) introduced a Framework for Smoking Cessation, to be implemented for new ambulatory cancer patients at the province’s 14 Regional Cancer Centres (RCCs). Over time, the program has evolved to become more efficient, use data for robust performance management, and broaden its focus to include new patient populations and additional data collection. In 2017, the framework was revised from a 5As to a 3As brief intervention model, along with an opt-out approach to referrals. The revised model was based on emerging evidence, feedback from stakeholders, and an interim program evaluation. Results showed an initial increase in referrals to cessation services. Two indicators (tobacco use screening and acceptance of a referral) are routinely monitored as part of Ontario Health’s system-wide performance management approach, which has been identified as a key driver of change among RCCs. Due to the COVID-19 pandemic, many RCCs reported a decrease in these indicators. RCCs that were able to maintain a high level of smoking cessation activities during the pandemic offer valuable lessons, including the opportunity to swiftly leverage virtual care. Future directions for the program include capturing data on cessation outcomes and expanding the intervention to new populations. A focus on system recovery from COVID-19 will be paramount. Smoking cessation must remain a core element of high-quality cancer care, so that patients achieve the best possible health benefits from their treatments.
Keywords:smoking cessation   program implementation   performance management
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