# Stop-smoking treatment offered to every person who smokes at a cancer diagnosis, as part of cancer care

Source: https://onco.cc/ideas/idea-upgrade-stop-smoking-treatment-at-diagnosis/  
OnCo record `idea-upgrade-stop-smoking-treatment-at-diagnosis` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Quitting smoking around a lung cancer diagnosis is linked to longer survival, and in a randomised trial of people newly diagnosed with cancer, longer counselling with free medicine raised the six-month quit rate from about one in five to one in three. In a survey of 762 accredited United States cancer programmes, 17.6 per cent regularly prescribed stop-smoking medicine.

## Summary

The randomised trial. Park and colleagues randomised 303 people who smoked and had recently been diagnosed with one of eight common cancers at two United States cancer centres. Both groups received four weekly telephone counselling sessions and medication advice; the intensive group also received further sessions over the following months and their choice of free nicotine replacement, bupropion or varenicline. Biochemically confirmed quit rates at six months were 34.5 per cent against 21.5 per cent (odds ratio 1.92).

What quitting is associated with. A 2022 meta-analysis of 21 observational studies including more than 10,000 people with lung cancer found that quitting at or around diagnosis was associated with better overall survival (summary relative risk 0.71, 95 per cent confidence interval 0.64 to 0.80), consistently in non-small-cell and small-cell disease. These are cohort comparisons, not randomised ones, which is why the grade here is moderate.

The measured gap. A baseline survey of 762 Commission on Cancer and breast-centre accredited programmes found 89.9 per cent regularly asked about smoking and 71.2 per cent advised quitting, but 41.3 per cent regularly helped patients quit, 18.2 per cent provided individual counselling and 17.6 per cent regularly prescribed medication; lack of trained staff (68.8 per cent) and of designated specialists (61.9 per cent) were the commonest barriers. Across 28 National Cancer Institute centres funded to build tobacco treatment programmes, a median of 96 per cent of patients were screened for tobacco use, but median reach, the proportion of people who smoked receiving any evidence-based treatment, was 15.4 per cent.

## Fields

- Kind: Idea
- Last checked: 2026-10-20
- Tags: protocol-upgrade; upgrade:proven-unevenly-used; evidence:moderate
- Hypothesis: An opt-out tobacco treatment pathway at cancer diagnosis, in which everyone recorded as smoking is referred to a tobacco specialist and offered medication unless they decline, raises treatment reach above 50 per cent and six-month verified abstinence above the rates seen with ask-and-advise practice.
- Rationale: The screening step already happens almost everywhere; the gap is between knowing someone smokes and treating it. The trial shows what sustained treatment achieves in exactly this population, and the surveys show where the pathway breaks.
- Proposed test: A cluster-randomised comparison of opt-out referral against usual ask-and-advise practice across cancer centres, with reach and biochemically verified abstinence at six months as co-primary endpoints and treatment complications and survival as long-term outcomes.
- Maturity: being-tested-at-scale
- Actor: clinic

## Sources

- Park et al., Sustained Smoking Cessation Counseling and Medication vs Shorter-term Counseling in Patients Recently Diagnosed With Cancer: a randomized clinical trial (JAMA 2020): https://doi.org/10.1001/jama.2020.14581
- Caini et al., Quitting Smoking At or Around Diagnosis Improves the Overall Survival of Lung Cancer Patients: a systematic review and meta-analysis (J Thorac Oncol 2022): https://doi.org/10.1016/j.jtho.2021.12.005
- Ostroff et al., Current Practices, Perceived Barriers, and Promising Implementation Strategies for Smoking Cessation Support in Accredited Cancer Programs of the American College of Surgeons (JCO Oncol Pract 2024): https://doi.org/10.1200/OP.23.00393
- Hohl et al., Integrating Tobacco Treatment Into Oncology Care: reach and effectiveness across NCI-designated cancer centers (J Clin Oncol 2023): https://doi.org/10.1200/JCO.22.00936

## Connected records

- ideas: [Every lung screening visit includes stop-smoking medicine, opt-out](https://onco.cc/ideas/idea-prev-opt-out-cessation-in-lung-screening/), [Put cytisine, a cheap plant-based quit-smoking pill, on every essential medicines list](https://onco.cc/ideas/idea-prev-cytisine-essential-medicine/)
- cancers: [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/)
- fronts: [Prevention & Risk](https://onco.cc/fronts/prevention/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Smoking cessation in cancer patients](https://onco.cc/technologies/smoking-cessation-after-diagnosis/)
- terms: [Stopping smoking](https://onco.cc/terms/smoking-cessation/)
- bottlenecks: [Knowledge reaches practice too slowly](https://onco.cc/bottlenecks/b-knowledge-diffusion/), [Prevention we already have is not deployed](https://onco.cc/bottlenecks/b-prevention-adoption/)

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