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

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.