People with cancer in Canada have better access to evidence-based smoking cessation support than ever before. This is because provinces and territories have made enormous progress implementing smoking cessation supports in cancer care settings. Still, ongoing efforts are needed to help people quit smoking after a cancer diagnosis, including funding to sustain smoking cessation supports and increase access to culturally safer care.
This report describes the impact of a pan-Canadian initiative on the implementation of smoking cessation in cancer care and the current state of smoking cessation support for people with cancer in each province and territory.
Smoking cessation aligns with the priorities of the Canadian Strategy for Cancer Control,a which is stewarded by the Canadian Partnership Against Cancer (the Partnership) in collaboration with provincial, territorial and national partners. Reducing smoking rates in people with cancer also contributes to reducing tobacco use to less than 5 percent by 2035, which is the goal of Canada’s Tobacco Strategy.a
The importance of smoking cessation in cancer care
Quitting smoking after a cancer diagnosis improves people’s survival and quality of life and reduces costs to the healthcare system. This makes smoking cessation support a critical component of first-line cancer treatment and high-quality cancer care.
People who smoke when they are diagnosed with cancer are more likely to die of cancer and other causes compared to people who have never smoked.1 When a person quits smoking, their cancer treatment becomes more effective, their quality of life improves and their chance of survival increases by about 40%.2,3
Quitting smoking can also substantially reduce healthcare costs by reducing the need for additional cancer treatments, treatment of non-cancer medical conditions and hospitalization.4,5 Canada could save $50 to $74 million annually in cancer treatment costs for every 5 percent of people with cancer who quit smoking.6
A national initiative to accelerate implementation
Driven by evidence from the 2014 U.S. Surgeon General’s report on the effects of smoking on people with cancer,1 the Partnership brought tobaccob control and cancer system partners together to increase access to smoking cessation for people with cancer. At that time, Ontario and Manitoba were the only provinces that had systems to help people with cancer quit smoking.
Over the past eight years, provinces and territories have invested in integrating smoking cessation supports into outpatient cancer care settings. Support from the Partnership, which included providing funding and technical assistance, convening a national network, and developing evidence-based resources, accelerated this work.
The Partnership provided provinces and territories project funding, and technical expertise and assistance in two phases. From 2015-17, nine provinces and territories received funding to plan, implement, or evaluate system-level, evidence-based approaches to delivering smoking cessation to people with cancer.
Building on the lessons learned from the first phase, from 2019-23, all 13 provinces and territories received funding to implement, enhance and/or evaluate sustainable smoking cessation supports in cancer care settings. Some partners received additional funding to better support their local populations during the pandemic, such as by mailing out free smoking cessation medications.c
In 2017, the Partnership established the Pan-Canadian Tobacco Cessation and Cancer Care Network (Network) to engage key leaders to integrate smoking cessation and cancer care. The Network included representatives from the cancer system and tobacco control in each province and territory, representatives from the federal government, and patient and family representatives. Network members and funded project teams met twice a year to learn and to exchange knowledge and to promote system change.
The Partnership and the Network collaborated to support the cancer system in implementing smoking cessation by co-developing evidence-based resources:
- Smoking cessation in cancer care Action Framework with performance indicators and an Implementation Checklist
- Progress report on smoking cessation in cancer care across Canada in 2020
- Business case to improve access to smoking cessation medications
- Map of financial coverage of smoking cessation medications
- Peer-reviewed publications on the smoking cessation in cancer care initiative, smoking cessation in cancer care during the pandemic and smoking behaviours of people with cancer
Several provinces and territories provided smoking cessation training to their cancer care staff through the TEACH program at the Centre for Addiction and Mental Health (CAMH). The Partnership funded CAMH to develop an online module for healthcare providers on addressing commercial tobacco use in cancer care settings.
Provinces and territories identified additional factors that supported the success of the initiative:
- Close collaboration between the Partnership and provinces and territories to establish smoking cessation in cancer care as a national priority, and assist them in engaging leadership to support the initiative and make a ‘cultural shift’.
- Engagement and support from leadership and staff at all levels (e.g., provinces and territories, cancer centres and clinics, community programs).
- Clear objectives, phased implementation, and defined indicators.
- Flexibility to design and adapt funded projects based on resources and needs, particularly during the COVID-19 pandemic, which severely affected personnel and project deliverables.
- Inclusion of patient and family advisors who shared their personal experiences.
Sustainability and culturally appropriate care
Cancer care settings in Canada have significantly expanded smoking cessation supports over the last few years. However, work is still needed to help people to quit smoking after a cancer diagnosis, including funding to sustain smoking cessation supports and increase access to culturally appropriate care for First Nations, Inuit and Métis.
An aim of the national initiative was to promote sustainable system change. Most provinces and territories have maintained or improved their smoking cessation supports after completing their funded projects. However, some have been unable to sustain their supports at the same level. For example, some provinces and territories no longer have staff to educate and provide resources to new front-line staff or oversee data collection and analysis; others are no longer able to provide free smoking cessation medications without project funding. In these jurisdictions, sustainable funding is needed to coordinate smoking cessation services in cancer care and offer free smoking cessation medications.
From 2023-27, the Partnership will continue to collaborate with provinces and territories through the Network and work directly with First Nations, Inuit and Métis organizations to support the sustainability, equity, and cultural safety of smoking cessation initiatives in cancer care settings.
The Partnership is committed to working in a reconciliatory way with First Nations, Inuit and Métis to improve the cancer system. The Partnership acknowledges that colonial practices and policies continue to impact the well-being of generations of First Nations, Inuit and Métis. First Nations, Inuit and Métis governments, organizations, and communities are leading the work that will result in improved well-being with the development and implementation of Peoples-specific, self-determined solutions. From 2023-27, the Partnership is supporting First Nations, Inuit, and Métis partners to implement culturally safe smoking cessationd approaches for First Nations, Inuit, and Métis communities. Supporting this work is key to sustainable system change and to closing the gaps in cancer care and outcomes between First Nations, Inuit and Métis and other people in Canada.
aQuebec is not a part of these pan-Canadian strategies.
bIn this report, tobacco refers to commercial tobacco products, not traditional or sacred tobacco. Traditional or sacred tobacco is used by some First Nations or Métis communities in ceremonial or sacred rituals for healing and purifying.
cSmoking cessation medications refers to nicotine replacement therapy and prescription smoking cessation medications (varenicline and bupropion), unless otherwise specified.
dThis refers to cessation of commercial tobacco products, not traditional or sacred tobacco. Traditional or sacred tobacco is used by some First Nations or Métis communities in ceremonial or sacred rituals for healing and purifying.
- U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. The health consequences of smoking – 50 years of progress: a report of the Surgeon General. Atlanta, GA.; 2014.
- U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Smoking cessation. A report of the Surgeon General. Atlanta, GA; 2020.
- U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute. Treating smoking in cancer patients: an essential component of cancer care. National Cancer Institute tobacco control monograph 23. Bethesda, MD; 2022.
- Cartmell KB, Dismuke CE, Dooley M, Mueller M, Nahhas GJ, Warren GW, et al. Effect of an evidence-based inpatient tobacco dependence treatment service on 1-year post-discharge health care costs. Med Care. 2018;56:883-9.
- Cartmell KB, Dooley M, Mueller M, Nahhas GJ, Dismuke CE, Warren GW, et al. Effect of an evidence-based inpatient tobacco dependence treatment service on 30-, 90-, and 180-day hospital readmission rates. Med Care. 2018;56:358-63.
- Iragorri N, Essue B, Timmings C, Keen D, Bryant H, Warren GW. The cost of failed first-line cancer treatment related to continued smoking in Canada. Curr Oncol. 2020;27:307–312.