A national audit of smoking cessation services in adult specialist cancer care hospitals in Ireland

ABSTRACT

BackgroundDespite the progress made in smoking reduction in Ireland, smoking remains a challenge, particularly in cancer patients where post-diagnosis smoking has detrimental impacts on treatment and survival. This audit was of existing hospital smoking cessation services (SCS) for all patients (including cancer) at the eight specialist adult cancer hospitals (tertiary referral university hospitals) and one specialist radiotherapy hospital.MethodsAn audit was conducted online, completed by smoking cessation (SC)/health promotion officers at each hospital in 2021, with questions based on literature review and the (first) consultative National Clinical Stop Smoking Guideline (published 2022).ResultsOne hospital did not participate due to unavailability of relevant staff. SCS were provided at 7 of 9 (77.8%) hospitals, predominantly to inpatients on admission or during hospital stay (5;55.5%) but also at lower rate at discharge (3;33.3%) and in outpatients (4;44.4%). SCS were provided in the main by medical, nursing and hospital SC officers (6;66.6%);just 44.4%% noted alignment with community SC (for ongoing support). SCS provided included brief intervention and or ongoing support (6;66.6%), intensive support (4;44.4%), follow up phone support (2;22.2%). SCS were delivered mainly (pre-COVID) as individual face-to-face (5;55.5%) but phone (4;44.4%), online (3;33.3%) and group work (1;11.1%%) were also utilised. Nicotine Replacement Therapy was the first-choice in 2021 which almost all provided (7;77.8%), with fewer offering varenicline (5;55.5%) or bupropion (2;22.2%). SCS was promoted on the hospital website in 55.5% despite hospital campuses being smoke-free, however, SC information was provided in appointment letters. Most hospitals (6;66.6%) provide/promote SC training;and 4 (44.4%) have staff trained to deliver intensive stop-smoking advice.Six (66.6%) of 9 hospitals provided SCS to cancer patients attending outpatient clinics, day units, inpatients or other departments (e.g., radiology, emergency). However, many hospitals noted low referral rates for cancer patients. While 6 hospitals recorded data on overall SCS uptake, one recorded it specifically for cancer patients. Cancer patients who smoke are automatically referred to SCS (at diagnosis/when starting systemic anti-cancer therapy/radiotherapy) and routinely prescribed SC medications at one hospital. Few oncology staff had received SC intervention training.ConclusionA hospital visit/admission provides a cue to action for smokers and is an important opportunity for brief intervention by healthcare professionals to promote SC. This first National Clinical Guideline should assist necessary strengthening of hospital SCS and promote smoking cessation support, particularly among cancer patients.