P86 ‘It’s a marathon and not a sprint’– qualitative findings from patients with cancer who smoke/smoked to inform the development of a smoking cessation pathway in cancer services

Background

Despite the well-recognised harms of smoking following a cancer diagnosis, smoking rates remain high, with reported suboptimal uptake of smoking cessation (SC) services by cancer patients. This study explored cancer patient perspectives regarding SC.

Methods

Semi-structured interviews were conducted with 25 cancer patients (from lung, breast, cervical, head & neck & general oncology services) attending four specialist cancer hospitals in Ireland, who were current smokers or had quit at/after diagnosis of cancer. Interviews were completed both in person and virtually on Zoom/Webex due to changing Covid-19 restrictions (2021 to 2022). Thematic analysis was applied to interview transcripts. Extensive patient engagement and data saturation were study strengths, while study limitation was lower recruitment of cervical and lung cancer patients.

Results

Five themes emerged: (1) Striving but struggling to quit: patients described multiple unsuccessful attempts in the past to quit a lifelong smoking habit despite frequent quit advice from doctors which participants noted was often ignored by them; infrequent SC supports were noted. (2) Diagnosis a shock but a cue to action: a cancer diagnosis prompted an attitude change towards smoking and most patients described a willingness to stop smoking with many quitting following brief advice from healthcare professionals (HCPs); however, some noted increased smoking to cope with the stress of diagnosis. (3) HCPs non-judgemental, but support variable: after diagnosis, most patients received frequent non-judgemental quit advice from HCPs but with inconsistent depth, emphasis and planning. Nicotine replacement therapy and passive information on SC interventions/services in the form of SC leaflets were the most common SC supports offered. Very few patients received a formal SC intervention with variable views on its effectiveness. (4) Facilitators and barriers to SC exist: facilitators included some self-help techniques which distracted from smoking, vaping, self-determination, family/HCP support, accountability to HCPs; barriers included smoking environment, lack of awareness and provision of SC supports. (5) SC is a marathon, not a sprint: Patients described their perspective regarding excellent SC support in terms of an effective SC pathway/service. The need for a multi-dimensional approach, early and frequent conversations including quit advice, proactive referrals to and sustained support of specialist SC service incorporating affordable pharmacological and tailored and empowering psychosocial interventions were suggested.

Conclusion

Cancer patients who smoke want interventions to help them quit smoking. Tailored comprehensive SC services should be integrated into cancer care to assist cancer patients who find it difficult to quit a lifelong smoking habit.