When a person is diagnosed with cancer, quitting smoking – alongside anti-cancer therapies – improves survival, recovery, and quality of life. Yet despite clear evidence and clinical guidelines, smoking cessation remains a neglected part of oncology care in Australia.
A new cross-sectional study by Christine Paul from the University of Newcastle and her colleagues reveals a concerning shortfall in how healthcare professionals address tobacco use in cancer patients. The research, titled “Smoking Cessation Practices in Australian Oncology Settings: A Cross-Sectional Study of Who, How, and When”, published in the Asia-Pacific Journal of Clinical Oncology, examines how and when oncology staff provide smoking cessation support and why this life-saving intervention often fails to reach patients who need it most.
Quitting after a cancer diagnosis saves lives
Smoking cessation after a cancer diagnosis has been repeatedly linked to improved treatment outcomes, lower recurrence rates, and longer survival. Continuing to smoke, on the other hand, increases the risk of complications, treatment toxicity, and the development of secondary cancers.
International and national oncology bodies, including the Clinical Oncology Society of Australia (COSA) and the National Comprehensive Cancer Network (NCCN), recommend integrating smoking cessation care as a routine part of oncology practice. The standard approach, known as the 3A’s model, urges healthcare providers to Ask about smoking, Advise on the benefits of quitting, and Act (or Help) by referring patients to cessation services or prescribing pharmacotherapy.
However, despite policy frameworks and growing awareness, the delivery of best-practice smoking cessation support remains inconsistent. According to Young and colleagues, this inconsistency undermines both patient outcomes and broader public health goals aimed at reducing tobacco-related disease burden in cancer populations.
Who, how, and when: what the study found
The research team surveyed 177 healthcare professionals across nine cancer centres in New South Wales and Victoria as part of the Care to Quit trial. Respondents included oncologists, nurses, and allied health practitioners working in hospital-based oncology units.
More than half of the participants reported asking their patients about smoking, and nearly 60% advised them to quit. Yet fewer than one in ten said they regularly referred patients to Quitline or prescribed nicotine replacement therapy (NRT). Only 3% were prescribed varenicline or referred to a general practitioner for this medication.
Doctors were significantly more engaged in all three components of the 3A’s model compared to nurses or allied health professionals. Specifically, doctors were seven times more likely than registered nurses to provide comprehensive smoking cessation care. Those with formal cessation training were nearly four times more likely to act on smoking cessation support compared to untrained staff.
Training and knowledge
The findings underscore the vital importance of professional training. Only 15% of healthcare professionals reported receiving smoking cessation education specific to oncology, while 24% had any form of general cessation training.
Among doctors who did not prescribe NRT or varenicline, the most common reason was simply not knowing how. Others cited lack of time or low prioritisation of cessation relative to immediate cancer treatment. Nurses, meanwhile, often viewed pharmacotherapy as outside their clinical remit, highlighting the need for clearer role definitions and interprofessional collaboration.
According to the study, this training gap translates into missed opportunities. Patients who receive advice, follow-up, and active assistance to quit smoking are significantly more likely to succeed. Yet without equipping clinicians with the necessary skills and confidence, the cancer care system continues to fall short of its potential to improve survival through integrated smoking cessation support.
When should clinicians act?
One of the key questions the researchers explored was the timing of cessation intervention. Nearly nine out of ten respondents agreed that smoking cessation should begin at diagnosis, with many also viewing treatment and post-treatment phases as appropriate windows.
This consensus aligns with growing evidence that quitting at any stage, even after treatment initiation, can improve both survival and quality of life. Smoking cessation has been shown to reduce radiation toxicity, improve surgical recovery, and enhance the effectiveness of chemotherapy.
Despite this, follow-up remained limited. Less than a third of clinicians said they routinely re-checked smoking status or followed up on whether patients had engaged with cessation services. Such missed follow-ups weaken the continuity of care and reduce the likelihood of sustained quitting.
What patients hear: Cancer-specific advice
The study also examined the type of messages healthcare providers deliver when advising patients to quit. Doctors were more likely to emphasise treatment outcomes and overall survival, while nurses and allied health professionals focused on quality-of-life improvements such as reduced breathlessness or improved taste.
Although both forms of advice have merit, the researchers stress the need to personalise messaging to each patient’s diagnosis and treatment plan. Evidence shows that when patients understand the direct medical benefits of quitting, such as improved radiotherapy response or reduced postoperative complications, they are more likely to attempt cessation.
Yet even when advice is offered, the absence of pharmacological or behavioural support limits success. According to previous studies, merely advising patients to quit increases long-term abstinence by around 47%, but combining advice with medication or counselling yields substantially higher quit rates.
The systemic challenge
One of the most revealing aspects of the study is how clinicians perceive smoking cessation within the context of cancer care. Many described cessation as a “low priority” compared to treating acute disease, reflecting a persistent cultural divide between oncology and preventive medicine.
This perception is not unique to Australia. Similar patterns have been documented in Europe and North America, where oncologists often see smoking cessation as important but secondary to immediate cancer management. However, researchers argue that cessation support should be viewed as integral to treatment rather than an optional add-on.
Training in prescribing or supporting pharmacotherapies, alongside behavioural referral, is a critical gap that demands attention. Doctors and nurses engage differently in cessation care, but both roles are essential in improving patient outcomes.
-Christine Paul
Moving towards integrated care
The study advocates for an integrated model of oncology practice that incorporates smoking cessation as a standard of care, rather than a discretionary service. This would involve regularly equipping all oncology staff with evidence-based training, simplifying referral systems to services like Quitline, and normalising cessation conversations at every stage of cancer care.
Australia has made progress in reducing national smoking rates, but these gains are not evenly reflected in oncology settings. Cancer patients who continue to smoke face poorer prognoses, yet they remain among the least likely to receive structured cessation support.
By reframing smoking cessation as part of cancer treatment rather than lifestyle counselling, healthcare systems could improve patient survival and quality of life. As the researchers emphasise, empowering clinicians with knowledge, time, and institutional support could close this longstanding care gap.
Reference
Young, A. L., McEnallay, M., Day, F., Vinod, S. K., Stone, E., Morris, S., Stefanovska, E., Devitt, B., Yip, P. Y., Kukard, C., Pal, A., Thawal, V., Wright, G., Hofman, A., Sareen, H., McLennan, J., Wong, S. O., Rubio, C., Liu, J., Smith, A., Betts, D., Mack, J., Donnelly, J., & Paul, C. (2025). Smoking cessation practices in Australian oncology settings: A cross-sectional study of who, how, and when. Asia-Pacific Journal of Clinical Oncology, 21, 290–299. https://doi.org/10.1111/ajco.14148
