{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T07:58:30Z","timestamp":1793347110419,"version":"4.5.0"},"reference-count":54,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,3,24]],"date-time":"2022-03-24T00:00:00Z","timestamp":1648080000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ontario Ministry of Health"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Patients who achieve smoking cessation following a cancer diagnosis can experience an improvement in treatment response and lower morbidity and mortality compared to individuals who continue to smoke. It is therefore imperative for publicly funded cancer centres to provide appropriate training and education for healthcare providers (HCP) and treatment options to support smoking cessation for their patients. However, system-, practitioner-, and patient-level barriers exist that hamper the integration of evidence-based cessation programs within publicly funded cancer centres. The integration of evidence-based smoking cessation counselling and pharmacotherapy into cancer care facilities could have a significant effect on smoking cessation and cancer treatment outcomes. The purpose of this paper is to describe the elements of a learning health system for smoking cessation, implemented and scaled up in community settings that can be adapted for ambulatory cancer clinics. The core elements include appropriate workflows enabled by technology, thereby improving both practitioner and patient experience and effectively removing practitioner-level barriers to program implementation. Integrating the smoking cessation elements of this program from primary care to cancer centres could improve smoking cessation outcomes in patients attending cancer clinics.<\/jats:p>","DOI":"10.3390\/curroncol29040183","type":"journal-article","created":{"date-parts":[[2022,3,25]],"date-time":"2022-03-25T00:05:18Z","timestamp":1648166718000},"page":"2252-2262","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Smoking Cessation Training and Treatment: Options for Cancer Centres"],"prefix":"10.3390","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4325-8354","authenticated-orcid":false,"given":"Wayne K.","family":"deRuiter","sequence":"first","affiliation":[{"name":"Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON M6J 1H4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2774-4395","authenticated-orcid":false,"given":"Megan","family":"Barker","sequence":"additional","affiliation":[{"name":"Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON M6J 1H4, Canada"},{"name":"Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 1M7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alma","family":"Rahimi","sequence":"additional","affiliation":[{"name":"Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON M6J 1H4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Ivanova","sequence":"additional","affiliation":[{"name":"Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON M6J 1H4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurie","family":"Zawertailo","sequence":"additional","affiliation":[{"name":"Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON M6J 1H4, Canada"},{"name":"Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Medical Sciences Building, Room 4207, 1 King\u2019s College Circle, Toronto, ON M5S 1A8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osnat C.","family":"Melamed","sequence":"additional","affiliation":[{"name":"Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON M6J 1H4, Canada"},{"name":"Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON M5G 1V7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5401-2996","authenticated-orcid":false,"given":"Peter","family":"Selby","sequence":"additional","affiliation":[{"name":"Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON M6J 1H4, Canada"},{"name":"Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 1M7, Canada"},{"name":"Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON M5G 1V7, Canada"},{"name":"Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,24]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2021). The Top 10 Causes of Death, World Health Organization."},{"key":"ref_2","unstructured":"Government of Canada, Statistics Canada (2021, November 30). Smoking, 2019, Available online: https:\/\/www150.statcan.gc.ca\/n1\/pub\/82-625-x\/2020001\/article\/00003-eng.htm."},{"key":"ref_3","unstructured":"NHIS (2022, March 18). Adult Tobacco Use\u2014Glossary, Available online: https:\/\/www.cdc.gov\/nchs\/nhis\/tobacco\/tobacco_glossary.htm."},{"key":"ref_4","unstructured":"Centers for Disease Control and Prevention (2010). C. for D. C. and P. Cancer."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1159\/000324601","article-title":"Chronic Obstructive Pulmonary Disease and Lung Cancer: New Molecular Insights","volume":"81","author":"Adcock","year":"2011","journal-title":"Respiration"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"18513","DOI":"10.18632\/oncotarget.14505","article-title":"Lung cancer and chronic obstructive pulmonary disease: From a clinical perspective","volume":"8","author":"Dai","year":"2017","journal-title":"Oncotarget"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1038\/nrc3725","article-title":"Connections of nicotine to cancer","volume":"14","author":"Grando","year":"2014","journal-title":"Nat. Cancer"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1038\/nrc1190","article-title":"Tobacco carcinogens, their biomarkers and tobacco-induced cancer","volume":"3","author":"Hecht","year":"2003","journal-title":"Nat. Cancer"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1002\/ijc.2910230504","article-title":"Low natural killer-cell activity and immunoglobulin levels associated with smoking in human subjects","volume":"23","author":"Ferson","year":"1979","journal-title":"Int. J. Cancer"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1038\/s41467-020-20733-9","article-title":"Nicotine promotes breast cancer metastasis by stimulating N2 neutrophils and generating pre-metastatic niche in lung","volume":"12","author":"Tyagi","year":"2021","journal-title":"Nat. Commun."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"75065","DOI":"10.18632\/oncotarget.20506","article-title":"Nicotine suppresses apoptosis by regulating \u03b17nAChR\/Prx1 axis in oral precancerous lesions","volume":"8","author":"Wang","year":"2017","journal-title":"Oncotarget"},{"key":"ref_12","unstructured":"U.S. Department of Health and Human Services (2014). The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General."},{"key":"ref_13","unstructured":"Canadian Partnership Against Cancer (2020). Smoking Cessation in Cancer Care across Canada, 2020, Canadian Partnership Against Cancer."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1097\/JTO.0b013e318288dc96","article-title":"Practice Patterns and Perceptions of Thoracic Oncology Providers on Tobacco Use and Cessation in Cancer Patients","volume":"8","author":"Warren","year":"2013","journal-title":"J. Thorac. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1200\/JOP.2013.001025","article-title":"Addressing Tobacco Use in Patients With Cancer: A Survey of American Society of Clinical Oncology Members","volume":"9","author":"Warren","year":"2013","journal-title":"J. Oncol. Pract."},{"key":"ref_16","first-page":"339","article-title":"Integration of tobacco cessation services into multidisciplinary lung cancer care: Rationale, state of the art, and future directions","volume":"4","author":"Warren","year":"2015","journal-title":"Transl. Lung Cancer Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"185","DOI":"10.3747\/co.23.3506","article-title":"Lessons Learned Implementing a Province-Wide Smoking Cessation Initiative in Ontario\u2019s Cancer Centres","volume":"24","author":"Evans","year":"2017","journal-title":"Curr. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1507","DOI":"10.1007\/s00520-015-2928-x","article-title":"The relationship between smoking and quality of life in advanced lung cancer patients: A prospective longitudinal study","volume":"24","author":"Danson","year":"2015","journal-title":"Support. Care Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1176\/appi.psy.48.2.142","article-title":"Depressive Symptoms, Smoking, Drinking, and Quality of Life Among Head and Neck Cancer Patients","volume":"48","author":"Duffy","year":"2007","journal-title":"J. Psychosom. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s11764-010-0147-5","article-title":"Smoking and quality of life among female survivors of breast, colorectal and endometrial cancers in a prospective cohort study","volume":"5","author":"Jang","year":"2010","journal-title":"J. Cancer Surviv."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1080\/23809000.2017.1271981","article-title":"Treating nicotine dependence and preventing smoking relapse in cancer patients","volume":"2","author":"Chang","year":"2016","journal-title":"Expert Rev. Qual. Life Cancer Care"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e427","DOI":"10.1016\/j.chest.2021.06.063","article-title":"Screening for Lung Cancer: CHEST Guideline and Expert Panel Report","volume":"160","author":"Mazzone","year":"2021","journal-title":"Chest"},{"key":"ref_23","first-page":"3409","article-title":"Awareness of the Harms of Continued Smoking among Cancer Survivors","volume":"28","author":"Eng","year":"2019","journal-title":"Supportive Care Cancer Off. J. Multinatl. Assoc. Supportive Care Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"622","DOI":"10.7326\/M15-2023","article-title":"Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Women: U.S. Preventive Services Task Force Recommendation Statement","volume":"163","author":"Siu","year":"2015","journal-title":"Ann. Intern. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.lungcan.2019.06.024","article-title":"Smoking cessation interventions for potential use in the lung cancer screening setting: A systematic review and meta-analysis","volume":"135","author":"Cadham","year":"2019","journal-title":"Lung Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.1001\/jama.2020.14581","article-title":"Effect of Sustained Smoking Cessation Counseling and Provision of Medication vs Shorter-term Counseling and Medication Advice on Smoking Abstinence in Patients Recently Diagnosed With Cancer","volume":"324","author":"Park","year":"2020","journal-title":"JAMA"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel, Liaisons, and Staff (2008). A Clinical Practice Guideline for Treating Tobacco Use and Dependence: 2008 Update: A U.S. Public Health Service Report. Am. J. Prev. Med., 35, 158\u2013176.","DOI":"10.1016\/j.amepre.2008.04.009"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1037\/0278-6133.10.5.360","article-title":"The Contemplation Ladder: Validation of a measure of readiness to consider smoking cessation","volume":"10","author":"Biener","year":"1991","journal-title":"Health Psychol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.1164\/rccm.202005-1982ST","article-title":"Initiating Pharmacologic Treatment in Tobacco-Dependent Adults. An Official American Thoracic Society Clinical Practice Guideline","volume":"202","author":"Leone","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_30","unstructured":"Canadian Partnership Against Cancer (2019). Implementing Smoking Cessation in Cancer Care Across Canada: A Framework for Action, Canadian Partnership Against Cancer."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"3147","DOI":"10.1200\/JCO.2013.48.8932","article-title":"Tobacco Cessation and Control a Decade Later: American Society of Clinical Oncology Policy Statement Update","volume":"31","author":"Hanna","year":"2013","journal-title":"J. Clin. Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1200\/JOP.2010.000138","article-title":"Models of Multidisciplinary Cancer Care: Physician and Patient Perceptions in a Comprehensive Cancer Center","volume":"6","author":"Bunnell","year":"2010","journal-title":"J. Oncol. Pract."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/s11764-019-00826-1","article-title":"Implementation of the Smoking Treatment and Recovery (STAR) program: Healthy cancer survivorship through integrated tobacco control","volume":"14","author":"Taylor","year":"2019","journal-title":"J. Cancer Surviv."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"107061","DOI":"10.1016\/j.addbeh.2021.107061","article-title":"Clinimetric properties of the Smoking Abstinence Expectancies Questionnaire","volume":"123","author":"Mansueto","year":"2021","journal-title":"Addict. Behav."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1002\/hed.10368","article-title":"Comparing cancer patients who enroll in a smoking cessation program at a comprehensive cancer center with those who decline enrollment","volume":"26","author":"Schnoll","year":"2004","journal-title":"Head Neck"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1002\/pon.756","article-title":"Characteristics of cancer patients entering a smoking cessation program and correlates of quit motivation: Implications for the development of tobacco control programs for cancer patients","volume":"13","author":"Schnoll","year":"2003","journal-title":"Psycho Oncol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e1912251","DOI":"10.1001\/jamanetworkopen.2019.12251","article-title":"Association of a Comprehensive Smoking Cessation Program with Smoking Abstinence Among Patients with Cancer","volume":"2","author":"Cinciripini","year":"2019","journal-title":"JAMA Netw. Open"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"361","DOI":"10.3747\/co.26.5201","article-title":"Implementation of a Comprehensive Smoking Cessation Program in Cancer Care","volume":"26","author":"Abdelmutti","year":"2019","journal-title":"Curr. Oncol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Gali, K., Pike, B., Kendra, M.S., Tran, C., Fielding-Singh, P., Jimenez, K., Mirkin, R., and Prochaska, J.J. (2020). Integration of Tobacco Treatment Services into Cancer Care at Stanford. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17062101"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1200\/JOP.2010.000175","article-title":"National Cancer Institute Conference on Treating Tobacco Dependence at Cancer Centers","volume":"7","author":"Morgan","year":"2011","journal-title":"J. Oncol. Pract."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Tang, M.W., Oakley, R., Dale, C., Purushotham, A., M\u00f8ller, H., and Gallagher, J.E. (2014). A surgeon led smoking cessation intervention in a head and neck cancer centre. BMC Health Serv. Res., 14.","DOI":"10.1186\/s12913-014-0636-8"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1097\/JTO.0000000000000659","article-title":"Identifying Targeted Strategies to Improve Smoking Cessation Support for Cancer Patients","volume":"10","author":"Warren","year":"2015","journal-title":"J. Thorac. Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Carson, K.V., Verbiest, M.E.A., Crone, M.R., Brinn, M.P., Esterman, A.J., Assendelft, W.J.J., and Smith, B.J. Training health professionals in smoking cessation. Cochrane Database Syst. Rev., 2012.","DOI":"10.1002\/14651858.CD000214.pub2"},{"key":"ref_44","first-page":"CD010742","article-title":"System change interventions for smoking cessation","volume":"2017","author":"Thomas","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.pec.2011.04.018","article-title":"Changing practitioner behavior and building capacity in tobacco cessation treatment: The TEACH project","volume":"86","author":"Herie","year":"2012","journal-title":"Patient Educ. Couns."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1503\/cmaj.081229","article-title":"Defining knowledge translation","volume":"181","author":"Straus","year":"2009","journal-title":"Can. Med. Assoc. J."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/chp.20001","article-title":"Achieving desired results and improved outcomes: Integrating planning and assessment throughout learning activities","volume":"29","author":"Moore","year":"2009","journal-title":"J. Contin. Educ. Health Prof."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1097\/CEH.0000000000000328","article-title":"Performance Change in Treating Tobacco Addiction: An Online, Interprofessional, Facilitated Continuing Education Course (TEACH) Evaluation at Moore\u2019s Level 5","volume":"41","author":"Ivanova","year":"2021","journal-title":"J. Contin. Educ. Health Prof."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Mersha, A.G., Gould, G.S., Bovill, M., and Eftekhari, P. (2020). Barriers and Facilitators of Adherence to Nicotine Replacement Therapy: A Systematic Review and Analysis Using the Capability, Opportunity, Motivation, and Behaviour (COM-B) Model. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17238895"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1111\/ijcp.12644","article-title":"Reasons for non-adherence to nicotine patch therapy during the first month of a quit attempt","volume":"69","author":"Yingst","year":"2015","journal-title":"Int. J. Clin. Pract."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1849","DOI":"10.1016\/S0140-6736(05)66615-9","article-title":"Effectiveness of a large-scale distribution programme of free nicotine patches: A prospective evaluation","volume":"365","author":"Miller","year":"2005","journal-title":"Lancet"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"i42","DOI":"10.1136\/tc.2007.019919","article-title":"Offering free NRT through a tobacco quitline: Impact on utilisation and quit rates","volume":"16","author":"Tinkelman","year":"2007","journal-title":"Tob. Control"},{"key":"ref_53","unstructured":"Babor, T.F., Higgins-Biddle, J.C., Saunders, J.B., and Monteiro, M.G. (2001). AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care, World Health Organization. [2nd ed.]."},{"key":"ref_54","unstructured":"De Ruiter, W., Mobin, A., Zawertailo, L., Baliunas, D., Minian, N., and Selby, P. (2018, January 1\u20133). Potential Impact of Scaling Lung Cancer Screening in Ontario, Canada. Proceedings of the Toronto Global Cancer Control Conference, Toronto, ON, Canada."}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/29\/4\/183\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:42:07Z","timestamp":1760136127000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/29\/4\/183"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,24]]},"references-count":54,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["curroncol29040183"],"URL":"https:\/\/doi.org\/10.3390\/curroncol29040183","relation":{},"ISSN":["1718-7729"],"issn-type":[{"value":"1718-7729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,24]]}}}