__Are you willing to make a quit attempt?__

This short and simple survey helps assess if a patient is willing to make a quit attempt. 

When complete, this form can be returned to the healthcare provider. 

*Created by Pfizer*

Willingness-to-Quit-Assessment-Tool

patient survey

Willingness to Quit Assessment Tool

This visual 1-pager lists some of the many reasons to quit smoking and ways to get help. 

Quitting smoking has many benefits. This is true no matter how old you are or how long or how much you have smoked.

*Created by the CDC*

twyd-poster-reasons-to-quit

reasons to quit

Reasons to Quit Smoking

A matrix of nicotine replacement therapy and medication options including pros/cons and dosing information.

tobacco-replacement

NRT options

Nicotine Replacement Therapy and Medication Options

The Tobacco Cessation Change Package was created by the Centers for Disease Control and Prevention (CDC) with the purpose of helping healthcare professionals in outpatient, inpatient, and behavioral health settings, as well as public health professionals who partner with these groups, to implement systems and strategies that improve care for patients who use tobacco.

Tobacco Cessation Change Pkg

change package

Tobacco Cessation Change Package

This guide covers how to talk to patients about tobacco use, motivating patients to stop using tobacco, treating nicotine dependence in patients with cancer, and  incorporating tobacco dependence treatment into your practice. 

*Created by The American Society of Clinical Oncology*

tobacco-cessation-guide

oncology

Tobacco Cessation Guide For Oncology Providers

Quitting smoking is a great way to improve your health and the health of those around you.

Deciding to quit smoking is the first step toward being a nonsmoker. The information and resources in this guide will help you reach your goal. You will have the best chance of success if you use the guide as a step-by-step workbook.

__Five key steps to quit smoking:__
1. Get ready.
2. Get support and encouragement.
3. Learn new skills and behaviors.
4. Get medicine and use it correctly.
5. Be prepared for relapse or difficult situations.

Whether you smoke cigarettes or use other types of tobacco or nicotine products, following these 5 steps will put you on a path to better health. Quitting smoking is hard work. This guide will show you how to quit, but success requires your energy, your determination, and your time. As you begin working toward your goal, keep in mind that half of all people who ever smoked have quit. You can do it, too!

*Created by the American Academy of Family Physicians*

stop-smoking-guide

guide

Quit Smoking Guide for Patients

A smoking diary 1-page handout to help patients track when they smoke and how it affects their mood. This handout can be used to support a patient's efforts to quit smoking.  

smoking-diary2021 pdf

smoking diary 

Smoking Diary

__Resources and Guidance for Patients and Families from the American Society of Clinical Oncology__

If you or a loved one has been diagnosed with cancer, quitting tobacco use is one of the best ways to improve the chances of successful cancer treatment. Some people believe that it is too late to quit after a cancer diagnosis, that the damage has already been done. Others believe that the smoking caused their cancer and feel like they have brought this on themselves. People who use tobacco should not blame themselves for a cancer diagnosis or feel that nothing can be done to help them. Quitting can have immediate and long-term benefits.

*Created by the American Society of Clinical Oncology*

stopping tobacco use

cancer quit guide

Stopping Tobacco Use After a Cancer Diagnosis Patient Toolkit

This clear and simple template helps patients learn about the importance of quitting smoking to improve their health and how to create a quit plan. 

tearsheet

quit plan template

Personalized Quit Plan Template

__Why choose the nicotine patch?__

- The nicotine patch is used to help you quit smoking by “replacing” the nicotine that you would normally get from a cigarette, but without the harmful chemicals found in cigarette smoke.
- It makes you more comfortable while you are quitting because it reduces the cravings and withdrawal that you feel when you stop smoking.
- It’s easy to use—you apply the patch once a day. Can be used with other nicotine medicines (gum,lozenge, nasal spray, or inhaler)—and studies have shown that this works better than using only the patch when quitting.
- It is inexpensive compared to some of the other medicines for quitting smoking, and is available without a prescription.    

Nicotine patch

Resources placeholder

Guide to the Nicotine Patch 

__Get access to tools, resources, and educational modules to help you care for your patients with tobacco dependence.__

Modules include:
- Best Practices for Tobacco Cessation Using Medication And Behavioral Support
- Michigan Medicaid and Quitline Benefits for Tobacco Cessation
- Special Quitline Programs For Tobacco Cessation
- Connecting The Harms of Tobacco Use to Chronic Health Conditions
- Tobacco Cessation for Behavioral Health Populations
- Vaping and E-Cigarette Devices: What Are They and How Do They Harm?

and more!

*These continuing education modules are offered free of charge by National Jewish Health. *

CME courses

Free Continuing Education Courses for Providers

__Quitting tobacco during pregnancy or postpartum is hard, but it’s one of the best ways a woman can protect herself and her baby’s health.__

National Jewish Health developed the first tobacco cessation program dedicated to pregnant and postpartum women. For nearly a decade, our Pregnancy and Postpartum Program has given new and expectant moms the support they need to stop using tobacco while they are pregnant and help to prevent relapse after giving birth.

__Participants receive:__

- Nine telephone coaching sessions (five during pregnancy and four postpartum) with a dedicated female Tobacco
- Cessation Coach. Our Coaches are specially trained to provide coaching during the sensitive physical and emotional times of pregnancy and the postpartum period.
- Nicotine replacement therapies (NRT) with physician consent (if offered by the state).
- A personalized Welcome Packet including special educational materials and the industry renowned My Quit Journey© workbook.
- A suite of eHealth services to supplement telephone coaching including customized email and text messages specific to pregnant and postpartum stages, two-way chat and interactive online resources.
- Incentives for all pregnancy and postpartum completed calls: $10 per completed pregnancy call and $20 per completed postpartum call.

Outcomes from this program have been positive. Women remain engaged in care for longer and a far greater number of women remain tobacco-free after delivery when compared to pregnant women who do not enroll in the program. Call 1-800-QUIT-NOW (1-800-784-8669) or visit Michigan.quitlogix.org. 

MI Tobacco Quitline-Pregnant Postpartum Program

Pregnancy and Postpartum Tobacco Cessation Program

The U.S. Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence, calls for system-level tobacco intervention efforts. Electronic health records (EHRs) allow for integration of this guideline into the practice workflow, facilitating system-level changes to reduce tobacco use.

The American Academy of Family Physicians (AAFP) advocates for EHRs that include a template that prompts clinicians and/or their practice teams to collect information about tobacco and nicotine use, secondhand smoke exposure, cessation interest, and past quit attempts. The EHR should also include automatic prompts that remind clinicians to:

- Encourage quitting
- Advise about smoke-free environments
- Connect patients and families to appropriate cessation resources and materials

The tobacco treatment template should be automated to appear when patients present with complaints such as cough, upper respiratory problems, diabetes, ear infections, hypertension, depression, anxiety, and asthma, and for well-patient exams.

*Created by the Academy of Family Physicians*

ehr-tobacco-cessation

emr tobacco 

Integrating Tobacco Cessation Into Electronic Health Records

__What are the benefits of quitting smoking?__

Many smokers think that because they have smoked for so long the damage has been done and it is too late to quit. This is not true. All smokers, no matter how heavily they smoke, will notice significant benefits after quitting smoking.

*Created by the CAMH Knowledge Exchange*

Health benefits of quitting smoking PDF

Health Benefits of Quitting Smoking Handout

Many interactions between tobacco smoke and medications have been identified. Note that in most cases it is the tobacco smoke—not the nicotine—that causes these drug interactions. Tobacco smoke interacts with medications by influencing the absorption, distribution, metabolism, or elimination of other drugs, potentially causing an altered pharmacologic response. Because of these interactions, smokers may require higher doses of medications. Upon cessation, dose reductions might be needed.

*Adapted and updated, from Zevin S, Benowitz NL. Drug interactions with tobacco smoking. Clin Pharmacokinet. 1999;36:425-438.
Copyright © 1999-2019 The Regents of the University of California* 

drug-interactions

drug interactions 

Drug Interactions with Tobacco Smoke

*Implementation of Ask‐Advise‐Refer is most successful when clinicians and staff work as a team to determine the best method to integrate it into routine patient care.*

This helpful guide from RX for Change explains how to implement Ask‐Advise‐Refer in your clinical setting including helpful tips, example dialogue, and additional information. 


A12 AAR

Implementing Ask, Advise, Refer Guide for Clinicians

Tobacco use is the leading preventable cause of death in the United States. Smoking or chewing tobacco may increase a patient’s risk for chronic obstructive pulmonary disease (COPD), coronary artery disease, lung cancer and stroke. While smokers account for less than 14% of the U.S. population, up to 30 to 40% of patients seen in emergency departments are smokers.

With this important knowledge of how many emergency room patients smoke, Yale Medicine is at the forefront of a growing movement to initiate smoking cessation interventions there, including several tobacco intervention-related research studies, says Steven L. Bernstein, MD, an emergency medicine physician and the principal investigator of the Yale Medicine emergency department’s tobacco-related studies.

yale emergency medicine

Tobacco Cessation in the Emergency Department

Quitting tobacco is a process. Whether you are thinking about quitting, are not yet ready to quit, or have already quit, Michigan Tobacco Quitlink can help you with each step of the way.

The Quitlink commercial tobacco cessation program uses clinically proven methods to achieve some of the highest quit rates in the country. We help more than 450 people a day in their journey to quit tobacco. With a 37 percent responder quit rate for those who use coaching and nicotine replacement therapy (NRT) and a 90 percent participant satisfaction rate, we are confident in our ability to help your patients live tobacco free.

# How do I enroll a patient?
Providers can complete the referral form on the the Quitlink website or by clicking [HERE.](https://michigan.quitlogix.org/en-US/Health-Professionals/Make-a-Referral)
# What services does the quitline offer?
- Phone-based coaching support and additional support via email, text, or instant message. Participants work with trained coaches to prepare a quit plan, set a quit date, identify tobacco triggers, manage cravings, and address relapses. Our standard program includes up to 5 proactive coaching sessions with unlimited inbound contacts. Coaches are available 7 days a week.
- Full pharmacotherapy program including nicotine replacement therapy (NRT), education, and coordination of pharmacy benefits.
- Planning and educational materials, either through our website or on paper, to help participants map out their road to quitting tobacco.
- Membership in an online community with others who have or are working to become tobacco free.

quitlink

Michigan Tobacco Quitlink

*Steven L Bernstein, Edwin D Boudreaux, Rita K Cydulka, Karin V Rhodes, Nadine A Lettman, Sherri-Lynne Almeida, Lynne B McCullough, Selma Mizouni, Arthur L Kellermann, American College of Emergency Physicians Task Force on Smoking Cessation*

__Smoking is the leading cause of preventable death and illness in the United States. National practice guidelines call for all health care providers to "ask" all patients about tobacco use, and to "advise, assess, assist, arrange" when smokers want to quit smoking (the "5 As").__ 

Emergency departments (EDs) have not been an important locus of tobacco control efforts, although ED patients typically smoke at rates exceeding that of the general population, are interested in quitting, and often have limited access to primary care. To address the role of emergency medicine in tobacco control, the American College of Emergency Physicians convened a task force of representatives of major emergency medicine professional organizations. Funded by the Robert Wood Johnson Foundation, the group met in 2004 and 2005. 

This article represents a summary of the task force's recommendations for tobacco control practice, training, and research. We call on emergency care providers to routinely assess patients' smoking status, offer brief advice to quit, and refer patients to the national smokers' Quitline (800-QUIT-NOW) or a locally available program. Given the global burden of tobacco-related illness, the task force considers it essential for emergency physicians to conduct research into the efficacy of ED-based interventions and to place tobacco control into the training curriculum for emergency medicine residencies. Tobacco control fits within the traditions of other ED-based public health practices, such as injury control. ED-based tobacco control would allow the specialty to help fulfill the Healthy People 2010 mandate to reduce the prevalence of smoking among US citizens.

clinical literature

Tobacco control interventions in the emergency department: a joint statement of emergency medicine organizations

__Why choose the nicotine inhaler?__ 

- The nicotine inhaler is used to help you quit smoking by “replacing” the nicotine that you would normally get from a cigarette, but without the harmful chemicals found in cigarette smoke.
- It makes you more comfortable while you are quitting because it reduces the cravings and withdrawal that you feel when you stop smoking.
- It can satisfy your urges to have something in your hand that you bring to your mouth.
- It can be used with the nicotine patch—and studies have shown that this works better than using only one nicotine replacement medicine.


Nicotine inhaler

Guide to the Nicotine Inhaler

__Why choose the nicotine gum?__

- The nicotine gum is used to help you quit smoking by “replacing” the nicotine that you would normally get from a cigarette, but without the harmful chemicals found in cigarette smoke.
- It makes you more comfortable while you are quitting because it reduces the cravings and withdrawal that you feel when you stop smoking.
- It can be used with the nicotine patch—and studies have shown that this works better than using only one nicotine replacement medicine.
- It is inexpensive compared to some of the other medicines for quitting smoking, and is available without a prescription.  


Nicotine gum

Guide to Nicotine Gum 

__Why choose the nicotine nasal spray?__

- The nicotine nasal spray is used to help you quit smoking by “replacing” the nicotine that you would normally get from a cigarette, but without the harmful chemicals found in cigarette smoke.
- It makes you more comfortable while you are quitting because it reduces the cravings and withdrawal that you feel when you stop smoking.
- It works more quickly than the nicotine patch, gum, lozenge, and inhaler.
- It can be used with the nicotine patch—and studies have shown that this works better than using only one nicotine replacement medicine.   


Nicotine nasal spray

Guide to Nicotine Nasal Spray 

__If you are having a hard time paying for medications that can help you quit smoking, there are programs that may be able to help.__

- Medicaid
- Medicare
- Michigan Tobacco Quitline
- The Medicine Assistance Tool
- Pfizer Pathways

Use this guide to help access smoking cessation medications for free or at a reduced cost. 


Free or Reduced-Cost Smoking Cessation Medication

Guide to Free Or Reduced Cost Smoking Cessation Medication 

The Quick Reference Guide for Clinicians contains strategies and recommendations from the Public Health Service-sponsored Clinical Practice Guideline Treating Tobacco Use and Dependence. 

The guideline was designed to assist clinicians, smoking cessation specialists, healthcare administrators, insurers, and purchasers in identifying and assessing tobacco users and in delivering effective tobacco dependence interventions. It was based on an exhaustive systematic review and analysis of the extant scientific literature from 1975–2007 and uses the results of more then 50 meta-analyses. 

tobaqrg

Treating Tobacco Use & Dependence Reference Guide for Clinicians

This document decribes what happens when a patient is reffered to the Michigan Tobacco Quitlink. 

What Happens When Your Patient is Referred to the Quitline

What Happens When Your Patient is Referred to The Michigan Tobacco Quitlink?

__Why choose the nicotine lozenge?__

- The nicotine lozenge is used to help you quit smoking by “replacing” the nicotine that you would normally get from a cigarette, but without the harmful chemicals found in cigarette smoke. 
- It makes you more comfortable while you are quitting because it reduces the cravings and withdrawal that you feel when you stop smoking.
- It can be used with the nicotine patch—and studies have shown that this works better than using only one nicotine replacement medicine. 
- It is inexpensive compared to some of the other medicines for quitting smoking, and it is available without a prescription. 	  	 


Nicotine lozenge

Guide to Nicotine Lozenge 

*Anna E Notier, Polly Hager, Karen S Brown, Laura Petersen, Louise Bedard, Graham W Warren*

Although smoking by patients with cancer and survivors causes adverse outcomes, many patients with cancer do not receive access to evidence-based tobacco use treatment. The purpose of this article is to report on delivery of tobacco use treatment to patients with cancer using a state-supported Quitline.

__Conclusion:__ Using statewide resources to increase access to evidence-based smoking cessation assistance to patients with cancer is achievable. In an increasingly cost-conscious health care environment, collaborative initiatives that use or enhance existing resources should be considered and refined to deliver effective evidence-based care.

clinical_lit_quitline

Using a Quitline to Deliver Opt-Out Smoking Cessation for Cancer Patients

*Anna E Schulze, Karen Brown, Polly Hager, Laura Petersen, Hilary Baca, Louise Bedard, Graham W. Warren*

Smoking by cancer patients and survivors causes adverse outcomes. Cancer treatment guidelines recommend evidence-based cessation support for all patients who use tobacco. However, there is little information on using existing state quitlines to provide support for cancer patients during and following cancer treatment.

__Conclusion:__ Partnering community oncology practices with quitlines can significantly increase access and delivery of evidence-based support. Results support integration of existing cessation resources into oncology practice to facilitate broad uptake.

clinical_lit_quitline2

Uptake and efficacy of using a state quitline to address tobacco use by cancer patients treated in community cancer centers.

Freedom From Smoking® is a group quitting class facilitated by one of Henry Ford's trained tobacco treatment experts. 

Freedom From Smoking classes provide group treatment for tobacco dependence and consist of 8 sessions over the course of 7 weeks. The group prepares for a shared "quit day" by learning about medications that can help them stop, lifestyle changes that make quitting easier, and how to stay smoke-free for good. As the weeks continue you will receive structured support and advice from fellow group members and staff.

freedom at henry ford

Freedom From Smoking® at Henry Ford Health

Website and other resources designed by the American Lung Association to help people quit smoking. Freedom From Smoking has been helping people quit smoking for 35 years and has been ranked as one of the most effective cessation programs in the country.

Freedom From Smoking

يقدم هذا الدليل المرئي نظرة عامة عالية المستوى على العلاج ببدائل النيكوتين وكيفية استخدامه. يتضمن الدليل أيضًا روابط ورمز QR إلى Michigan Tobacco Quitline.

Resource guide pdf Arabic 

resource guide arabic 

HBOM Nicotine Replacement Therapy Guide (Arabic) 

Tobacco use and dependence is a chronic, relapsing condition that, like other chronic diseases, may require repeated intervention and long-term support. Most people who use tobacco want to quit, but most try to quit multiple times before succeeding. As a healthcare professional, you play a critical role in helping people quit using tobacco.

__Clinical Intervention Works__

-  Even brief advice from a provider increases the chance a patient will try to quit.
- Counseling and medication can double a patient’s chances of quitting.
- Providing tobacco dependence treatment is reimbursable and covered as a preventive service.
- Providing tobacco cessation support increases patient satisfaction with care.   

*Created by the CDC*

You-Can-Help-Your-Patients-Quit-Tobacco-Use-508

cdc help patients

Help Your Patients Quit Tobacco Use

This guide provides simple steps and suggested language that you can use to briefly (3 to 5 minutes) intervene with patients who use tobacco. These steps can be integrated into the routine clinical workflow and can be delivered by the entire clinical care team.

__Key considerations for treating tobacco dependence:__

- Behavioral counseling can benefit all patients
- Medication can help patients quit and can be used with most patients, though special considerations may apply for some individuals.
- Combining behavioral counseling and medication is more effective than either treatment alone.
- Follow-up is key to monitoring patients for treatment adherence, side effects, and efficacy, along with providing support and continued assistance.


hcp-conversation-guide

cdc guidelines

A Practical Guide to Help Your Patients Quit Using Tobacco

1-page visual handout with top tools for quitting. 

*Created by the AAFP *

Infographic Smoking

clean the air

Clear the Air: Quitting is Hard Infographic 

A First Nations-specific toolkit for commercial tobacco cessation.

The purpose of this toolkit is to support helpers in offering commercial tobacco interventions with First Nations. It is organized into six circles with each circle focusing on specific learning outcomes. 

__The goal of the circles will be to support First Nations in:__

- Preparing for their commercial tobacco cessation or reduction journey (e.g., thinking about quitting or reducing).
- Mapping their commercial tobacco cessation or reduction journey (e.g., developing a plan to quit or reduce).
- Staying with their commercial tobacco cessation or reduction journey (e.g., learning ways to prevent resuming smoking)

IT-S TIME - FN Helper-s Guide

first nations

IT'S TIME: Helper's Guide

A First Nations-specific toolkit for commercial tobacco cessation.

Indigenous Tools and Strategies on Tobacco including interventions,  medicines and education.


IT-S TIME - FN Participant Booklet

IT’S TIME: First Nations Quit Toolkit

Quitting tobacco use brings about a variety of physical and psychological withdrawal symptoms. For some people, coping with withdrawal symptoms is like riding a roller coaster—there can be sharp turns, slow climbs, and unexpected plunges. This sheet covers common symptoms of tobacco withdrawl and how to cope with them. 

*Created by Rx for Change*

WITHDRAWAL SYMPTOMS INFORMATION SHEET

Withdrawal Symptoms Information Sheet

This visual card is designed to be printed as a postcard and shows the two medication options for tobacco cessation including pros/cons and dosing information. On the back, it provides information on the Michigan Tobacco Quitline and how to contact them. 

HBOM medication card

medication card

HBOM Tobacco Cessation Medications Card

This visual guide provides a high-level overview of nictotine replacement therapy and how to use them. The guide also includes links and a QR code to the Michigan Tobacco Quitline. 

HBOM NRT guide

hbom nrt

HBOM Nicotine Replacement Therapy Guide

This easily printable 1-page flyer encourages pregnant women to quit smoking and call the Michigan Tobacco Quitline for support. 

Did you know?
- Smoking can cause you to deliver too soon.
- By quitting, you're making sure your baby is getting enough oxygen to grow.


pregnant and smoking flyer

pregnant and smoking 

Pregnant and Smoking MDHHS Flyer

Toothpicks can be a great tool when quitting tobacco. They can keep your hands and mouth busy during cravings and many quitters like the distraction that intense flavors like cinnamon or mint can give.

Use these simple instructions to make your own flavored toothpicks. 

toothpick

toothpicks

Make Your Own Cinnamon Toothpicks

This guide provides questions and answers tobacco users who want to quit should consider when selecting a health insurance plan. 

Q: I’m a smoker, but I eventually want to quit. What should I think about when choosing a health insurance plan?

A: There are several things for current and potential “quitters” to consider when choosing a health insurance plan...

*Created by the American Lung Association* 

choosing-plan-for-tobacco-users

Choosing a Health Insurance Plan: Tobacco Users

A list of myths and facts about tobacco use. For example:

Myth: Tobacco is not a drug.

Fact: The nicotine found in tobacco products is a very addictive
drug. Addiction to nicotine has been compared to having an
addiction to drugs like cocaine or heroin. Exposure to nicotine
alters brain chemistry resulting in tobacco dependence and
nicotine addiction.

*Created by the MHealthy Tobacco Consultation Service*

smoking-myths 0

myths

Myths about Tobacco Use

This helpful 1-pager provides a list of a tips, coping strategies, and benefits of quitting smoking. This can be used as a high level overview of information when talking to patients about quitting. 

*This resources was created by Mhealthy Tobacco Consultation Service and encourages patients to contact their services. If you are outside of the University of Michigan system, consider copying the information to an appropriate format for your health system. * 


tcs helpful tips 2sided handout

Helpful Tips To Make Quitting Easier

A visual guide for tobacco treatment aids including nictotine replacement therapy and medications. 

*Created by MHealthy Tobacco Consultaton Service*

quitaids

quit aids

Tobacco Treatment Aids

A helpful list of things you can do when you're having a craving or are experiencing nicotine withdrawal symptoms. 

instead-of-tobacco

Things to do other than using tobacco 

An example clinical work flow for tobacco cessation interventions. 

Harvard Work Flow

work flow

Harvard Vanguard Work Flow For Interventions With Smokers

Tobacco cessation treatment can and should be a team effort. Also, successful cessation attempts occur across multiple interactions — clinic visits, quitline phone calls, follow-up appointments, etc. 

The 2008 Public Health Service Tobacco Cessation Guidelines recommend organizing a patient's quit attempt around the "5 As" — Ask, Advise, Assess, Assist, and Arrange. Find out how to incorporate the 5 As into practice and access useful resources related to each A.


ASCO

Tobacco Cessation Tools & Resources from the American Society of Clinical Oncology

*Benjamin A. Toll, Thomas H. Brandon, Ellen R. Gritz, Graham W. Warren, Roy S. Herbst, and Writing Committee for the AACR Subcommittee on Tobacco and Cancer*

When diagnosed with cancer, patients can immediately make a meaningful positive impact on their health by stopping their tobacco use. Scientific evidence clearly shows that tobacco use in patients with cancer leads to poorer outcomes. The specific biological processes driving tobacco consumption’s interference in cancer therapy are the subject of continuing research, but the evidence is clear that tobacco use in patients with cancer leads to decreased treatment efficacy and safety, decreased survival, decreased quality of life, increased treatment-related toxicity, and increased risk of cancer recurrence and second primary tumors. Data suggest that tobacco cessation can improve outcomes and survival in patients with cancer, yet full execution of evidence-based cessation interventions is infrequent in oncology settings. Therefore, both improved provision of cessation assistance to all patients with cancer who use tobacco or have recently quit and further study of the deleterious effects of tobacco use and benefits of tobacco cessation on cancer progression and treatment are needed and recommended by the American Association for Cancer Research. Progress on both fronts begins with universal assessment and documentation of tobacco use as a standard of quality cancer care regardless of treatment setting and will be further facilitated through the development of reliable, valid, and standard measures of tobacco use, incorporation of evidence-based procedures into quality and accreditation procedures, and the development of appropriate training, clinical infrastructure, and incentives for delivery of tobacco cessation interventions.

Assessing Tobacco Use by Cancer Patients and Facilitating Cessation: An American Association for Cancer Research Policy Statement

*Graham W. Warren, Karin A. Kasza,Mary E. Reid, K. Michael Cummings, James R. Marshall*

The effect of smoking on survival in cancer patients is limited by the lack of structured prospective assessments of smoking at diagnosis. To assess the effect of smoking at diagnosis on survival, structured smoking assessments were obtained in a cohort of 5,185 cancer patients within 30 days of a cancer diagnosis between 1982 and 1998. Hazard ratios (HRs) or odds ratios were generated to analyze the effects of smoking at diagnosis on overall mortality (OM) and disease-specific mortality (DSM) in a patient cohort from 13 disease sites containing at least 100 patients in each disease site. With a minimum of 12 years of follow-up, current smoking increased OM risk versus recent quit (HR 1.17), former (HR 1.29) and never smokers (HR 1.38) in the overall cohort. Current smoking increased DSM risk versus former (HR 1.23) and never smokers (HR 1.18). In disease sites with proportionately large (>20%) recent quit cohorts (lung and head/neck), current smoking increased OM and DSM risks as compared with recent quit. Current smoking increased mortality risks in lung, head/neck, prostate and leukemia in men and breast, ovary, uterus and melanoma in women. Current smoking was not associated with any survival benefit in any disease site. Data using prospective structured smoking assessments demonstrate that current smoking increased long-term OM and DSM. Standardized smoking assessment at diagnosis is an important variable for evaluating outcomes in cancer patients.

Smoking at diagnosis and survival in cancer patients

How much support should I give someone quitting smoking? Everyone who quits needs a different amount or type of support. Just ask them what kind of support they want and how much.

support quitting

 FAQs for Helping Someone Quit (Smokefree.gov)

__A 3-STEP PROTOCOL FOR CLINICIANS__

Many individuals who relapse back to smoking do so because they fail to plan. Often, patients think that they can simply “make” themselves quit and do not avail themselves of the many proven behavior change programs provided by various sources. Furthermore, most smokers do not use a cessation medication or, if they do, they use it incorrectly. Generally speaking, patients significantly under-dose or stop pharmacologic therapy too soon.

You can help patients who relapse regain abstinence by encouraging them to learn from their prior experiences rather than use those experiences as proof that they cannot quit. To underscore this perspective, advise patients that the best way to quit smoking is to combine a behavior change program
with a cessation medication. The following 3-step protocol will help you provide this information in an efficient, effective manner for patients who are ready to try again.

A8 RELAPSE

Relapsed Smokers Who Are Ready To Try Again: What To Do?

__A guide for using the 5As with patients including suggested dialogue for each step.__ 

Step One: __ASK__ about Tobacco use
Step Two: __ADVISE__ to Quit
Step Three: __ASSESS__ Readiness to Quit
Step Four: __ASSIST__ with Quitting
Step Five: __ARRANGE__ Follow-up Counseling

A1 GUIDE

Tobacco Cessation Counseling Guidesheet

COGNITIVE STRATEGIES focus on retraining the way a patient thinks. Often, patients will deliberate on the fact that they are thinking about a cigarette, and this leads to relapse. Patients must recognize that thinking about a cigarette doesn’t mean they need to have one

BEHAVIORAL STRATEGIES involve specific actions to reduce risk for relapse. These strategies should be considered 
prior to quitting, after determining patient-specific triggers and routines or situations associated with tobacco 
use. Below are strategies for several of the more common cues or causes for relapse.


A6 COPING

Coping With Quitting: Cognitive And Behavioral Strategies

A simple guide to using Bupropion for tobacco cessation. 

__Information includes:__
Why choose bupropion SR?
How do I use bupropion SR? 
Dosing schedule
How long is the treatment?
What are the side effects of bupropion SR? 
What else do I need to know?


Bupropion SR

Guide to Bupropion 

__If you are having a hard time paying for medications that can help you quit smoking, there are programs that may be able to help.__

This guide includes instructions for accessing cost assistance programs through Medicaid, Medicare, the Michigan Tobacco Quitline, The Medicine Assistance Tool, and Pfizer. 

Guide To Free Or Reduced Cost Smoking Cessation Medication

A visual 1-pager listing the ways that quitting smoking can benefit different parts of your body. 

A10 BENEFITS

Health benefits RX for change

Quitting Smoking: How Quitting Can Benefit Your Health

__This simple worksheet helps patients plan to quit smoking and reflect on their motivations and previous attempts.__

Understanding the reasons why you smoke, in addition to considering your smoking patterns and routines, are important to the design of a successful quitting plan. Consider the following before you quit:

- Why do I still smoke?
- Why is quitting important?
- What were your main difficulties with quitting in the past?
- What are your barriers to quitting now?
- Are you ready to quit now?

Smokers don’t plan to fail. Most fail to plan. To plan for quitting, you should: 

(1) identify triggers for smoking and how to cope with them, (2) identify persons to help you 
throughout your quit attempt, and (3) choose the best methods—for you—for quitting


A7 PLANNING

Planning For Change: Thinking About Quitting Patient Worksheet

Table detailing dosing, cost, adverse effects, etc for all nictoine replacement therapy and cessation medication options created by RX For Change. 

A9 PRODUCTS

RX for change table

Pharmacologic Product Guide: FDA-Approved Medications for Smoking Cessation

__How much will you save if you quit smoking?__

Smoking cigarettes is expensive. Use this calculator to find out how much of your money is going up in smoke.

A Perioperative Smoking Cessation Intervention with Varenicline: A Double-blind, Randomized, Placebo-controlled Trial