Country profile: Australia, New South Wales. From validation to implementation: Progressing tobacco smoking cessation among people with cancer and beyond via relevant authorities

1Introduction

Methods of smoking cessation or abstinence at the population level and individually based methods to quit have been proven to be effective, showing significant declines in population prevalence of smoking. Regarding the latter, the WHO Framework Convention on Tobacco Control guidelines 14 (c) states that signatory countries endeavour to “establish in health care facilities and rehabilitation centres programmes for diagnosing, counselling, preventing and treating tobacco dependence” [1] .

While smoking cessation programs such as those in the USA in the 1990 s focused on “well” people, [2] there was limited emphasis on people hospitalised with cancer where the emphasis was rather centred on supportive care needs. While supportive care needs included smoking cessation [3] these were not discussed in the early 2000 s in national survivorship plans of the USA, [4] Canada, Australia [5] , UK, Nordic countries, or Europe [6] . In Australia, much of the emphasis after a diagnosis of cancer focused on patient-centred supportive care needs and psychosocial support [7] . However by the early 2000 s, evidence around the “teachable moment” of smoking cessation among people hospitalised with cancer was emerging [8] .

In 2014 [9] the US Surgeon General’s report extensively reviewed the topic and concluded that smoking continuation after a cancer diagnosis was causally linked to adverse outcomes and cessation provided survival benefits akin to conventional treatments for cancer, and that most people diagnosed with cancer expressed a desire to quit. This followed work in the USA [10] and Australia [11] showing that smoking cessation after a cancer diagnosis significantly improves overall survival, and cost benefit analyses showing smoking cessation after a cancer diagnosis as a cost-effective option, on par with usual treatment for lung cancer [12] and hospitalised patients in general [13] . Knowledge of this evolving evidence however, is without benefit unless the relevant information is delivered in a trusted context, and means to quit by the hospital and allied sectors are made available. In a 2016 national survey [14] of 682 Australian (members of the Medical Oncology Group of Australia and of the Trans-Tasman Radiation Oncology Group) medical and radiation oncologists, only 2–3% of those surveyed actively managed their patients smoking cessation efforts and > 95% preferred to have such interventions managed by other health workers. Further, there were concerns that there was inadequate smoking cessation infrastructure to progress this.

This paper describes how a government agency embarked on a process of change in the cancer clinical sector and how these goals were assisted by engagement of multiple authorities in one jurisdiction in Australia, New South Wales (pop. 8.2 m). Without recognition of, and support from a wide scope of cancer-engaged professionals, there would be no prospect of increasing the likelihood of smoking cessation by cancer patients in Australia.