Provision of smoking cessation intervention in lung cancer multidisciplinary clinics

Smoking cessation improves outcomes in lung cancer patients but is often underutilized. This study evaluates adherence to the Ask, Advise, Help (AAH) smoking cessation model in lung cancer clinics and examines factors associated with lower adherence.We reviewed adherence to AAH for patients newly diagnosed with lung cancer referred to our multidisciplinary team (2018−2020). Clinical notes from 1,252 outpatient visits of 725 patients (213 who currently smoked) were analysed using backward stepwise regression to explore risk factors for reduced intervention. Seven hundred and twenty-five patients were referred. Two hundred and thirteen (29.4%) patients identified as currently smoking at diagnosis and received 1,252 out-patient visits. Seventy-one percent of out-patient visits were delivered by respiratory physicians and medical oncologists. AAH compliance decreased progressively: Ask: 497/1,252 (38%) out-patient encounters documented smoking status; Advise: 78/1,252 (7%) encounters documented provision of brief advice; Help: 24/1,252 (2%) encounters documented referral to counselling, and 43/1,252 (4%) encounters documented prescription of smoking cessation medication). The majority of encounters (781/1,252, 62%) had no documentation of any component of AAH delivery. Backward stepwise regression modelling for each patient revealed that advanced clinical stage (TNM stage III and IV) was associated with a lower likelihood of clinicians providing smoking cessation interventions for all three steps. Female gender is associated with a lower likelihood of intervention, though this was variable in statistical significance across the three AAH steps.Smoking cessation intervention is poorly documented in lung cancer care, with wide variability across specialties. Patient factors like advanced stage and female gender may impact clinician adherence to AAH recommendations.