Tobacco use assessment and treatment in cancer patients: a scoping review of oncology care clinician adherence to clinical practice guidelines in the U.S
Open accessAbstract
Background: Smoking after a cancer diagnosis negatively impacts health outcomes; smoking cessation improves symptoms, side effects, and overall prognosis. The Public Health Service and major oncology organizations have established guidelines for tobacco use treatment among cancer patients, including clinician assessment of tobacco use at each visit. Oncology care clinicians (OCCs) play important roles in this process (noted as the 5As: Asking about tobacco use, Advising users to quit, Assessing willingness to quit, Assisting in quit attempts, and Arranging follow-up contact). However, OCCs may not be using the “teachable moments” related to cancer diagnosis, treatment, and survivorship to provide cessation interventions. Materials and Methods: In this scoping literature review of articles from 2006 to 2017, we discuss (1) frequency and quality of OCCs' tobacco use assessments with cancer patients and survivors; (2) barriers to providing tobacco treatment for cancer patients; and (3) the efficacy and future of provider-level interventions to facilitate adherence to tobacco treatment guidelines. Results: OCCs are not adequately addressing smoking cessation with their patients. The reviewed studies indicate that although >75% assess tobacco use during an intake visit and >60% typically advise patients to quit, a substantially lower percentage recommend or arrange smoking cessation treatment or follow-up after a quit attempt. Less than 30% of OCCs report adequate training in cessation interventions. Conclusion: Intervention trials focused on provider- and system-level change are needed to promote integration of evidence-based tobacco treatment into the oncology setting. Attention should be given to the barriers faced by OCCs when targeting interventions for the oncologic context. Implications for Practice: This article reviews the existing literature on the gap between best and current practices for tobacco use assessment and treatment in the oncologic context. It also identifies clinician- and system-level barriers that should be addressed in order to lessen this gap and provides suggestions that could be applied across different oncology practice settings to connect patients with tobacco use treatments that may improve overall survival and quality of life.
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Evidence-based smoking cessation treatments exist for the general population but are rarely implemented in oncology care or offered to cancer patients.
“While efficacious evidence-based smoking cessation treatments exist for the general population, existing treatments are rarely implemented in oncology care or offered to cancer patients.14–16”
From Efficacy of smartphone applications to help cancer patients quit smoking: Protocol of the Quit2Heal randomized controlled trial (2023) · cites this paper as [16]
Routine screening for tobacco use and referral to evidence-based tobacco control interventions is underutilized in cancer patients.
“but this practice is underutilized.41”
From Electronic health record activity changes around new decision support implementation: monitoring using audit logs and topic modeling (2025) · cites this paper as [41]
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Understanding cancer patients’ desire to quit tobacco without assistance: A mixed-methods study
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“…population of people who smoke include lack of proper advice, assistance, and follow-up from healthcare professionals; inadequate social support; lack of community-based resources; and concerns about the affordability of treatment (Farley et al., 2016; Price et al., 2019; Warren et al., 2013).”
Specialty Tobacco Treatment Implementation in Oncology: A Qualitative Study
Bird, J. E., Chladek, J. S., D’Angelo, H., Minion, M. M., Pauk, D., Adsit, R. T., Conner, K. L., Zehner, M. E., Fiore, M. C., Rolland, B., et al. (2024) · JCO Oncology Practice · doi:10.1200/op.24.00145 · Cited by 2 · see citing works
Ryan, A., Young, A. L., Tait, J., McCarter, K. L., McEnallay, M., Day, F. L., McLennan, J., Segan, C., Blanchard, G., Healey, L., et al. (2022) · Health Services and Outcomes Research Methodology · doi:10.1007/s10742-022-00288-6 · Cited by 2 · see citing works
“Belief that patients lack the motivation to quit (Charlesworth et al. 2019; Conlon et al. 2017; Gosselin et al. 2011; Ma et al. 2016; Price et al. 2019; Sarna et al. 2001; Simmons et al. 2009; Warren et al. 2013a, b; Weaver et al. 2012; Weiss et al. 2020) is commonly reported, while HCPs have often believed that patie…”
BackgroundBird, J. E., Nguyen, C. V., Hohl, S. D., D’Angelo, H., Pauk, D., Adsit, R. T., Fiore, M. C., Minion, M. M., McCarthy, D. E., & Rolland, B. (2023) · Implementation Research and Practice · doi:10.1177/26334895231185374 · Cited by 2 · see citing works
“Programs that have reported program outcomes also report implementation challenges and low patient reach (D ’ Angelo et al., 2019), with about half of the patients with cancer advised to quit (Price et al., 2019; Talluri et al., 2020) and even fewer referred to treatment (Price et al., 2019).”
BackgroundShah, H. B., Khan, I., Khan, S. U., Kershan, J., Ahmed, S. M., & Ayaz, S. (2023) · Pakistan Armed Forces Medical Journal · doi:10.51253/pafmj.v73i4.9241 · Cited by 2 · see citing works
Finkelstein‐Fox, L., Sicks, J. D., Wagner, L. I., Carlos, R. C., Miranda, I., Rosen, R. L., Lopes, M., Goshe, B. M., Gareen, I. F., Herman, B. A., et al. (2024) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntae304 · Cited by 2 · see citing works
May, J. R., Jao, N. C., McCarter, K. L., Klass, E., Pearman, T. P., Leone, F. T., Schnoll, R. A., & Hitsman, B. L. (2020) · Oncology nursing forum · doi:10.1188/21.onf.112-120 · Cited by 2 · see citing works
“, 2019), fewer than 40% of oncology providers assist their patients in quitting, either by prescribing a medication or referring to treatment (Price et al., 2019; Warren et al., 2015).”
BackgroundThe Tobacco Endgame—A New Paradigm for Smoking Cessation in Cancer Clinics
Stone, E. C. A., & Paul, C. L. (2022) · Current Oncology · doi:10.3390/curroncol29090497 · Cited by 2 · see citing works
“Health care practitioners (HCPs) who work in cancer clinics commonly ask about smoking, with a review finding that more than 75% of oncology cancer clinicians assessed tobacco use during an intake visit [14].”
BackgroundBricker, J. B., Westmaas, J. L., Ostroff, J. S., Mull, K. E., Sullivan, B. M., & Santiago-Torres, M. (2023) · Contemporary Clinical Trials · doi:10.1016/j.cct.2023.107180 · Cited by 2 · see citing works
Implementing Evidence-Based Tobacco Treatment Interventions in Oncology to Achieve Optimal Outcomes
Studts, J. L., & Hamann, H. A. (2023) · Journal of Clinical Oncology · doi:10.1200/jco.22.02534 · Cited by 1 · see citing works
Self-citationPu, T., Burris, J. L., Matulewicz, R. S., McCarthy, D. E., Ostroff, J. S., Reilly, E. M., Shelton, R. C., Warren, G. W., Weigel, R. J., Mullett, T. W., et al. (2026) · Journal of Clinical Oncology · doi:10.1200/jco-25-01815 · Cited by 2 · see citing works
Tobacco Cessation Prescription Utilization Rates Among Veterans with Cancer Who Smoke
Herbst, E. D., Hoggatt, K. J., Leonard, S. J., Purcell, N., Rossi, N., & Bialous, S. A. (2023) · Journal of General Internal Medicine · doi:10.1007/s11606-023-08381-3 · Cited by 1 · see citing works
Yang, L., & Liao, Z. (2023) · PubMed Central · doi:10.12182/20231160605 · Cited by 1 · see citing works
Lung cancer outcomes: Are BMI and race clinically relevant?
Braillon, A. (2020) · Lung Cancer · doi:10.1016/j.lungcan.2020.12.021 · Cited by 1 · see citing works
Braillon, A. (2020) · Psycho-Oncology · doi:10.1002/pon.5406
“The denial is a global one as assistance for smoking cessation is too rarely provided: for example, in the United States, only 75% of oncologists assess tobacco use at intake visit, 60% advise patients to quit, and substantially less recommend treatment.(4) Further, when assistance for cessation is provided it is rare…”
BackgroundEducating Providers on Delivering Brief Tobacco Cessation Interventions to Cancer Patients
Hernandez, E. K. (2019) · UA Campus Repository (The University of Arizona)
Effekte von modifizierbaren Risikofaktoren auf Krebserkrankungen
Bleckwenn, M. (2020) · Forum · doi:10.1007/s12312-020-00861-5
CANCER PATIENTS’ TOBACCO USE AND TOBACCO TREATMENT REFERRAL RESPONSE
Borger, T. N. (2020) · UKnowledge (University of Kentucky) · doi:10.13023/etd.2020.509
Smoking Cessation Support: A Marathon, Not a Sprint; The Perspectives of Cancer Patients Who Smoke
Fox, P., Bhardwaj, N., Lyons, A., Niranjan, V. R., Frazer, K., Syed, S., McCann, A. H., Brennan, S., Brennan, D. J., Kelly, C. M., et al. (2024) · Seminars in Oncology Nursing · doi:10.1016/j.soncn.2024.151584
Nayak, M. M., Mazzola, E., Jaklitsch, M. T., Drehmer, J. E., Nabi-Burza, E., Bueno, R., Winickoff, J. P., & Cooley, M. E. (2024) · Tobacco Induced Diseases · doi:10.18332/tid/186272
“Price et al. 12 found that providers assess and advise patients to quit smoking but were substantially less likely to prescribe cessation medication.”
BackgroundSubstance Use Disorders Among Cancer Survivors
Braillon, A. (2024) · JAMA Oncology · doi:10.1001/jamaoncol.2024.1044
He, H., Liang, L., Tian, T., Zhang, X., & Lyu, J. (2024) · Tobacco Induced Diseases · doi:10.18332/tid/189199
“We applied stricter inclusion criteria and found only 92 SNPs related to smoking initiation, which is far fewer than the 378 found by Larsson and Burgess 24 .”
BackgroundMethodInfluentialSmoking cessation medication among patients with cancer: a herd of elephants in the room?
Braillon, A. (2025) · Supportive Care in Cancer · doi:10.1007/s00520-025-09222-1
“How to ignore that more than 75% of oncology care clinicians assess tobacco use during an intake visit and > 60% typically advise patients to quit, a substantially lower percentage recommend or arrange smoking cessation treatment” [2].”
Webster, M. A., Burris, J. L., Cipri, C. S., Bird, J. E., Hayes, R. B., Sheffer, C. E., Khanna, N., Lenhoff, K., Minion, M. M., & Tong, E. K. (2025) · Supportive Care in Cancer · doi:10.1007/s00520-025-10244-y
Ohde, J. W., Warner, D. O., Egginton, J. S., & Hagedorn, H. (2023) · Figshare · doi:10.6084/m9.figshare.24172135
Ohde, J. W., Warner, D. O., Egginton, J. S., & Hagedorn, H. (2023) · Figshare · doi:10.6084/m9.figshare.24172138
Ohde, J. W., Warner, D. O., Egginton, J. S., & Hagedorn, H. (2023) · Figshare · doi:10.6084/m9.figshare.24172129
Ohde, J. W., Warner, D. O., Egginton, J. S., & Hagedorn, H. (2023) · Figshare · doi:10.6084/m9.figshare.24172123
Ohde, J. W., Warner, D. O., Egginton, J. S., & Hagedorn, H. (2023) · Figshare · doi:10.6084/m9.figshare.24172132
Ohde, J. W., Warner, D. O., Egginton, J. S., & Hagedorn, H. (2023) · Figshare · doi:10.6084/m9.figshare.24172126
Enhancing Delivery of Tobacco Treatment in Oncology Care: Moving the Needle
Vidrine, J. I. (2026) · Journal of Clinical Oncology · doi:10.1200/jco-26-00342
Wakeman, M., Asvat, Y., Ruiz, R. A., Brett, E. I., Talbot, V., Tiro, J. A., & King, A. C. (2026) · Journal of Clinical Oncology · doi:10.1200/jco-25-02029
Carney-Knisely, G., Ferketich, A. K., Singh, P., Gur, T., & Padamsee, T. J. (2026) · Journal of Health Psychology · doi:10.1177/13591053261461883
Rosen, R., Lee, J., Gareen, I. F., Herman, B. A., Fenech, A. L., Kircher, S. M., Carlos, R. C., Kumar, S. K., Mayer, I. A., Saba, N. F., et al. (2026) · JCO Oncology Practice · doi:10.1200/op-25-01346
- Authors
- Price, S. N., Studts, J. L., & Hamann, H. A.
- Affiliations
- University of Arizona (US)
- University of Kentucky (US)
- Corresponding author
- Price, Sarah N.
- Venue
- The Oncologist
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-11-16
- Volume
- 24
- Issue
- 2
- Pages
- 229-238
- ISSN
- 1083-7159 (ISSN-L)
- 1549-490X
- PMC
- PMC6369951
- OpenAlex
- W2900468817
- Cited by
- 66
- References
- 46
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 9 · 2023: 15 · 2022: 10 · 2021: 6 · 2020: 13 · 2019: 5
- FWCI
- 0.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Oncologist (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Arizona Fellows Program
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- tobacco use, smoking cessation, cancer patients, clinical practice guideline adherence, 5As framework, tobacco use assessment, clinician training, cancer survivors
- MeSH terms
- Delivery of Health Care, Female, Humans, Male, Medical Oncology, Middle Aged, Quality of Life, Guideline Adherence, Tobacco Use
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