Addressing the Effects of Smoking on Cancer by Increasing National Access to Smoking Cessation Across Canada

Introduction: Smoking cessation after a cancer diagnosis improves cancer outcomes, but there are limited data demonstrating national improvements in access to evidence-based care. A national quality improvement initiative was developed to improve access to evidence-based smoking cessation support across ambulatory cancer care settings. Methods: Between 2016 and 2023, a pan-Canadian quality improvement initiative was developed to increase access to smoking cessation for patients with cancer. The Canadian Partnership Against Cancer coordinated financial, experiential, educational, and logistical support in collaboration with all Canadian jurisdictions to develop jurisdiction-specific implementation approaches and report on implementation outcomes. Structured assessments for reach were developed and shared among jurisdictions, including assessment of barriers and facilitators at biannual to annual Network meetings. Results: A national vision, implementation framework, educational resources, and performance metrics were developed and implemented. Between 2016 and 2023, access to smoking cessation support increased from 26% to 95% of ambulatory cancer centers and was maintained at 95% through 2025. At project completion, a median of 76% (range 10%–100%) of patients with cancer were screened for tobacco use and a median of 64% (range 7%–89%) were referred for smoking cessation support. Facilitators included education, leadership support, funding, multilevel engagement, clear objectives, defined performance metrics, adaptive jurisdiction-specific implementation approaches, and continuous communication throughout the initiative. Conclusion: National prioritization to address smoking by patients with cancer and survivors through coordinated leadership and tailored implementation approaches can increase access to smoking cessation support across ambulatory cancer care settings.