SMOKING CESSATION should be treated as a standard component of cancer care, according to new guidance highlighting its potential to improve survival and reduce treatment-related harm in people diagnosed with cancer.
Cancer, a group of malignant diseases characterised by uncontrolled cell growth, remained strongly linked to tobacco use, with cigarette smoking continuing to be the leading avoidable cause of cancer and cancer-related deaths in the United States.
The editorial argued that all newly diagnosed patients who smoke should be proactively offered evidence-based smoking cessation treatment, yet noted that few currently receive such support despite well-established benefits. It cited evidence that quitting after a cancer diagnosis improved survival and outlined practical strategies for implementing routine tobacco treatment.
The authors suggested tobacco treatment should stand alongside surgery, radiotherapy, and chemotherapy or immunotherapy as a core element of cancer management.
The editorial pointed to an opt-out smoking cessation programme developed through the National Cancer Institute’s Cancer Center Cessation Initiative (C3I) as an evidence-based model for delivering tobacco treatment in cancer care. Rather than waiting for patients to request support, the programme routinely offered treatment to eligible patients while allowing them to choose their preferred cessation approach.
According to the editorial, the programme reached nearly 55% of adult cancer registry patients identified as smokers through electronic health records and delivered smoking cessation treatment to almost one in four patients who smoked. The authors described the model as a promising, low-touch strategy that could help cancer centres implement evidence-based tobacco treatment more consistently.
The guidance summarised evidence showing that continuing to smoke after a cancer diagnosis increased treatment side effects, cancer mortality and all-cause mortality. Patients who smoked at diagnosis experienced a 61% higher overall risk of death than those who did not smoke, while quitting after diagnosis was linked to a 45% reduction in mortality compared with continuing to smoke. The editorial also noted that treating tobacco dependence within the first six months after diagnosis appeared especially beneficial.
Between 2018 and 2022, C3I-supported cancer centres provided tobacco treatment to more than 100,000 patients, while generating implementation strategies now available through an online Tobacco Treatment Implementation Roadmap.
The recommendations outlined practical steps for embedding smoking cessation into routine oncology practice. These included screening at least 90% of newly diagnosed patients for tobacco use, documenting smoking status within electronic health records, routinely offering counselling and pharmacotherapy using an opt-out approach, and monitoring programme performance to improve reach, effectiveness and equity.
The authors acknowledged barriers such as limited clinician time, uncertainty about responsibility for intervention, and patient concerns including fear, hopelessness and stigma. However, they concluded that existing implementation tools and updated Commission on Cancer standards provided cancer programmes with practical pathways to establish smoking cessation as a routine standard of care.
Reference
Fiore MC et al. Smoking in patients with cancer: guidance for delivering effective tobacco treatment in cancer care. J Clin Oncol. 2026;DOI:10.1200/JCO-26-01169.
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