Difficult Conversations: Smoking Cessation

By Laurie M. Robbins, BSN, RN, CBCN® - Last Updated: March 21, 2022

Nurses can help to reduce the risk of cancer among the general population by helping people quit smoking. Oncology nurses, however, may have an even more significant impact on improving patient outcomes after a cancer diagnosis. Cancer survivors who quit smoking live longer, have better treatment results with fewer side effects, recover more quickly and with more energy, and have a better quality of life than cancer survivors who continue to smoke. 

Tobacco, Nicotine, and Cancer

Tobacco use is the leading cause of preventable disability, disease, and death in the United States. Tobacco smoke contains more than 70 known carcinogens that directly affect cellular DNA, leading to uncontrolled and rapid cancer cell division and growth. Through cigarettes, cigars, bidis, kreteks, pipes, or hookahs, smoking or smokeless tobacco (chewing, snuff, snus, or dissolvable tobacco products) puts the whole body at risk for disease and affects every organ. In addition, evidence suggests that electronic nicotine delivery systems, including e-cigarettes, e-hookahs, and vape pens, are also dangerous, often in different ways than more traditional tobacco products.

 Best Counseling Recommendations

The most effective way for people who smoke to reduce their risks of developing cancer and improve outcomes after a cancer diagnosis is to quit smoking. However, nicotine is highly addictive and makes quitting smoking one of the hardest things some people will ever do. Therefore, clinicians must counsel patients on the risks of smoking to empower them to quit.

Many nurses are already familiar with the Agency for Healthcare Research and Quality’s “5 A’s” for tobacco cessation counseling. However, the American Academy of Family Physicians (AAFP) suggests a simpler 2-step Ask and Act program:

  1. Ask all patients about tobacco use
  2. Act to help them quit
Ask: Do you smoke?


Ask: Do you want to quit?
Ask: “What do you think of quitting smoking in the next month?” Ask: “What do you know about the benefits of quitting smoking?”

I am ready to quit


I am not ready to quit

Provide: “Because of the benefits you mentioned [and/or others], I strongly urge you to stop smoking as soon as possible. What do you think of this?”

Act: Answer patients’ questions and provide resources if they accept


·  Offer appropriate pharmacotherapy

·  Refer to community smoking cessation program


·   Offer “reduce to quit” strategy

·   Refer to community smoking cessation program for further counseling


In addition, the AAFP lists many resources for both healthcare providers and patients regarding smoking cessation, including:

  • Guide on how to discuss quitting with patients
  • Telehealth guide to improving adherence to quitting
  • List of medications to help patients quit
  • Patient resource guide to quitting
  • Patient education on smoking, vaping, and smokeless tobacco cessation

The CDC provides many resources for healthcare providers, including illustrated flyers, notepads with printed website resources, a list of medications to help patients quit, and a patient-centered smartphone app with quit tools.

Although smoking cessation can be a difficult, challenging conversation with patients, it is necessary to improve the outcome of their cancer treatment journeys and overall health. No matter the duration of use, quitting tobacco has immediate, short-term, and long-term effects that can boost psychological well-being and enhance the physiologic quality of life. Sometimes, patients need someone to ask them if they’re ready and give them the resources to help them quit.

With available tools, oncology nurses can incorporate these difficult discussions into every patient conversation to help normalize the topic and reduce stigma. You, as oncology nurses, can strengthen patient education through repetition, provide consistency of care and documentation, and improve the health of communities—one person at a time. Then, the topic of quitting smoking becomes less difficult to discuss and more a part of the routine patient care.


Stopping Tobacco Use After a Cancer Diagnosis

Smoking & Tobacco Use: Data and Statistics

Tobacco and Cancer

Five Major Steps to Intervention (The “5 A’s”)

Ask and Act Tobacco Cessation Program

Tips From Former Smokers