1. PETRA Workshop Tobacco Cessation and Cancer Treatment Dr. Larry Pan, MD, FRCPC Radiation Oncologist Chelsea Soga, MA, BSc RTT Radiation Therapist and Project Lead of the CTC Tobacco Cessation Project November 3, 2015 Brackley Commons Community Centre

2. Decreasing PEI’s Cancer Burden A significant proportion of cancer cases are Predictable and Preventable

3. Magnitude of Impact of Tobacco Smoking contributes to 30% of all cancer deaths Smoking accounts for approximately 80% of lung cancer deaths

4. Magnitude of Impact of Tobacco Approximately 25% of patients referred to cancer centres for oncologic treatment are current or recent smokers (smoked in the previous 6 months) [Ontario data]

5. Surgeon General’s 2014 Report In cancer patients and survivors, the evidence is sufficient to infer a causal relationship between cigarette smoking and  increased all-cause mortality and cancer-specific mortality  increased risk for second primary cancers known to be caused by cigarette smoking, such as lung cancer

6. Smoking and Radiation Therapy Smokers who continue to smoke during RT  significantly lower rate of complete response to radiation therapy (45% vs 74%)  significantly lower 2-year survival (39% vs 66%) Browman GP at al. NEJM 1993

7. Smoking and Chemotherapy Irinotecan  Lowered dose-normalized area under plasma concentration-time curve in smokers compared to non-smokers  Grade 3 to 4 treatment-induced neutropenia: 6% smokers, 30% non-smokers Van der Bol et al. J Clin Oncol 2007; 25: 2719- 2726 Erlotinib  Lower overall response in smokers vs never smokers (3.9 vs 24.7%; p, 0.001) Shepherd FA et al NEJM 2005; 353: 123-132

8. Select Key Messages… Addressing the stigma of lung cancer… “victim blaming” The benefits of smoking cessation is often much greater than the benefits of some chemotherapeutic agents or radiation therapy Smoking is the #1 cause of preventable death in Canada We cannot deliver “quality cancer care” unless we also focus on smoking cessation Performance indicators to drive quality improvement

9. PEICTC Tobacco Cessation Program - Overview

10. Support for Cancer patients The gap: staff at the PEICTC do not have a process or the training to support our cancer patients while on treatment to quit using tobacco. A tobacco cessation program will fill this gap.

11. Funding Opportunity Canadian Partnership Against Cancer (CPAC):  Integrating evidence-based tobacco cessation and relapse prevention as a cancer care quality improvement initiative

12. CPAC Objectives Support implementation of tobacco cessation and relapse prevention into cancer systems. Facilitate knowledge sharing and learning among involved cancer settings. Gather standard evaluation metrics from across the Country.

13. PEICTC Goals Inform patients about the importance to help quit smoking while on treatment. Provide patients with the support and resources to overcome barriers to quit smoking. Improve outcomes of patients undergoing cancer treatment

14. PEICTC Program Scope 1. Establish a program based on Ottawa Model of Smoking Cessation (OMSC) 2. Develop and implement staff training modules 3. Improve access to pharmacotherapy 4. Evaluate project outcomes and success

15. 1. Establish a program based on OMSC Sites include oncology departments at QEH and PCH Model of Ask, Advise, Assess, Assist and Arrange (5A's) Utilize TelAsk and Smokers helpline for follow up care

16. 2. Develop and implement staff training modules All staff trained on:  Tobacco addiction  Importance of tobacco cessation and  Overview of 5As of OMSC model Increased training for leaders or “quit specialists”:  Performing the 5A and Consultation (Assess, Assist and Arrange)  Online and In person training

17. 3. Improve access to pharmacotherapy Develop report to provide evidence and projections for required pharmacotherapy support for cancer patients. Provide support to stakeholders towards efforts to include cessation medication in formulary

18. 4. Evaluate project outcomes and success Patient evaluation Report on indicators to CPAC, Health PEI and Stakeholders Knowledge transfer and Exchange evaluation through CPAC

19. Time lines Project begins Jan 2, 2016 Staff training plan begins Sept 2016 Project roll out to follow – Fall of 2016 National indicators reported in late 2017

20. Thank you! Stakeholder consultation plan  Stakeholder letter of support included in proposal  Collaboration and information sharing to continue throughout project Thank you for your support on our proposal! We are looking forward to working with you!