In this TOGA Podcast, we discuss smoking cessation in the face of smoking-related stigma and nihilism. Dr Henry Marshall, Associate Professor and Clinical Academic Fellow, UQ Thoracic Research Centre and Thoracic Physician, The Prince Charles Hospital Queensland is joined by Professor Christine Paul: Behavioural Scientist at the University of Newcastle and School of Medicine and Public Health Dr. Matt Steliga: Chair of The IASLC Tobacco Control and Smoking Cessation Committee and Surgical Oncologist at Winthrop P. Rockefeller Cancer Institute, Little Rock, Arkansas. The COSA Smoking Cessation in Cancer Patients position statement recommends that brief advice on smoking cessation is everyone’s role, but surveys suggest that many healthcare professionals feel they are inadequately trained to conduct these conversations, and in lung cancer, perceived sensitivities around smoking-related stigma may further hamper the delivery of appropriate smoking cessation advice. Despite clear benefits of smoking cessation and the recognition by healthcare professionals that smoking cessation is part of an individualised treatment plan, smoking cessation support for cancer patients may still not be successfully integrated into patient treatment plans. This podcast provides practical advice on how to start the conversations using variations on the “Ask, Advise, Help” model and emphasising brief advice and referral that can be conducted by any healthcare professional. The podcast also covers why continuing to check in on progress at each visit is important, that stigma-related sensitivities are actually negated by asking about quitting regularly and that tandem pharmacotherapy to combat physical withdrawal and behavioural support (e.g QUITLine counselling) is evidence-based best practice for quitting. Finally, the podcast covers some system-based changes that have had phenomenal results, with over 90% uptake of behavioural support services in both lung cancer and non-cancer cohorts, and a 68% quite rate in a lung cancer cohort, and description of a clinical trial in the Australian healthcare system with a similar intervention. Resources referred to in this podcast:13QUIT for telephone adviceQUIT online referral formClinical Oncology Society of Australia Smoking Cessation Working Group. Smoking Cessation in Cancer Patients: Embedding Smoking Cessation Care in Australian Oncology Health Services. Clinical Oncology Society of Australia. August 2020.https://www.cosa.org.au/media/332692/cosa-smoking-cessation-in-cancer-patients-140820-final.pdf Position Statements | COSA tobacco-cessation-guide.pdf (asco.org) Quitting Smoking At or Around Diagnosis Improves the Overall Survival of Lung Cancer Patients: A Systematic Review and Meta-Analysis - Journal of Thoracic Oncology (jto.org)

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