Title : Preoperative identification and implementation of smoking cessation strategies in oncological patients: The role of healthcare providers
Abstract:
Introduction: The preoperative period represents a key opportunity to identify modifiable risk factors in oncological patients and to implement strategies that optimize outcomes before major surgery. Smoking cessation prior to surgery has been shown to reduce perioperative stress, maintain postoperative physiological stability, and accelerate recovery, while lowering morbidity and mortality.
To support pre-surgical assessment, NICE guidelines and ERAS protocols recommend the use of screening tools to identify smokers and implement targeted cessation interventions. Evidence indicates that counselling and guidance provided by healthcare professionals during the cessation process have a significant positive impact and enhance treatment adherence. This project aims to optimize preoperative patients by targeting modifiable risk factors.
Objectives: To evaluate whether preoperative oncological patients who are smokers were counselled and referred for smoking cessation support as part of the NICE clinical guideline NG209 (Tobacco: preventing uptake, promoting quitting and treating dependence). Additionally, to propose strategies to improve the referral pathway for community-based services.
Materials and Methods: A retrospective analysis was conducted of patients who underwent colorectal cancer surgery at a single centre in June 2025. Smoking status and referral for cessation were identified from preoperative assessment records. Based on these findings, a structured “Smoking Cessation Pathway” was subsequently developed to provide a standardized, user-friendly process for patient identification, counselling, and referral. The pathway algorithm was implemented during the first week in July 2025 across all pre-assessment units, including day-case surgery, the pre-surgical assessment clinic, and the endoscopy department. Outcomes measured included the prevalence of active smokers, provision of smoking cessation advice, and acceptance of referral to support services.
Results: Before implementation, 58 patients with a median age of 64 years old were evaluated preoperatively, of whom 9 patient (15%) were active smokers. Patients referred having a smoking history of over 45 years, consuming on average between a quarter and half a pack of cigarettes per day. Although verbal counselling may have been provided, documentation within the pre-assessment notes did not record this or referral to community smoking cessation services.
Following implementation of the “Smoking Cessation Pathway”, 49 patients were assessed, with 7 patients (14%) identified as active smokers. All received smoking cessation counselling, and of this group, 3 patients (6%) accepted referral to the NHS Better Health Stop Smoking Service.
Among the patients who were active smokers, the most common cancer type was gastrointestinal, followed by colorectal and urological.
Conclusion: The preoperative setting represents a crucial opportunity to identify modifiable risk factors and implement strategies to optimize patients before surgery. During this stage, healthcare professionals play a fundamental role in delivering smoking cessation advice and facilitating referral to structured support services.
