Aim: To investigate the magnitude and impact of smoking status non-disclosure on the ability to successfully implement a smoking cessation program for patients with a cancer diagnosis. To report smoking prevalence, magnitude, willingness to report and smoking cessation program participation, retention and success rates.

Methods: Patient-reported smoking behaviors and smoking cessation program participation among cancer patients at Peter MacCallum Cancer Centre were retrospectively reviewed for the two-year period 2009-2011. Program participation, retention and success rates were evaluated through an audit of medical and pharmacy records and by phone interview with a subset of patients.

Results: 50% (10,401) of patients newly registered to the hospital identified as having ever smoked with 12% (2448) current smokers. Magnitude of smoking was high; average pack-years of patients who have ever smoked was 22.6 and for current smokers was 27.8; 155 patients reported smoking magnitude as greater than 100 pack years. Recruitment of patient-identified current smokers into the smoking cessation program was low (7.3%) and nearly half of those recruited (46%) received just one consultation. 78% of patients in the program utilised pharmacotherapy. 43% (134) of patients enrolled into the program had not disclosed their smoking status at hospital registration. Among patients who participated in follow-up interviews (n=30), the point prevalence smoking cessation rate was 33% and 66% of patients reported successful outcomes (cessation or reduction in consumption).

Conclusion: Smoking cessation program recruitment and retention was poor despite active efforts to refer patients into an established and fully funded interventional cessation program. The prevalence and magnitude of smoking among cancer patients was high despite a gross under-reporting of smoking behaviors. Those who did access the program were highly likely to receive pharmaceutical support and successful outcomes. Efforts need to focus on improving accessibility to the program and developing a model that promotes patient disclosure of smoking behaviors.