Identifying Smokers in your Practice

I recently read an article on health care that included the phrase, “What gets measured gets managed.” It’s such a good quote and applies to so many aspects of medicine. For example, we now have an EMR that facilitates measurement.

CCO’s 2013 Cancer Risk Factors in Ontario estimates that 15 per cent of all new cancer cases are attributed to cigarette smoking. And of course smoking also causes other chronic diseases.

Do you know which patients in your practice smoke? Can you print a list of them easily? I used to input smoking status under risk factors (ie. non smoker or smoker 1 ppd), however it’s not searchable. I now use OSCAR and have started a smoking registry (code305) that is searchable. Where can you put smoking in your EMR so it is searchable? For Practice Solutions you can use the ‘Risk Factor’ module.

Besides ensuring that I try to address smoking at each and every visit, I am creating this registry for the future when I may be able to offer patients screening for lung cancer – the leading cause of cancer death for women and men, with an estimated 7,100 people having died of this disease in 2016.

There is good evidence that in an organized program, screening for lung cancer in smokers is effective. The number needed to screen using low dose CT to prevent one lung cancer death reported in the NLS Trial was 320. (National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. NEJM 2011; 365(5):395-409.)

In order to determine how to best implement organized lung cancer screening in Ontario, there are three pilot sites. We do not have one in our LHIN and Cancer Care Ontario does not advise physicians to encourage patients to travel outside of their region to participate in the pilots. Also, lung cancer screening for people at high risk using low dose CT should only be conducted as part of an organized screening program.

For more information please see the CCO Lung Cancer Screening FAQ.

Meanwhile I will keep working away at smoking cessation. I refer patients to the Smoker’s Helpline. This free, confidential service operated by the Canadian Cancer Society offers support and information about quitting smoking and tobacco use.