Tobacco cessation treatment can and should be a team effort. Also, successful cessation attempts occur across multiple interactions — clinic visits, quitline phone calls, follow-up appointments, etc. The 2008 Public Health Service Tobacco Cessation Guidelines recommend organizing a patient's quit attempt around the "5 As" — Ask, Advise, Assess, Assist, and Arrange. Find out how to incorporate the 5 As into practice and access useful resources related to each A.

Additional Resources

The following patient and provider guides from ASCO are available in hard copy through the ASCO University Bookstore:

The 5-A's of Tobacco Cessation

ASK:

Every patient about their tobacco use at every clinic visit. Responses should be documented. Current use and historic use is best measured by asking about duration and amount of tobacco use prior to the cancer diagnosis. Even though many cancer patients will report discontinuing their tobacco use immediately prior to their diagnosis, relapse is common, so it is important to assess tobacco use at each patient encounter.

Tools:

ADVISE:

Current tobacco users to quit immediately. Be clear about the risks of continued tobacco use and the benefits of cessation for patients with cancer. Try to personalize the information as much as possible, and include information on how continued tobacco usage can affect treatments like chemotherapy, radiation, or surgery.

Tools:

ASSESS:

Current tobacco users' willingness to quit. Encourage them so set a quit date. Patients may have many excuses for why they cannot quit or are not ready to quit. Be prepared to offer thoughtful responses to each answer or "excuse," reinforcing that quitting is important.

Tools:

How recently former tobacco users quit. Be sure to ask if they are facing any difficulties in their ongoing quit attempt, and identify individuals at high risk for relapse.

Tools:

ASSIST:

Current tobacco users in their attempts to quit. Put together a personalized quit plan for patients including target quit date, counseling, quitline or community referrals, prescription for FDA-approved tobacco cessation treatment agents (if needed), and expected quit-attempt challenges (including nicotine withdrawal symptoms).

Tools:

Former tobacco users who are at risk of relapse. Determine what challenges they are facing and make any necessary revisions to their current quit plan.

ARRANGE:

For appropriate follow-up with every patient. Follow-up contact, either in person or via telephone, should be made within a week or two to assess their progress in altering tobacco-use behaviors. Additional follow-up contact is recommended so that the importance of discontinuing tobacco use is conveyed to the patient.

For patients who are struggling to remain tobacco free, consider a referral to a psychologist or a professionally trained smoking cessation counselor. During the follow-up period it is important to reinforce the patient’s accomplishments regarding efforts made to change their tobacco use behavior. Contact can be particularly helpful to assess pharmacotherapy use and problems. In the event tobacco use has resumed, talk to the person, focus on the positives, and try to figure out how to make their next attempt more successful. Work with the individual to either modify their cessation plan or build a new one, paying close attention to any cultural, emotional, literacy, or behavioral barriers that may exist.