A series of short, powerful videosproduced by Quit Centre and Cancer Council Australia feature Medical Oncologist Dr Malinda Itchins and Radiation Oncologist Dr Graham Warren. The experts explain the important role of clinicians in providing smoking cessation care to people with cancer and describe the ways clinicians can help their patients who smoke to quit.
View the full version below.
Quit Centre has recently partnered with the Stroke Foundation, with support from the Heart Foundation/a> to produce a series of short key message videos featuring cardiologist Professor Andrew Pipe, world leader in smoking cessation for people with cardiovascular disease.
In the short videos, Professor Pipe outlines the importance of providing smoking cessation care for patients with cardiovascular disease. He describes some simple strategies and conversations tips clinicians can use to support their patients who smoke to quit. View the full version below.
Nicotine 4mg and 2mg gum and lozenge have been deleted from the PBS, effective 1 July 2023.
A Quit Centre review of interventions for vaping cessation concluded that while much research is underway, there is currently a lack of evidence about effective interventions for vaping cessation. While we eagerly await new information, prominent researchers, clinicians and organisations suggest that vaping cessation interventions theoretically align with evidence-based practices for smoking cessation, i.e. combine pharmacotherapy with behavioural counselling.
The Royal Australian College of General Practitioners (RACGP) has released provisional guidance updates on smoking and vaping cessation support related to Australia’s vaping regulation, including a new section on vaping cessation. Where clinically appropriate, a patient may be eligible for PBS subsidised NRTs provided they are nicotine dependent from the inhalation of any nicotine containing product. Quitline has counselling protocols to support people who are using NVPs to quit smoking and also supports people who want to stop vaping, including young people. Refer patients at www.quitcentre.org.au/referral-form
In Victoria, the number of new clients contacting Quitline for support with stopping vaping tripled in 2022 from 2.6% in Quarter 1 to 7.9% in Quarter 4. Clients often describe unexpected levels of addictiveness to vaping and difficulties with reducing and stopping vaping. Some clients calling Quitline indicate they are using e-cigarettes to stop smoking, while many younger people using e-cigarettes have never previously smoked and are experiencing nicotine addiction for the first time. There are also clients contacting Quitline who are smoking and vaping at the same time (dual users) with some trying to quit both smoking and vaping.
A major review on the health effects of vaping provides evidence that e-cigarettes can be harmful to health, with uncertainty regarding their longer-term impacts on a range of important health and disease outcomes. The most recent national data on vaping prevalence indicates that current vaping (use of e-cigarettes in the last month) has more than quadrupled among Australians aged 14+ between late 2020 and early 2023, from 2.0% to 8.9%. The increase has been most apparent in people aged under 35 years, with those aged 18 to 24 years having the highest prevalence of current vaping (19.8%) in early 2023.
Champix remains unavailable with supply impact dates currently listed until 30 June 2024.
An ARTG varenicline combination pack (Pharmacor Varenicline 500 microgram tablet and 1mg tablet) is available on the Pharmaceutical Benefit Scheme (PBS) from 1 November 2023, alongside Pharmacor Varenicline 1mg tablet.
An ARTG varenicline 1mg tablet (Varenapix) is available on the PBS.
Information around the unregistered products (APO-Varenicline 1mg tablet (Canada) and APO-Varenicline 0.5mg tablet (Canada)) can be found here.
On 1 Jan 2024, the government introduced a ban on the importation of disposable single use vaping products, along with a new Special Access Scheme (SAS) pathway to facilitate legitimate patient access by enabling medical practitioners and nurse practitioners to prescribe therapeutic vaping products where clinically appropriate, without requiring pre-approval or authority from the TGA.
Further information about the reforms is available on the TGA’s Reforms to the regulation of vapes page.
Results of the Australian National Diabetes Audit (ANDA) showed that people who currently smoke had poorer glycaemic and lipid control and higher odds of macrovascular and microvascular complications compared to those who had never smoked.
Results of data collected from 15,352 patients, including 72.2% with type 2 diabetes and 13.5% who were currently smoking, showed that people who currently or have previously smoked, have a median HbA1c 0.49% and 0.14% higher than those who have never smoked, respectively, as well as higher triglyceride and lower HDL levels (all p values < .0001). People who currently or have previously smoked had higher odds of myocardial infarction, stroke, peripheral vascular disease, lower limb amputation, erectile dysfunction and peripheral neuropathy (all p values ≤.001), with no significant change over time.
These findings are supported by this retrospective cohort study of 3044 participants, examining the extent of the association between smoking and glycaemic control in patients newly diagnosed with type 2 diabetes. It shows that active smoking is associated with poorer glycaemic control with the difference in HbA1c reduction between people who smoke and those who don’t being 0.33% (95% CI, 0.05-0.62%) at 3 months of follow-up. Additionally, the benefits of risk factor management for prevention of cardiovascular events among patients with diabetes are attenuated by current and former smoking.
A recently published randomised clinical trial Efficacy and Safety of Varenicline for Smoking Cessation in Patients With Type 2 Diabetes concludes that varenicline use in a smoking cessation program is efficacious in achieving long-term abstinence without serious adverse events. The authors conclude that ‘varenicline should be routinely used in diabetes education programs to help patients with type 2 diabetes stop smoking.’
Dr Andrew Pipe urges all clinicians to prioritise smoking cessation, arguing that provision of smoking cessation care is a “fundamental responsibility”, with clinicians playing an essential role.
In the publication titled Smoking cessation: health system challenges and opportunities Pipe, Evans and Papadakis highlight the significance of provision of smoking cessation care as a key intervention in primary care, using a tabulated comparison (the number needed to treat [NNT] to prevent one death
) for some common primary care clinical interventions such as statins for primary prevention and antihypertensives for mild hypertension.
Australian clinical guidelines recommend that the combination of behavioural intervention with pharmacotherapy approved by the Therapeutic Goods Administration (TGA), if clinically appropriate, is the best way to help people who smoke to quit.
Behavioural intervention involves multiple sessions of tailored behavioural counselling delivered by professional smoking cessation counsellors. Drawing on evidence-based behaviour-change techniques and approaches, such as cognitive behavioural therapy (CBT), acceptance and commitment therapy, and motivational interviewing (MI), the counselling helps motivate people to make a quit attempt and develop skills to manage withdrawal and adjust to life without smoking. In Australia, Quitline’s free service is the most accessible provider. It’s quick and easy to refer you patient. Refer at www.quitcentre.org.au/referral-form.
Adherence to smoking cessation pharmacotherapy improves the rate of successfully quitting, however an Australian survey found only 28.4% of people (including those who currently smoke and have previously smoked) who used smoking cessation pharmacotherapy were adherent to these medications.
Health professionals have a key role in supporting their patients pharmacotherapy use. Health professionals may facilitate adherence to pharmacotherapies by providing advice on correct use of the products, addressing and managing any adverse effects and also by discussing the effectiveness of pharmacotherapy to enable realistic expectation-setting.
Access online training, including how to use pharmacotherapy to support smoking cessation in patients.
Facts and Issues is a regularly updated comprehensive online resource of the major issues in smoking and health in Australia, compiled by Cancer Council Victoria.
A complete Endnote library of all citations for all chapters and sections is available.
Quit Centre Quarterly Newsletter
Last updated: 9 January 2024