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.
People who smoke expect their health professionals to ask them about their smoking and to provide them with help to stop. The most effective care to support long-term smoking cessation is a combination of pharmacotherapy, as clinically appropriate, and multi-session behavioural intervention, such as Quitline.
A recent consultation project with general practitioners and community pharmacists aimed to gain insights into the provision of cessation care, knowledge gaps and emerging practice issues. The insights gleaned included limited understanding of Quitline, which has informed the development of a four-minute video outlining how health professionals can partner with Quitline to support their patients who smoke.
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. With this rapid rise in vaping, there has also been an increase in people seeking support to stop vaping.
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 of the 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) who may wish to quit both smoking and vaping.
A major review on the health effects of vaping outlines that there is evidence that e-cigarettes can be harmful to health and that there is uncertainty regarding their impacts on a range of important health and disease outcomes.
The Australian clinical guidelines published by the Royal Australian College of General Practitioners in 2021, provide advice on weaning and ceasing nicotine vaping products (NVPs) that have been used as a smoking cessation aid. According to the guidelines, attempting to wean or cease NVPs after 12 weeks of use is recommended, and transferring to nicotine replacement therapy (NRT) may be an option. There may be a role for the use of other approved smoking cessation pharmacotherapies in ceasing NVPs, however, further research is required.
Quit Centre recently conducted a literature review of interventions for vaping cessation. This review concluded that while there is currently much research underway to build the evidence base for people wanting to stop vaping, at the moment, there is 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. pharmacotherapy plus behavioural counselling interventions.
In Australia, 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
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.
Supplies may be limited of the unregistered product (APO-Varenicline 1 mg tablet (Canada)) approved for import and supply in Australia under Section 19A. A unregistered product (APO-Varenicline 500 microgram tablet (Canada)) is approved for import and supply in Australia under Section 19A. Both are available on the PBS.
From 21 July 2021, 18 new temporary items are available for patients to access nicotine and smoking cessation care through General Practice. The new temporary MBS items include six face-to-face, six telehealth and six phone services. These items are temporary and were initially scheduled to end on 30 June 2022, but will now be in place until 31 December 2023.
Medicare benefits are paid for telehealth health care services relating to nicotine and smoking cessation counselling, without the requirement for the patient to have an established clinical relationship with the general practitioner. Each consultation with a patient who smokes is a potential opportunity to offer brief advice.
From 1 October 2021, consumers require a prescription for nicotine vaping products (NVPs), such as nicotine e-cigarettes, nicotine pods and liquid nicotine. This includes products purchased both in Australia and imported from overseas.
View Clinical guidelines for smoking cessation, including place in treatment for NVPs.
Access Online training for health professionals, including considerations for prescribing and dispensing NVPs.
Visit Therapeutic Goods Administration for detailed information on how to legally access, prescribe and supply NVPs.
Visit National Prescribing Service (NPS) MedicineWise for information on the nicotine regulatory changes.
View the Quit and Heart Foundation Position Statement: Smoking and Vaping Cessation, which has been endorsed by other peak health and medical groups.
A PMR of medicines for smoking cessation is currently underway. Medicines included in the review are nicotine replacement therapy (NRT), varenicline and bupropion.
The Pharmaceutical Benefits Advisory Committee (PBAC) released their recommendations in response to the PMR on 17 June 2022.
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.
Last updated: 9 November 2023