Patient engagement in CPD in radiation oncology and radiation therapy across Canada: A national survey.

BACKGROUND: The aim of this study was to investigate patient engagement (PE) in the development and delivery of Continuing Professional Development (CPD) programs for health care providers within radiation oncology, radiation therapy and medical physics across Canada. This study looked at the current state of PE in CPD programs across Canada and how to address the benefits and barriers to PE to advance these programs. METHODS: A quantitative, exploratory survey was conducted among radiation oncologists, radiation therapists and medical physicists across Canada. The questionnaire was developed by a multi-disciplinary team and piloted among interprofessional (IP) faculty with a special interest in patient education. The survey was web-based and disseminated through the Canadian Association of Medical Radiation Technologists (CAMRT) and Canadian Radiation Oncologists (CARO) professional associations. RESULTS: A total of 97 responses were obtained, 43.3% (n = 41) were radiation oncologists 64% (n = 54) were radiation therapists and 2(2%) were medical physicists. There was representation from all provinces, except Newfoundland, with the majority 36% (n = 35) from Ontario. 57% (n = 46) of participants agreed that patients should be involved in CPD, and 11% (n = 9) disagreed. The most agreed-upon barriers are financial costs for patients and clinician bias when selecting patients. The most agreed-upon solutions were improving patient resources and creating training programs for patients. Radiation therapists agreed significantly more (p<0.05) with the potential benefits of PE in CPD, compared to radiation oncologists. DISCUSSION: PE in CPD programs is a novel and controversial topic but is still highly rated and important. We intend to advocate for patients to take an active role in our CPD programs. Further research is warranted.

Retrospective analysis of VES-13 questionnaires in the Senior Women's Breast Cancer Clinic at Sunnybrook Health Sciences, Toronto, Ontario, Canada.

PURPOSE: Vulnerable Elder Survey (VES-13) is a screening tool used in assessing older vulnerable patients at risk of functional decline. We sought to evaluate how VES-13 tool would impact oncologist referral pattern to geriatricians as our primary outcome. We also sought to better understand how VES-13 scores impacted referral to additional services (allied healthcare), and modification to oncological treatment. METHODS: A retrospective review of VES-13 questionnaires completed by older women (age 70 or older) with breast cancer referred to the Senior Women's Breast Cancer Clinic (SWBCC) was undertaken. Patients with a VES-13 score of three or greater, who were at significantly higher risk of functional decline, had further retrospective chart review for risk factors that would contribute to functional decline such as Eastern Cooperative Oncology Group (ECOG) score, social supports, and current living situation. The primary and secondary endpoints described above were analyzed through bivariate comparisons and multivariable logistical regression to determine if there was any statistical significance (p < 0.05). RESULTS: 701 patients completed VES-13 form, of which 235 (33.5%) had a VES-13 score of three or greater. Less than 5% of oncologists documented VES-13 scores in their notes, with less than 5% of patients being referred for geriatric services. Neither VES-13 (p= 0.900) nor ECOG (p= 0.424) were associated with referral for geriatrics assessment. Referral to allied healthcare services was significantly associated with (ECOG) score (OR 2.24 [1.49-3.37], p < 0.0001), while not significantly associated with VES-13 score (OR 0.89 [0.78-1.02], p= 0.102). VES-13 (OR 1.23 [1.04-1.45], p=0.014) and ECOG (OR 2.37 [1.29-4.37), p=0.005) were both associated with modification in oncology treatment (chemotherapy or radiation). CONCLUSION: Approximately one third of our population was at risk of functional decline. VES-13 scores were infrequently mentioned in oncologists notes from their clinical assessments, with very few patients being referred for geriatric assessment. By not collecting and analyzing VES-13 scores, and relying on performance status alone, there is a missed opportunity in assessing for functional decline and reducing potential complications from treatment for our patients.

Radiation therapists' knowledge and attitudes regarding specialized clinics for geriatric assessment of older women with early stage breast cancer: A cross sectional study.

INTRODUCTION: Older patients with breast cancer have specialized needs compared to younger patients. Currently, there is disparity of care, with comprehensive cancer centres unable to adequately respond to the needs of this population. Specialized geriatric oncology clinics in Europe focus on care for older patients and are increasingly of interest in Canada due to the aging population. This study examines radiation therapist (RT) views on the need for specialized geriatric oncology clinics for women over age 70 with early stage breast cancer. METHODS: The study utilized a cross sectional survey design, with Likert scale, multiple choice and open ended questions. Surveys were sent out via email to all RTs registered with the Canadian Association of Medical Radiation Technologists. Demographic information was collected. Descriptive statistics were used to analyze quantitative data. Responses to open ended questions were compiled for thematic analysis. RESULTS: 240 therapists completed the survey (17% response rate). 90% of RTs were unaware of specialized geriatric oncology clinics but 66% felt these clinics could be useful. Similarly, 80% of RTs were not familiar with assessment tools geared toward older patients but 86% felt these tools would be useful. Therapists identified both benefits and drawbacks of both geriatric oncology clinics and the use of specialized assessment tools. DISCUSSION: Canadian RTs report that older women with breast cancer could benefit from specialized geriatric oncology clinics and assessment tools geared toward this population. However, most RTs were not familiar with these assessment tools indicating a need for education regarding their application within the clinic environment. Regardless, many RTs felt knowledgeable and confident in recognizing and helping with the special needs of their older patients.

Exploring Tobacco Use and Smoking Cessation Best Practices From the Perspectives of Individuals With Lung Cancer and Health Care Professionals.

BACKGROUND: Lung cancer patients who continue to smoke after diagnosis are at increased risk of treatment toxicity, residual/recurrent disease, future malignancies, and all-cause mortality. Guidelines including those from National Comprehensive Cancer Network and Cancer Care Ontario advocate for screening, counseling, and access to smoking cessation services for all cancer patients; however, barriers from both patient and health care professional (HCP) perspectives contribute to lack of implementation. OBJECTIVE: The objective of this study was to identify the different perspectives among patients and HCPs in how the promotion of person-centred approaches may be used when offering smoking cessation services to patients who are receiving care within a regional cancer centre. METHODS: Qualitative data were generated using various methods, including focus groups with HCPs and interviews with patients. In total, 16 HCPs participated in three focus groups: including nine radiation therapists, five registered nurses, one registered dietitian, and one physiotherapist. Of 55 patients accrued, 19 were interviewed. Both focus groups and interviews were audio recorded, and the recordings were transcribed verbatim. Transcripts were then analyzed using narrative thematic analysis to define and identify themes. RESULTS: The identified themes were categorized into three topic areas: knowledge (eg, impact of smoking on illness and why they should not smoke); individual decision to quit (eg, motivators), and the social unacceptability of smoking (eg, the public perception of smoking over the last 40 years). HCP-identified themes included identification of smokers, triggers to start a conversation, approach, gaps and barriers to cessation, rationale for cessation, and judgment. Patient-identified themes included knowledge, individual decision to quit, and the social unacceptability of smoking. CONCLUSION: Understanding patient and HCP perspectives on smoking cessation will help influence practice to ensure that patients are not judged, assumptions are not made, and individualized and person-centred care is provided. HCP awareness of these themes and the patient perspective may challenge assumptions and values.

Catalyst for Change: Measuring the Effectiveness of Training of All Health Care Professionals to Provide Brief Intervention for Smoking Cessation to Cancer Patients.

BACKGROUND: Smoking cessation is recommended to prevent individuals from developing cancer, with additional benefits after a cancer diagnosis. Tobacco use during cancer treatments increases the risk of complications and may reduce the effectiveness of treatment; patients who quit smoking are less likely to experience recurrence. Health care professionals play a vital role in assessing and educating cancer patients on how to quit. We report on the effectiveness of peer-to-peer education of a brief smoking cessation intervention to patients. METHODS: An interprofessional team was created to implement and integrate smoking cessation best practices into daily clinical care. Health care providers were provided with peer-to-peer training to provide brief interventions of smoking cessation to patients. After training, participants were invited to complete an electronic survey to assess the effectiveness of the peer-to-peer training sessions. The survey consisted of 3 domains: confidence, comfort, and knowledge. Participants were asked to rate a series of statement questions using a Likert scale as well as to self-assess knowledge. The survey also included open-ended questions to invite respondents to share further comments and feedback. RESULTS: Approximately 90% of staff across the oncology program participated in a training session. This included nurses, radiation therapists, and patient and family support professionals. Sixty-one surveys were returned (30% response rate). Most respondents had >10 years of clinical experience (70%), 91% agreed it was important to support patients in their efforts to quit smoking, 88% agreed they have an impact on their patients' smoking cessation attempts, and 67% had opportunities in daily practice to support smoking cessation. Sixty-one percent would benefit from additional education. Fifty-three percent indicated they experienced challenges providing interventions and patients' responsiveness to the intervention. CONCLUSIONS: Peer-to-peer training for smoking cessation can increase confidence, comfort, and knowledge. Challenges include comfort level of clinician, determining the best time to ask patients, and having the confidence in knowing their scope of practice.

Gait Speed vs. VES-13: A Pilot Study Comparing Screening Tools to Determine the Need for a Comprehensive Geriatric Assessment in Senior Women with Breast Cancer.

BACKGROUND/OBJECTIVES: Patients aged 70 years and older may be suboptimally treated with cancer therapy because of the lack of clinical trial data in this population. The Comprehensive Geriatric Assessment can be time consuming, and access to geriatricians is limited. This study aims to determine whether gait speed (GS) analysis is equivalent to the widely accepted Vulnerable Elders Survey 13 (VES-13) in identifying vulnerable or frail patients in need of a Comprehensive Geriatric Assessment. METHODS: A pilot prospective cohort study was carried out at a tertiary cancer centre in Toronto, Canada, in a radiation oncology breast follow-up clinic. GS analysis and VES-13 were completed by each patient at the same clinic visit. GS of <1 meter/second (m/s) and VES-13 score ≥3 were considered abnormal. Sensitivity, specificity, positive and negative predictive values, and Kappa characteristic were calculated for GS compared with VES-13. RESULTS AND DISCUSSION: Twenty-nine participants aged 70 years and older with any stage of breast cancer were included. The GS was 67% sensitive and 95% specific for abnormal VES-13 scores. The GS had an 86% positive predictive value and 86% negative predictive value for abnormal scores on VES-13. Overall, the GS showed a substantial strength of agreement with the VES-13 (kappa 0.66, P < .0001). CONCLUSION: The GS analysis compared very well with VES-13 scores, and this may be a reasonable alternative to VES-13 screening. This pilot data warrant further study in a larger group of patients.

National Survey Among Radiation Oncology Residents Related to Their Needs in Geriatric Oncology.

Currently, there is no formal curriculum addressing geriatric oncology within Canadian radiation oncology (RO) residency programs. Knowledge related to geriatric medicine may help radiation oncologists modify RT based on frailty status and geriatric considerations. Understanding specific learning needs allow program coordinators to align the current curriculum with residents' geriatric oncology learning needs. The purpose of this study is to determine the geriatric oncology educational needs of the Canadian RO residents and to inform Canadian RO residency training. A cross-sectional survey, with Likert, multiple choice, and open-ended questions, was pretested and distributed electronically by program directors to Canadian RO residents over 6 weeks. Responses were analyzed with descriptive statistics and common themes. One-hundred and thirty-five Canadian RO residents were contacted and 63 responded (47%). Half (49%) lacked confidence managing the elderly with multiple comorbidities, polypharmacy, functional and cognitive impairment, and challenging social circumstances;73% agreed additional training would be helpful. Forty-four percent lacked confidence regarding psychogeriatric referrals, fall prevention, palliative and hospice care, and community resources preventing re-hospitalization; 63% agreed additional training would be helpful. Seventy-six percent believed discussion groups, continuing education, geriatric oncology electives, and journal clubs would provide learning opportunities. Seventy-one percent agreed integrating geriatric assessment into RO curricula would improve care. Seventy-nine percent believed geriatric oncology principles have not been adequately integrated into radiation oncology curricula. There are significant gaps specific to geriatric assessment and management of older cancer patients in the current Canadian RO curricula. Most residents agreed that it is important to integrate geriatric oncology training to improve and personalize the care of older cancer patients.

Assessing the Psychological Impact of Daily Bowel Preparation on Prostate Patients Who Receive Radiation Therapy.

PURPOSE: Evidence has shown that the prostate moves depending on filling of the rectum and, to a lesser extent, the bladder; many radiation therapy departments have adopted standardized bladder filling/rectal emptying protocols for radiotherapy treatment. Daily treatments may be delayed until appropriate volumes are attained; the resultant psychological impact of these delays on patients is unknown. The purpose of this study was to determine levels of anxiety, depression, distress, and bother related to bowel preparation for prostate cancer patients undergoing radiation therapy treatment. METHODS: A prospective cohort analysis of prostate cancer patients undergoing external beam radiation therapy was completed. Patients were assigned to one of three groups; Group A was standard of care, Group B was standard of care plus increased educational information regarding bowel preparation, Group C was standard of care plus increased educational information regarding bowel preparation plus an anti-flatulent medication. Hospital Anxiety and Depression Scale, Distress Thermometer, and a Bowel Status Bother survey were completed by participants at the start of theircourse of radiation treatment, mid-way through, and at the end. Analysis of variance testing was completed to determine differences in mean scores between the three groups. RESULTS: Mean age of patients (N = 30) was 66 years; 50% of the participants had a university education; 80% were married. Anxiety levels decreased over time in all groups (P = .039) with no difference between groups (P = 0.447). Depression levels across time for each group remained low (P = .577). Overall distress levels associated with bowel preparation were low among each group, and no significant differences were reported (P = .978). All groups reported high rates of quality of life. CONCLUSIONS: Findings from this study indicate that collectively across three groups and over time, there were low levels of anxiety, depression, and distress from bowel preparation. Amount, timing, quality, and approach to educational information are important factors to ensure patients feel prepared for their radiation therapy treatments.

Patterns of Care Related to Post-Operative Radiotherapy for Patients with Prostate Cancer among Canadian Radiation Oncologists and Urologists.

The American Society for Radiation Oncology (ASTRO) and American Urological Association (AUA) developed post-prostatectomy radiotherapy (RT) guidelines to aid patient counseling on adjuvant (ART) and salvage radiotherapy (SRT). Our study compared how aware and compliant Canadian radiation oncologists and urologists are to these guidelines. Our online survey was distributed through the Canadian Association of Radiation Oncology (CARO) and Canadian Urology Association (CUA) to radiation oncologists and urologists that treat prostate cancer. We used Wilcoxon rank-sum test and Chi-square test to compare radiation oncologists and urologists. P values for significant findings are reported. A total of 128 participants responded the survey, 52 radiation oncologists, and 76 urologists. The majority (82%) of radiation oncologists had read these guidelines, compared to only 49% of urologists (p < 0.001). Radiation oncologists were more likely to recommend ART >50% for adverse pathological findings post-radical prostatectomy compared to urologists (76 vs. 51%, p = 0.011). Urologists were more likely to monitor their patient's PSA level post-prostatectomy compared to radiation oncologists (93 vs. 77%, p = 0.016). Post-thematic analysis of open-ended questions revealed that urologists rarely refer patients to radiation oncologists for ART, with radiation oncologists confirming that they rarely receive referrals. This study demonstrates the low compliance to ASTRO/AUA guidelines. While radiation oncologists were more aware and compliant to guidelines, urologists were significantly more likely to monitor their patient's PSA. This study highlighted the need for better communication between urologists and radiation oncologists, especially in referrals for ART, to facilitate treatment delivery that is concordant with ASTRO/AUA guidelines.

Adverse Health Outcomes Associated with Postdiagnosis Smoking in Prostate Cancer Patients: A Literature Review.

This literature review presents what is currently known about the association between postdiagnosis smoking and adverse health outcomes in prostate cancer. A literature search was conducted using Ovid Embase and Ovid MEDLINE. Information from 36 studies was summarized. There is strong evidence across the included studies of higher overall mortality and biochemical recurrence in current smokers diagnosed with prostate cancer. In addition, enhanced adverse effects following surgery, radiation, and hormone therapy have also been identified in current smokers of this population.

The Perceptions and Expectations of Older Women in the Establishment of the Senior Women's Breast Cancer Clinic (SWBCC): a Needs Assessment Study.

This study explored older women's perceptions and expectations of the prospective Senior Women's Breast Cancer Clinic (SWBCC) at Sunnybrook Odette Cancer Centre (SOCC) in Toronto, Ontario, Canada. In our previous studies, older breast cancer patients had expressed a greater need for informational, decisional, and post-treatment support. This study also assessed women's perspectives on the involvement of geriatricians and incorporation of geriatric assessment in their cancer care. Twelve breast cancer patients aged 68 years or older who were treated at the SOCC participated in the study. We recorded and transcribed 11 interviews and analyzed them using qualitative thematic analysis methods to identify major themes; one interview was excluded due to recording defect. Eight major themes were identified: transportation issues, service, communication between patient and healthcare professionals, communication between healthcare professionals, support during treatment, support after treatment, informational resources, and patient suggestions. Important issues were raised by participants, such as difficulties in arranging transportation to the clinic, barriers in accessing family physician service, and communication breakdown that result in treatment delay and unaddressed complications. In conclusion, there were important gaps in the cancer care of older women with breast cancer that could be detected earlier and better addressed in the new multidisciplinary SWBCC. The participating women were highly supportive of the initiative and made several suggestions on how the clinic could better accommodate their specific needs during and after breast cancer treatment.

Towards an optimal multidisciplinary approach to breast cancer treatment for older women.

The treatment of breast cancer presents specifc concerns that are unique to the needs of older female patients. While treatment of early breast cancer does not vary greatly with age, the optimal management of older women with breast cancer often requires complex interdisciplinary supportive care due to multiple comorbidities. This article reviews optimal approaches to breast cancer in women 65 years and older from an interdisciplinary perspective. A literature review was conducted using MEDLINE and EMBASE, choosing articles concentrated on the management of older breast cancer patients from the point of view of several disciplines, including geriatrics, radiation oncology, medical oncology, surgical oncology, psychooncology, palliative care, nursing, and social work. This patient population requires interprofessional collaboration from the time of diagnosis, throughout treatment and into the recovery period. Thus, we recommend an interdisciplinary program dedicated to the treat ment of older women with breast cancer to optimize their cancer care.

Providing Supportive Care for Young Breast Cancer Patients: Exploring the Comfort Level and Educational Needs of the Interprofessional Health Care Team at a Comprehensive Cancer Centre.

INTRODUCTION: Younger patients diagnosed with breast cancer have unique issues compared with their older counterparts, including premature menopause, body image, and fertility/relationship concerns. However, breast cancer information tends to focus on older patients. The interprofessional team at a large hospital was surveyed to assess comfort level and knowledge of supportive care for the younger population. METHODS: A one-time, cross-sectional survey was distributed to oncologists, nurses, radiation therapists, and other supportive care professionals. The survey included multiple-choice, Likert scale, and open-ended questions asking participants to assess their knowledge and comfort level around the issues faced by younger breast cancer patients. Demographic information was collected, and results were analyzed using descriptive statistics. RESULTS: In total, 67 questionnaires were returned (22% response rate); 92% of respondents felt comfortable providing care to young breast cancer patients, whereas 72% were confident in their ability to provide support for their psychosocial needs. However, most participants rated their knowledge of issues specific to these patients higher than their comfort level. Disparity between the professions occurred, with oncologists and nurses reporting a higher comfort level than other professions. CONCLUSIONS: Although most professionals felt they had good knowledge of the issues faced by young breast cancer patients, many felt less confident addressing these issues with their patients. This informational needs gap presents an opportunity for the emergence of champions to heighten awareness and educate colleagues in the supportive care of this patient population.

Educating our patients collaboratively: a novel interprofessional approach.

Providing cancer patients with more information regarding their treatments allows them to feel more in control, increases self efficacy, and can decrease anxiety. The aims of the present study were to develop an interprofessional group education session and to evaluate the usefulness and acceptability of this session. In addition, informational distress levels pre- and post-education were evaluated. A prostate radiation therapy (RT) education session was developed and facilitated by an interprofessional team. Topics discussed included how RT works, side effects and management, and support services available. Prior to the education session, participants reported their informational RT distress levels using the validated Distress Thermometer (DT). Post-education session, the DT was readministered. In addition, participants completed an acceptability survey to assess format, structure, and usefulness of the education session. Participants agreed that the session contained valuable and useful information helping them understand expectations during treatment, including resource availability, side effects and management, as well as procedural expectation during treatment. All stated they would recommend the session to other patients. The interprofessional nature of the sessions was deemed useful. Suggested areas for improvement included addition of a dietitian, information on long-term side effects, statistics of radiotherapy side effects, impact of radiotherapy on sexual function, and overall quality of life. The group education session significantly improved informational distress levels (p = 0.04). Educating prostate cancer patients utilizing an interprofessional group format can decrease anxiety and stress related to their RT treatment. Future development of group education sessions for other disease site groups may be valuable.

Examining the Effectiveness of Action Plans Derived from the Root Cause Analysis of Incidents Occurring in a Radiation Therapy Department.

PURPOSE: In 2011, the Canadian Partnership for Quality Radiotherapy developed guidelines for quality improvement. In the same year, a large academic cancer centre initiated a program of root cause analysis (RCA) and incident learning for major incidents. RCAs were performed on seven incidents; more than 40 action items were developed with the intent to prevent these incidents from recurring. The aim of this study was to determine the efficacy of implementation of the six action items, evaluate radiation therapists' (RTTs') awareness of these new action items, and determine whether communication among staff members was satisfactory. METHODS AND MATERIALS: The study consisted of two components. Part one examined four action items using a questionnaire distributed to all RTTs at the cancer centre. Part two examined two action items by auditing the radiation treatment software, MOSAIQ. RESULTS: Staff communication and RTTs' awareness of the action items ranged from 71% to 98%. For the first four action items, although most RTTs were aware of them, only 40%-70% of RTTs always or often used these action items and considered them effective. The fifth action item, implementation of the new breast tolerance setting, had 51% more overrides after implementation. Further investigation indicated only 40% of the tangent breast setups had new tolerance settings applied. CONCLUSIONS: Communication plays an important role in the dissemination and application of interventions identified from an RCA. A standardized route of communication is required to ensure that all RTTs fully understand an action item. A follow-up program and continuous monitoring of the action items are key to an effective RCA program.

Role Development for Radiation Therapists: An Examination of the Computed Tomographic Simulation Procedure for Patients Receiving Radiation Therapy for Breast Cancer.

PURPOSE: This study investigated the role of radiation therapists (RTs) in the computed tomographic (CT) simulation procedure for patients receiving radiation therapy for breast cancer at a large comprehensive cancer clinic. RTs had developed a "hybrid role" whereby they practiced autonomously during a "therapist-led CT simulation." As well as CT scanning, RTs assessed the images, performed isocentre and field placement, and contoured the organs at risk in preparation for dosimetrists to optimize the dose distribution. A comparison between the confidence of the radiation oncologists (ROs) in delegating tasks to RTs for this procedure was compared with the RTs' confidence (self-assessed) in performing the task. Changes to the patient's plan after the CT procedure were recorded to examine the level of autonomy that was achieved as well as to identify areas for the development of RT skill, knowledge, and judgment. METHODS: A prospective mixed method two phase study was performed. In phase 1, seven key areas of critical tasks performed by RTs in the CT simulation procedure were identified and documented by the study population. Changes made to these critical tasks after CT simulation was complete were categorized. Responsibility for the changes (RT or RO), the presence of the RO at the CT simulation, and other issues were documented. In phase 2, surveys were distributed to ROs and RTs to rank their confidence levels of RTs performing the identified critical tasks during the CT simulation. RESULTS: For phase 1, 330 CT simulation cases for breast cancer over a 4-month period were documented. Eighty-four percent of cases remained unchanged and were approved by the RO; the majority of changes were initiated by a second more experienced RT. The majority of changes were related to cardiac coverage for left-sided patients (4.8%) and scar coverage (3.3%). ROs were present for 42% of the cases. For phase 2, 9 RO surveys (75% response) and 21 RT surveys (81% response) were returned. The majority of ROs and RTs agreed that they had confidence in RTs' abilities to perform the identified critical tasks. Factors that influenced RTs' confidence were complexity of the patient; self-confidence; and experience of the RT, RO practice preferences, and RT training availability and consistency. CONCLUSIONS: RTs have achieved a level of autonomy in their practice illustrated in the CT simulation process for breast cancer patients. This may be expanded with continued training and education. Formal mentoring relationships in CT simulation may aid in knowledge development. Enhanced communication between ROs and RTs will improve the process. This will enable RTs to provide a more efficient process and better patient care through improvements to continuity, flow, and quality.

Smoking Cessation Basics: An Essential Component of Radiation Therapy Clinical Practice.

Tobacco addiction is among the top preventable health risks to combat cancer. Smoking is responsible for almost 30% of cancer deaths in Canada; it increases the risk of developing cancers of the lung, mouth, throat, larynx, cervix, pancreas, esophagus, colon, rectum, kidney, and bladder and in acute myeloid leukemia. Nonsmokers exposed to second-hand smoke are also at higher risk of developing lung cancer and other respiratory diseases. More than 300 nonsmokers die from lung cancer each year due to second-hand smoke. Smoking cessation programs can improve overall health and quality of life for cancer survivors. Most cancer patients would like to quit smoking, but they find it difficult. Advice and support from health care professionals can increase success. A cancer diagnosis may be the impetus required for patients to make that positive change in their lives. Studies have shown that continued smoking while receiving radiation therapy limits treatment efficacy. Additionally, smoking interferes with chemotherapy and can negatively affect wound healing. Smoking cessation is an evidence-based program; patients who quit smoking are less likely to experience recurrence of disease or additional primary cancers. Even brief interventions may be what the patient needs to assess the benefits of quitting. Many cancer health care professionals do not feel prepared to discuss smoking cessation with their patients. A large number of cancer patients survive more than 5 years past their diagnosis, making smoking cessation an even more important focus in long-term disease management and improving the length and quality of life for these patients. The aim of this directed reading is to assist radiation therapists to support their patients who smoke and integrate smoking cessation into clinical practice.