Putting patients front and centre in Partnership-supported smoking cessation program in New Brunswick

Shelley Hewitson discusses Horizon Health Network’s innovative smoking cessation strategy, the success of the Nicotine Addiction Treatment Hub, and the Partnership’s support to improve their programs and outcomes for people with cancer.

In January 2024, the Canadian Partnership Against Cancer (the Partnership) released a report on the Partnership-funded smoking cessation initiative that resulted in 95 per cent of cancer care settings in Canada offering support to help people quit smoking. This successful pan-Canadian initiative was the result of extensive collaboration with partners across Canada, such as Horizon Health Network, which has made, and continues to make, significant progress in providing access to high-quality, evidence-based smoking cessation supports in cancer care settings.

For National Non-Smoking Week 2025, the Partnership spoke with Shelley Hewitson, Regional Manager for the Centre of Excellence for Clinical Smoking Cessation at Horizon Health Network, one of the two health authorities in New Brunswick. Hewitson oversees Horizon’s smoking cessation initiatives across 90 clinical sites, including in hospitals, health centres, mental health and addictions, public health, oncology, and ambulatory and speciality clinics.

The interview has been edited for length and clarity.

The Partnership: Why are clinical smoking cessation services important for people diagnosed with cancer?

Shelley Hewitson: Continued smoking after a cancer diagnosis can make cancer treatments less effective, but many patients are not aware of this. Implementing smoking cessation programming in cancer clinics provides an opportunity to share this information with patients and provide cessation support, which increases the chances of successfully quitting. For example, before the Ottawa Model for Smoking Cessation (OMSC) program was implemented in Horizon’s cancer clinics, the quit rate was 4.9 per cent. After the program was implemented, the quit rate increased to 16 per cent. The quit rate further increased to 25 per cent when follow-up support was improved and free smoking cessation medication was provided at point of care.

How has the Partnership’s support helped with your work in providing smoking cessation counseling and free medication to people with cancer?

We were fortunate to participate in two projects funded by the Partnership, in collaboration with the New Brunswick Cancer Network.

The first round of funding, from 2015 to 2017, was used to implement the OMSC program in Horizon’s two largest cancer clinics, and to begin work with a third clinic. Program implementation would have continued irrespective of additional project funding; therefore, for the second round of funding (2019–2022), we focused on the factors that could increase the likelihood of successfully quitting smoking. Studies indicate that smoking cessation medications double or triple the chance of successfully quitting; follow-up support also improves success rates.

With the second round of funding, we provided free smoking cessation medication at the point of care, offering as much as they needed for as long as they needed it. We also hired a clinician who provided patients with personalized follow-ups at standardized checkpoints and who they could call for additional support as required.

In addition to the funding support, the Partnership also provided leadership nationally by sharing evidence of the impact of continued smoking on cancer treatment. The Pan-Canadian Tobacco Cessation and Cancer Care Network provided the opportunity to bring leaders in cancer care and smoking cessation together to share ideas, lessons learned, tools and resources, which improved our program, and helped change the conversation around smoking cessation as a standard of care in cancer care. This collaboration has led to better patient outcomes.

The Partnership provided an opportunity to bring leaders in cancer care and smoking cessation together. Strong clinical leadership, combined with evidence, has contributed to the cultural shift that is necessary to prioritize smoking cessation as an integral part of cancer care.

– Shelley Hewitson

The cost-effectiveness of offering people with cancer smoking cessation support and medication was highlighted through a study that you co-authored in August 2024. What are some of the key takeaways from that study?

The purpose of our study was to evaluate the cost-effectiveness of providing cost-free smoking cessation medication at point of care for oncology patients who received an OMSC intervention, compared to the usual care. Our primary outcomes were incremental cost per quit and incremental cost per cancer treatment failure avoided. The return on investment was between 4.86 times and 12.29 times the original investment. In New Brunswick, the cost of providing the OMSC program and medications is less than three per cent of the medication cost, and less than one per cent of the total treatment cost for cancer patients who smoke. These findings were shared with decision-makers, which led to provincial funding for free smoking cessation medications for all cancer patients in New Brunswick accessing care in any cancer clinic with programming in place. From a health equity lens, this is a win!

Horizon Health Network launched a virtual Nicotine Addiction Treatment Hub in 2022. How does the Hub work?

The development of the virtual Nicotine Addiction Treatment Hub was a Health Canada-funded initiative, in partnership with the University of Ottawa Heart Institute, leveraging support provided by the Partnership. The Hub centralizes cessation services, and provides personalized clinical follow-up and system navigation, making service delivery more comprehensive and efficient. The Hub supports hospitalized patients on discharge and oncology patients. Patients are contacted by phone on day 3, day 7, day 14, day 30, and at six months post-discharge/clinic visit. The patient can also call the Hub for additional support as required. The Hub also facilitates access to the provincial coverage for smoking cessation medication for oncology patients.

What kind of feedback have you received from patients and healthcare providers who accessed the Hub?

The feedback has been overwhelmingly positive. Patients appreciate the personalized support and the ability to access free medication without barriers. We’ve received testimonials that highlight how impactful the free medication and follow-up support have been in their quit attempts. In fact, we’ve seen that offering free medication again at the six-month follow-up to patients who have not been successful or have relapsed often motivates them to make another quit attempt.