Lung screening in Canada, 2023-24
About this section
Helping people quit smoking is a critical part of lung screening. Smoking is the leading cause of lung cancer, as well as many other cancers and chronic diseases. Quitting smoking reduces a person’s risk of getting lung cancer and lowers a person’s risk of dying. Learn more about the importance of smoking cessation.
Smoking cessation
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All lung screening programs have incorporated or are planning to incorporate smoking cessation supports into their screening pathways. Jurisdictions vary in offering smoking cessation services only to participants who are eligible for screening or offering smoking cessation services to all patients who smoke.
The use of smoking cessation medications, including prescription medications and nicotine replacement therapy (NRT), can more than double quit rates. Learn more about increasing access to smoking cessation medications, and financial coverage of these medications. Many lung screening pilots and studies offered participants pharmacotherapy to help them quit smoking.
Note: In this report, tobacco refers to commercial tobacco products, not traditional or sacred tobacco. Traditional or sacred tobacco is used by some First Nations or Métis communities in ceremonial or sacred rituals for healing and purifying.
Smoking cessation integration with lung screening programs
| P/T | Who can access smoking cessation support? | What smoking cessation supports are available? Are they offered through the hospital/cancer centre or in the community? | Where are these supports offered? | How and when in the lung screening pathway are patients referred to smoking cessation supports? |
|---|---|---|---|---|
| YT | – | – | – | – |
| NT | – | – | – | – |
| NU | – | – | – | – |
| BC | All patients (including those ineligible for screening) | Brief smoking cessation counselling is provided over the phone by program navigators. Navigators provide information regarding cessation resources available in BC such as NRT and other quit strategies. Navigators email (or mail) information regarding smoking cessation resources such as QuitNow. PCPs receive cessation information in results letters and are encouraged to follow-up with their patients to provide pharmacotherapy such as varenicline, alone or in combination with NRT. | At point of contact with navigator or PCP | During intake and return to screening, program navigators discuss smoking cessation strategies and provide information regarding available smoking cessation supports. PCPs are informed of the patients’ smoking status and are asked to follow-up directly with the patient to provide pharmacotherapies or other resources. |
| AB | All patients referred to the Alberta Lung Cancer Screening Program (ALCSP) who currently smoke cigarettes or who quit recently | Behavioural counselling provided by a Certified Tobacco Educator (tobacco cessation case manager, or TCCM) who operates out of Alberta Health Services (AHS) Health Link program. TCCM completes baseline assessment with patient over the phone. TCCM also conducts three-month and six-month follow-up calls, one-to-one counselling if required, as well as relapse prevention. TCCM makes referral to other provincial tobacco cessation supports (primary care network resources, QuitCore, etc.). | Virtual — telephone or Zoom, Quitline, primary care network, and community | Patients are referred to the tobacco cessation program at intake into the ALCSP by the nurse practitioner. Patients may opt out when TCCM calls them. |
| SK | Under development | |||
| MB | – | – | – | – |
| ON | Screening-eligible patients* | Minimum 10-minute hospital-based smoking cessation counselling with recommendation for behavioural counselling, pharmacotherapy (nicotine replacement therapy, varenicline or bupropion) and follow-up support delivered by established community-based smoking cessation services. | Behavioural counselling and NRT are offered at point of contact with navigator during 10-minute counselling. Follow-up supportive contact is provided through hospital or community-based programs. | Navigator provides brief advice during risk assessment phone call to all people who currently smoke.
Opt-out approach utilized for in-hospital counselling on day of LDCT screening scan. Follow-up arranged with hospital or community-based smoking cessation service (e.g., Health811 fax referral). Participants who refuse follow-up services are encouraged to follow up with their primary care provider. At recall and six-month follow-up LDCT scan appointments, current smokers will be given brief advice by the screening navigator and offered an appointment with a hospital-based smoking cessation counsellor, or a fax or online referral to Health811. |
| QC | All patients | Referral to the I QUIT NOW helpline and Quit Smoking Centres (ongoing pilot project with a QSC). | Helpline and in-person support at the Quit Smoking Centres (ongoing pilot project with a QSC). | At intake, during eligibility assessment by coordination centre nurses and during each new screening cycle. |
| NB | All eligible participants^ | Linkage to existing smoking cessation resources | ||
| NS | All patients | Educational materials, referral to Tobacco Free NS (TFNS) for behavioural counselling, NRT for screening-eligible patients only, and information about other community-based cessation programming (e.g., Mental Health & Addictions) | Quitline (TFNS) for behavioural counselling. NRT to be mailed directly to eligible patients by CAMH. Educational materials and links to other services provided by lung screening program. | Nurse navigator will advise on NRT and counselling services for those who may benefit, including referral to TFNS and CAMH as appropriate. |
| PE | All patients | Provincial pharmacare program, Smokers’ Helpline, and counselling via screening program delivered by Respiratory Therapist navigator (proposed) | Provincially and across the health care spectrum | Tobacco use will be assessed at the time of initial interview. |
| NL | All patients | One-on-one phone support sessions/counselling, pharmacotherapy, and NRT. NRT distributed through mail or available for pickup. Smokers’ Helpline also available. | Provider initiates contact with cancer centre and NRT distributed via mail or pickup from cancer centre. | Opt-out approach. Tobacco use will be assessed early in program recruitment. |
*ON: Patients ineligible for screening will be offered a referral to Health811
^NB: Anticipated approach. To be determined in consultation with Provincial Lung Cancer Screening Implementation Advisory Committee
Access to pharmacotherapy
| P/T | How screening participants access pharmacotherapy (nicotine replacement therapy or prescription smoking cessation medications) | Is pharmacotherapy available for free for screening participants? If so, please describe how this is offered. | Additional details about pharmacotherapy for screening participants |
|---|---|---|---|
| YT | – | – | – |
| NT | – | – | – |
| NU | – | – | – |
| BC | At local pharmacy. | BC residents can visit any pharmacy and register to access resources for up to three months’ time in any calendar year. | NRT is free for three months a year without a prescription in a local pharmacy. Varenicline is partially covered by PharmaCare. |
| AB | The primary care networks (PCN) educator will work with the client to develop a quit plan and set a quit date. If the individual was identified as a candidate for financial support during the TCCM intake, the educators will then submit a request to the TCCM for a benefit card by submitting an intake form on RedCap. Intakes are uploaded once per week to Alberta Blue Cross. Once processed, the benefit card and an instruction letter will arrive by mail. If the client does not receive the card within 10 business days, they should advise the TCCM. | ✓ | When the client receives the benefit card, they will also receive a letter identifying each of the five types of Nicotine Replacement Therapy (NRT), and all brand names covered through this program. They will not be required to have a prescription for NRT (which is different from most benefit programs). They will need a prescription for Champix (varenicline) or Zyban (bupropion SR) from either the PCP or a prescribing pharmacist if this is identified as the best treatment option.
The client can take the benefit card to a community pharmacy/pharmacist of their choice and work with them to select the best products that help minimize withdrawal as they are making behaviour changes to reduce and stop smoking. The benefit card will cover a maximum of $500 of NRT, Champix, and/or Zyban. The card expires 14 weeks after the enrollment date. |
| SK | Under development | ||
| MB | – | – | – |
| ON | At point of care during screening visit | The Ontario Lung Screening Program (OLSP) does not provide free pharmacotherapy. However, some hospitals offer free nicotine replacement therapy (NRT) from their own budgets. | Ontario provides the following smoking cessation medication coverage options:
|
| QC | Via prescription. | Yes, for three months. | Referring professionals and the Ligne J’Arrête informs participants about pharmacotherapy and sends a letter to their pharmacist indicating their interest. |
| NB* | – | – | – |
| NS | NRT received by mail (facilitated by CAMH). | Yes. Contract with CAMH for mailing of NRT to qualifying clients. | Those who are eligible for LDCT will be offered free NRT through a collaborative partnership with CAMH. |
| PE | Local pharmacy. | Seeking support, otherwise access via primary care consult. | Currently must be referred by community nursing, cancer treatment centre staff, or local pharmacist.
Prescription from a physician/NP or pharmacist required for medications other than NRT. |
| NL | By mail. | ✓ | The NP who is proposed as part of the program team will be able to prescribe NRT, or a clinical pharmacist could provide support and prescribe NRT. |
*NB: To be determined in consultation with Provincial Lung Cancer Screening Implementation Advisory Committee