By Catherine Danko
After nearly five decades of smoking up to a pack a day, Alan Reeve made the life-changing decision to quit.
Weeks before undergoing critical surgery, he stopped smoking entirely on his physician's recommendation, marking a pivotal moment for his health after being diagnosed with lung cancer.
Alan received a successful lobectomy — a surgical operation where a lobe of the lung is removed — at UHN's Toronto General Hospital (TGH). Had he not quit smoking, he would have been at a higher risk for infections, respiratory and cardiovascular complications, and a longer post-operative hospital stay.
Many lung cancer patients, such as Alan, gain significant benefits from quitting smoking before surgery. A new program at UHN is dedicated to helping them achieve that goal.
"Having lung cancer is a huge motivating factor for surgical candidates to quit smoking, but it can be challenging," says Marco Cheung, clinical nurse coordinator in the Division of Thoracic Surgery, who devised a smoking cessation program for patients in the Lung Cancer and Rapid Assessment and Management Program (LungRAMP) at TGH.
"We wanted to create a program that would provide patients with a point of contact before and after surgery to help them stay smoke-free and reduce any post-operative complications," he says.
Lung Cancer Awareness Month, observed in Canada every November, aims to raise awareness about the risks, prevention and treatment of lung cancer, encouraging early detection and support for those affected.
For many, the journey to quitting smoking — a heavy contributor to lung cancer — is a personal and challenging one.
"It wasn't until my doctor sat me down and showed me a scan of the large tumour in my left lung that I felt that deep, inner drive to quit," says Alan, who had successfully reduced his smoking to about 10 cigarettes a day before eventually quitting prior to surgery.
LungRAMP, which sees more than 1,000 patients annually — a number that is expected to rise — streamlines consultations and diagnostic investigations for patients suspected of having lung cancer.
Although lung cancer is the leading cause of cancer deaths in Canada, Marco identified a significant gap in the program: there was no in-house pre-surgical smoking cessation support for patients. Patients were referred externally for guidance or support, with most initiatives starting just one week before surgery — often insufficient time to ensure consistent quitting.
With the support of his manager, Ina Cherepaha-Kantorovich, Clinical Manager of the Medical Day Unit at TGH, Marco developed a new care model. Now, at the point of referral to LungRAMP and before surgery, patients can choose to enroll in a smoking cessation program that supports them from pre-surgery through recovery, continuing until a week after surgery or longer if needed.
Marco and Rachel Downie, also a clinical nurse coordinator within thoracic surgery, serve as the initial point of contact for all patients entering the LungRAMP and esophageal cancer programs, often building trusting relationships with them. From there, patients have the option to receive additional benefits, including smoking cessation support and counseling.
"Many long-term smokers are diagnosed with lung cancer and are advised to quit smoking before beginning treatment," says Rachel. "This news can be overwhelming and isolating as they come to terms with such a significant change in their lives."
Marco adds that what sets their program apart from others is the flexible counseling approach they're able to offer.
"If a patient tells me that they benefit from the rapport we've established and would like an additional follow-up next week, we are adaptable enough to provide it, no matter when the date of their surgery was," he says.
Launched in April 2024, the smoking cessation initiative within LungRAMP has resulted in a 46 per cent cessation rate up until surgery, a notably high rate when compared to other similar programs.
Nurses have also completed the Centre for Addiction and Mental Health's (CAMH) smoking cessation training program, with new medical directives allowing them to provide medication, so that they are also able to provide additional support to patients.
'They don't have to struggle on their own'
Karla Krogh Carrasco Jensen, clinic coordinator at TGH's Outpatient Clinic for Gastrointestinal, Respirology, and General and Thoracic Surgery, works closely with patients choosing to enroll in the smoking cessation initiative.
She notes that while many patients who have quit smoking may not have ongoing support from family and friends, the program provides a strong network of resources and encouragement to help them succeed.
"It reinforces to patients that they don't have to struggle on their own, which is really important," says Karla.
"They know that they're going to receive that call from me each week and it helps them stay accountable, because it gives them that additional incentive to remain smoke-free or give it their best effort," she says.
Moving forward, Marco hopes his new model of care will expand beyond the LungRAMP program to other surgical disciplines, as the benefits of smoking cessation before surgery apply to all types of procedures.
"There's evidence that active smokers going into any sort of surgery — whether it's ears, nose, throat, abdominal or bariatric — attributes to prolonged hospital stays and post-operative complications," he says.
"The goal of our initiative is to help patients across all disciplines quit smoking, so that they can have a healthier, faster and safer recovery."
