The Tobacco Endgame—A New Paradigm for Smoking Cessation in Cancer Clinics
Round 1
Reviewer 1 Report
Please see attached pdf file for my comments.
Comments for author File: 
Comments.pdf
Author Response
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Author Response File: Author Response.pdf
Reviewer 2 Report
This review provides an excellent discussion of the current status of tobacco cessation in cancer care and insightful views of the tobacco endgame. I have read this 4 times looking for areas to change and do not have any suggestions for improvement aside from one minor editorial note: Ref 34 looks to be a reference without a web page link. I am sure the authors could add it in easily
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The Tobacco Atlas Bhutan.
No other suggestions for improvement, but some reflections.
Publishing this in a journal with a target audience of oncologists is right on target. All too often, I hear perspectives from individuals in Oncology that prevention isn't really their duty, but by emphasizing that "Effective quitting leads to much better cancer outcomes" brings this message to the core of cancer care.
By stressing how cessation improves therapy it gets out of the limited scope that smoking is an issue related only to etiology, as a risk factor. I feel that the limited view of it only as an etiology concern is behind some of the indifference toward cessation after diagnosis. It is great to see the discussion that it is a part of comprehensive treatment.
Some Oncologists may not view the tobacco endgame as a priority, due to potential unspoken or subconscious concerns about decreased patient volume (particularly in health care economies which are compensated on a fee-for-service basis). I have actually heard oncology practitioners whose practices are primarily in tobacco related cancer (thoracic, head & neck) voice concerns about how fighting Big Tobacco could be 'bad for business.' If some have spoken that, many more think that. However, it is important to recognize that the tobacco endgame is over the course of many years and even if all tobacco use stopped today, the accumulated risk burden may drop cancer incidence more slowly over many many years to decades.
Finally I feel that the tobacco endgame may actually have significant positive impacts on cancer care treatment volume. Cessation improves therapy. If patients are not smoking, they will better tolerate all forms of therapy and have better treatment outcomes for all cancers. They will be healthier to tolerate therapy. Living longer can also include tolerance of more treatment.
Overall a superbly written piece that is both thought provoking and inspiring. Thank you for the privilege of reviewing this important piece prior to publication.
I had agreed to do the review in 7 days, and it's day 8. I apologize for missing the deadline, life gets busy in unpredictable ways. Thanks for your patience and thank you for all the work in this incredibly important area.
Author Response
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Author Response File: Author Response.pdf
Reviewer 3 Report
Very nice article but a few suggestions:
1)The introduction is too "wordy" and winding. Your point is the tobacco endgame, and the intro rather loses the reader. Also, suggest cite reference for " those who smoke understand risk to varying degrees but most smokers want to quit".
2) "higher rates of smoking among cancer patients than background"- "background" meaning patients without cancer but another smoking related illness? For example are you comparing to a population with a non cancer diagnosis like vascular disease, or healthy population? please clarify who is the comparison group and a citation here would be good.
3) Agree with you and good points, but do primary care doctors give smoking related advice or offer medications more often than specialty clinics? including such data would be pertinent here.
4) Suggest "most HCPs... do not feel competent" (rather than proficient). Also, suggest break this part up into "clinic" and "hospital" separately
5) Informative section, but I think you statement" relatively few details are available regarding programs and plans" is a bit unclear. SI this only about Bangla Desh? If applies to all then should be somewhere in the beginning of the section.
Author Response
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Author Response File: Author Response.pdf
