Integrating Tobacco Treatment Into Oncology Care: Reach and Effectiveness of Evidence-Based Tobacco Treatment Across National Cancer Institute–Designated Cancer Centers

Abstract

PURPOSE Quitting smoking improves patients' clinical outcomes, yet smoking is not commonly addressed as part of cancer care. The Cancer Center Cessation Initiative (C3I) supports National Cancer Institute–designated cancer centers to integrate tobacco treatment programs (TTPs) into routine cancer care. C3I centers vary in size, implementation strategies used, and treatment approaches. We examined associations of these contextual factors with treatment reach and smoking cessation effectiveness. METHODS This cross-sectional study used survey data from 28 C3I centers that reported tobacco treatment data during the first 6 months of 2021. Primary outcomes of interest were treatment reach (reach)—the proportion of patients identified as currently smoking who received at least one evidence-based tobacco treatment component (eg, counseling and pharmacotherapy)—and smoking cessation effectiveness (effectiveness)—the proportion of patients reporting 7-day point prevalence abstinence at 6-month follow-up. Center-level differences in reach and effectiveness were examined by center characteristics, implementation strategies, and tobacco treatment components. RESULTS Of the total 692,662 unique patients seen, 44,437 reported current smoking. Across centers, a median of 96% of patients were screened for tobacco use, median smoking prevalence was 7.4%, median reach was 15.4%, and median effectiveness was 18.4%. Center-level characteristics associated with higher reach included higher smoking prevalence, use of center-wide TTP, and lower patient-to-tobacco treatment specialist ratio. Higher effectiveness was observed at centers that served a larger overall population and population of patients who smoke, reported a higher smoking prevalence, and/or offered electronic health record referrals via a closed-loop system. CONCLUSION Whole-center TTP implementation among inpatients and outpatients, and increasing staff-to-patient ratios may improve TTP reach. Designating personnel with tobacco treatment expertise and resources to increase tobacco treatment dose or intensity may improve smoking cessation effectiveness.

Overcoming Barriers to Tobacco Cessation and Lung Cancer Screening among Racial and Ethnic Minority Groups and Underserved Patients in Academic Centers and Community Network Sites: The City of Hope Experience

“…Our program has been dependent on high staff resources and long-term support from the institution. Efforts must be continued to utilize methods that are likely to ensure the sustainability of the program [ 20 ] and attempt to minimize staffing needs [ 21 , 22 ].…”

Integrating Tobacco Use Assessment and Treatment in the Oncology Setting: Quality Improvement Results from the Georgetown Lombardi Smoking Treatment and Recovery Program

“…To assess the program’s strengths and limitations, we conducted a QI assessment of the implementation strategies and an analysis of the patient-level predictors of enrollment, treatment engagement, and abstinence. A total of 19,344 unique patients were assessed for tobacco use over two clinical sites, which averaged to a 7% rate of current tobacco use, comparable to other C3i sites [ 41 ] and to national rates of smoking among older patients with cancer [ 42 ]. The difference in smoking rates by site is unclear, but may be explained in part by the small sample size at MWHC and the higher percentage of individuals with private insurance at MGUH [ 43 ].…”

“…The percentage of patients who engaged in treatment was 31.6% at MGUH ( Figure 1 ) and 25.3% at MWHC ( Figure 2 ), both higher than the 18.4% median across 28 C3i programs [ 41 ]. Similarly, the 6-month abstinence rate at MGUH was 27.4% higher than the 18.4% median of the C3i programs, and with data collected on 85% of those enrolled.…”

“…Our data indicated that we can improve in this area, as an average of one half of the engaged patients received medication from the program, possibly suggesting that not all patients understood the benefits of medication and/or its availability (i.e., free NRT or prescription medication that is covered by insurance). Furthermore, improved communication regarding the importance of engaging in behavioral counseling may be needed for patients smoking a few cigarettes a day, as their lower engagement may suggest less motivation to stop smoking and/or have a plan to quit on their own [ 41 ]. Efforts to increase patient engagement may benefit from communicating our findings to patients who are uncertain about engaging in treatment, such that patients who completed two+ counseling sessions were almost three times as likely to report abstinence compared to those who completed ≤1 session.…”

Implementing Evidence-Based Tobacco Treatment Interventions in Oncology to Achieve Optimal Outcomes

“…In the article accompanying this editorial, 11 the investigators present compelling data regarding the reach and effectiveness of diverse evidence-based approaches to tobacco treatment delivery in the oncology setting. Although solely drawn from National Cancer Institute–designated cancer centers, the breadth and depth of data provide insights and guidance to inform integration of tobacco treatment as an integral component of cancer care in all settings.…”