Introduction to the Cancer Center Cessation Initiative Working Groups: Improving Oncology Care and Outcomes by Including Tobacco Treatment

Abstract

Cigarette smoking remains the leading cause of preventable cancer and cancer-related deaths in the United States, responsible for roughly 30% of all cancer deaths, representing more than 150,000 Americans killed by tobacco-caused cancer each year. 1,2 Among the estimated 1.9 million people who will be diagnosed with cancer in the United States in 2021, 3 many will receive their oncology care at one of the 64 clinical NCI-designated Cancer Centers 4 ; approximately 24% will be cigarette smokers at the time of diagnosis. 5 Although compelling data have shown that quitting smoking after a cancer diagnosis leads to better health and quality of life outcomes, a 2009 survey reported that only 38% of NCI Cancer Centers recorded smoking as a vital sign, and fewer than half had dedicated personnel to provide smoking cessation treatment. 6 Only about half of patients with cancer who smoke and just 15% of those who have completed treatment are counseled to quit. 7 These missed opportunities were highlighted in the 2014 Surgeon General's Report, which documented that continuing to smoke after a cancer diagnosis was associated with significant increases in all-cause mortality, cancerspecific mortality, and second primary cancers. 2 In 2015, NCCN established Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Smoking Cessation, highlighting best practices for assessment and treatment of tobacco dependence in cancer care. 8 A recent commentary called for tobacco cessation to be designated as the "Fourth Pillar of Cancer Care," in recognition of its vast potential for improving the lives of patients with cancer. 9 Integrating tobacco cessation into routine cancer care may be particularly beneficial for some racial, ethnic, and sexual and gender minorities; rural residents; those of low socioeconomic status; and underinsured or uninsured populations, because they experience a higher burden of tobacco-related cancers and chronic diseases. 2,10 In fact, medically underserved populations are less likely to even be offered tobacco cessation services and less likely to participate even though they report high rates of interest in quitting. 11