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

Sarah D. Hohl, Richard S. Matulewicz, Ramzi G. Salloum, Jamie S. Ostroff, Timothy B. Baker, Robert Schnoll, Graham Warren, Steven L. Bernstein, Mara Minion, Katie Lenhoff, Neely Dahl, Hee Soon Juon, Ursula Tsosie, Linda Fleisher, Heather D'Angelo, Alex T. Ramsey, Kimlin T. Ashing, Betsy Rolland, Margaret B. Nolan, Jennifer E. BirdClaire V.T. Nguyen, Danielle Pauk, Robert T. Adsit, Hilary A. Tindle, Kimberly Shoenbill, Sophia Yeung, Cary A. Presant, Kara P. Wiseman, Kuang Yi Wen, Lou Anne Chichester, Li Shiun Chen

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

PURPOSEQuitting 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.METHODSThis 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.RESULTSOf 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.CONCLUSIONWhole-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.

Original languageEnglish
Pages (from-to)2756-2766
Number of pages11
JournalJournal of Clinical Oncology
Volume41
Issue number15
DOIs
StatePublished - May 20 2023

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