Achieving Equity in the Reach of Smoking Cessation Services Within the NCI Cancer Moonshot-Funded Cancer Center Cessation Initiative

Abstract

Background: Ensuring equitable access to smoking cessation services for cancer patients is necessary to avoid increasing disparities in tobacco use and cancer outcomes. In 2017, the Cancer Center Cessation Initiative (C3I) funded National Cancer Institute (NCI)-designated Cancer Centers to integrate evidence-based smoking cessation programs into cancer care. We describe the progress of C3I Cancer Centers in expanding the reach of cessation services across cancer populations. Methods: Cancer centers (n = 17) reported on program characteristics and reach (the proportion of smokers receiving evidence-based cessation treatment) for two 6-month periods. Reach was calculated overall and by patient gender, race, ethnicity, and age. Results: Average reach increased from 18.5% to 25.6% over 1 year. Reach increased for all racial/ethnic groups, and in particular for American Indian/Alaska Native (6.6-24.7%), Asian/Native Hawaiian/Pacific Islander (7.3-19.4%), and black (18.8-25.9%) smokers. Smaller gains in reach were observed among Hispanic smokers (19.0-22.8%), but these were similar to gains among non-Hispanic smokers (18.9-23.9%). By age group, smokers aged 18-24 years (6.6-14.5%) and > 65 years (16.1-24.5%) saw the greatest increases in reach. Conclusion: C3I Cancer Centers achieved gains in providing smoking cessation services to cancer patients who smoke, thereby reducing disparities that had existed across important subgroups. Taking a population-based approach to integrating tobacco treatment into cancer care has potential to increase reach equity. Implementation strategies including targeted and proactive outreach to patients and interventions to increase providers' adoption of evidence-based smoking cessation treatment may advance reach even further.

Using a multilevel implementation strategy to facilitate the screening and treatment of tobacco use in the outpatient urology clinic: A prospective hybrid type I study

“…However, we did determine that racial and ethnic minority patients may be more willing to quit than White veterans. This finding is similar to those of other VA studies and a recent report from centers participating in the Cancer Center Cessation Initiative (C3I) of the National Cancer Institute (NCI), 28 but it conflicts with other studies of the general public. 29 Lastly, VA hospitals may have a greater availability of formal smoking cessation clinics and more resources than many other care settings.…”

Proposing a Model of Proactive Outreach to Advance Clinical Research and Care Delivery for Patients Who Use Tobacco

“…Other times the population is only those people who report tobacco use in electronic patient communications (e.g., an EHR-facilitated survey). The population may also include anyone with a certain diagnosis (e.g., cancer) 21 or who is seen in a specific healthcare setting or point of service (e.g., hospital admission, lung cancer screening, outpatient surgery). 27 Sometimes, patients must indicate readiness to quit in the next 1–6 months to be eligible for treatment, but sometimes the population is expanded to include people who are not ready to quit or who quit recently but remain at risk for relapse.…”

“…16 In contrast to reactive treatment models, proactive treatment models take a population-based approach with the objective of extending tobacco treatment to all patients who use tobacco. 10,17,18 Evidence suggests many advantages of proactive treatment such as prompting quit attempts among patients who initially report very low or ambivalent motivation to quit, 19,20 addressing health disparities via equitable opportunity to receive evidence-based treatment, 17,21 and improving quit rates at the population level. 18,22,23 Proactive treatment models are designed to and appear to increase the impact of evidencebased tobacco treatment.…”

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

“…11 These efforts have increased tobacco treatment reach , defined as patients' receipt of one or more components of evidence-based tobacco treatment, such as counseling, pharmacotherapy, and referrals to quitlines. 12…”