Tobacco Use and Tobacco Treatment Referral Response of Patients With Cancer: Implementation Outcomes at a National Cancer Institute–Designated Cancer Center

Abstract

PURPOSE: Smoking after a cancer diagnosis is linked to cancer-specific and all-cause mortality, among other adverse outcomes. Yet, 10%-20% of US cancer survivors are current smokers. Implementation of evidence-based tobacco treatment in cancer care facilities is widely recommended, yet rarely accomplished. This study focuses on the early outcomes of a population-based tobacco treatment program integrated within an National Cancer Institute–designated cancer center. METHODS AND MATERIALS: The sample consists of 26,365 patients seen at the cancer center during the first 18 months of program implementation. The study is a retrospective chart review of patients' tobacco use and, among current users, patients' treatment referral response. RESULTS: More than 99% of patients were screened for tobacco use. Current (past month) use was observed in 21.05% of patients; cigarettes were the most popular product. Only 17.22% of current users accepted a referral for tobacco treatment; among current users who declined, the majority were not ready to quit (65.84%) or wanted to quit on their own (27.01%). Multiple demographic variables were associated with tobacco use and treatment referral response outcomes. CONCLUSION: Despite cancer diagnosis presenting a teachable moment for tobacco cessation, patients with cancer may not be ready to quit or engage with treatment. Clinically proven strategies to increase motivation, prompt quit attempts, and encourage treatment use should be key components of tobacco treatment delivery to patients with cancer.

Engagement and outcomes of cancer patients referred to a tobacco cessation program at a National Cancer Institute‐designated cancer center

“…Engagement of patients with the program (47%) was higher than reports from other NCI‐designated Comprehensive Cancer Centers (17% and 6.4%). 21 , 22 However, the referral process was initiated by the cancer care team provider (or a minority of patients who self‐referred), whereas other programs automatically referred a patient if tobacco use was documented in the electronic medical record, which precludes potential smokers from not being properly identified and referred by the provider. Therefore, it is not unexpected that the engagement rates are higher in our cohort.…”

“…However, they found no correlation between race or relationship status with engagement with cessation services as we did. 21 They did find males were less likely to accept a referral, though we did not find a correlation between gender and referral acceptance.…”

The Tobacco Endgame—A New Paradigm for Smoking Cessation in Cancer Clinics

“…Smoking cessation may be hard to implement in cancer clinics. In the first 18 months of a tobacco treatment program for over 26,000 patients with cancer, only 17% of current smokers accepted assistance [ 17 ]. This appears to reflect primary care settings where more patients receive advice on quitting than pharmacotherapy [ 18 ].…”

Tragic Triad of Tobacco Dependence, Cancer, and COVID-19 Pandemic: An Urgent Call for Attention by Health Care Systems and Professionals

“…In the article that accompanies this editorial, Burris et al 1 shows that among 26,365 patients with cancer, among the 21% current smokers universally referred for tobacco cessation, only 17% initiated cessation efforts. Importantly, the heightened deleterious effects of the triad of tobacco dependence, cancer, and COVID-19, especially in minorities, should stimulate the deployment of multilevel actions by health systems, clinicians, community health agencies, researchers, and policymakers.…”