ASPO Abstracts
Implementation strategies to increase the reach and utilization of smoking cessation treatment in cancer patients
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2020
Abstract Body:
Purpose: An estimated 25% of US cancer survivors smoke. Smoking after a cancer diagnosis increases mortality,
risk of recurrence, and negatively impacts treatment effectiveness and quality of life. Although assessment of
smoking is common in oncology practice, increased access to and utilization of evidence-based smoking
cessation treatment is needed to improve outcomes.
Methods: We conducted a pilot assessing the feasibility and preliminary efficacy (7-day smoking abstinence) of
implementation strategies to increase cessation treatment use among cancer patients. Implementation strategies
included electronic referral using the opt-out approach and presenting patients with the choice of three cessation
treatment options. Patients at three oncology clinics were offered the choice of referral to external cessation
services (quitline or in-person group sessions) or a 6-week cognitive behavioral therapy intervention (mCBT)
delivered via smartphone video conferencing with a tobacco treatment specialist. Patients completed baseline
questionnaires and outcomes were collected at 12 weeks.
Results: Of 545 eligible patients visiting the 3 clinics, 90 agreed to enroll in the study for a reach of 16.5%.
Enrollment rates by clinic ranged from 11.3%-22.9%. Of the enrolled patients, 39 (43.3%) chose quitline, 37
(41.1%) chose mCBT, and 14 (15.6%) chose group sessions. Convenience was the most frequently reported
reason for cessation treatment choice in quitline and mCBT patients. Of the patients reached for follow-up (n=35),
19 (54.3%) reported receiving cessation treatment. Using intent-to-treat analysis, 3 (7.7%) quitline, 2 (5.4%)
mCBT, and 2 (14.3%) group patients reported 7-day abstinence, for a 7.8% quit rate. Mean treatment acceptability
scores were highest for mCBT (8.0), followed by quitline (5.9), and group (5.7).
Conclusions: This pilot study demonstrates the feasibility of using implementation strategies to promote access
and utilization of cessation treatment among cancer patients. Providing multiple cessation options may increase
patient engagement. Tailoring implementation strategies to individual clinic workflows (e.g. timing of discussions,
personnel entering referrals) may improve reach. Opportunities remain for improving intervention reach and
utilization.
Keywords: tobacco, implementation science