ASPO Abstracts
Identifying the barriers to implementation of a tobacco cessation program within the clinical care of a comprehensive cancer center
Category: Early Detection & Risk Prediction
Conference Year: 2020
Abstract Body:
The National Cancer Institute recognizes the importance of tobacco cessation programs in improving long-
term outcomes for cancer patients and reducing secondary cancers. The objective of the Tobacco
Cessation Program (TCP) at the Columbia University Herbert Irving Comprehensive Cancer Center
(HICCC) is to fill a gap in cancer care. Using electronic health record (EHR) data collected from our data
warehouse over a 6-month period in 2019, we determined that of 21,408 patients with cancer seen at
HICCC, 3.6% were recorded as current smokers, 17.8% former smokers, 48.5% never smokers, <0.01%
alternative tobacco users, and 30.1% had no recorded smoking status. These percentages demonstrate a
need for routine assessment of tobacco use in order to obtain an accurate smoking status for all cancer
patients. Additionally, 38 different labels were associated with smoking status, therefore showing
inconsistency in how tobacco use history is assessed and recorded in EHR. The TCP seeks to address
the following barriers in tobacco cessation implementation within cancer care: outdated patient tobacco
use history in EHR, inconsistent and incomplete assessment of tobacco use, and lack of a direct referral
system for tobacco cessation services for cancer patients. A significant step for the TCP has been to
establish a centralized administrative and clinical support team consisting of coordinators, patient
navigators, and tobacco treatment specialists. A system using patient navigators to directly identify and
refer smoking cancer patients was developed and piloted in Thoracic Oncology. This identification system
is currently being adapted and implemented in seven other key oncology areas throughout the Medical
Center. In the oncology departments that do not have a patient navigator, meetings with physicians to
learn about TCP and a “warm handoff” approach for direct referrals have been crucial in addressing the
lack of an electronic referral system. The critical components of the TCP at HICCC, such as a centralized
team and database, a direct identification system using patient navigators, and a “warm handoff” approach
for physician referrals, have the potential to address the barriers to the direct identification and referral of
cancer patients to tobacco cessation services.
Keywords: tobacco cessation; cancer patients; patient navigation; risk reduction; cancer prevention