Accelerate tobacco treatment in cancer care with evidence-based implementation strategies: How to get from here to there?

Abstract

e13548 Background: Tobacco use is associated with 40% of all cancer diagnoses in the United States. Individuals with cancer who continue to smoke are at increased cancer-specific and all-cause mortality, treatment complications, and higher health care costs. As such, the American Society of Clinical Oncology emphasizes that the benefits of stopping cigarette use after a cancer diagnosis include longer and better quality of life, faster and more successful recovery, and lower risk of secondary cancers and infections. Different care models for tobacco cessation treatment programs exist. Here, we present a qualitative analysis from interviews from representatives of the Cancer Center Cessation Initiative (C3I) centers describing these care models. Methods: This analysis follows up on a cross-sectional study in 2023 that evaluated reach and effectiveness of tobacco treatments from 28 C3I centers. The centers were divided into four groups based on reach and effectiveness: Group A) High Reach/High Effectiveness, Group B) High Reach/Low Effectiveness, Group C) Low Reach/High Effectiveness, Group D) Low Reach/Low Effectiveness. Qualitative interviews were conducted with representatives from 16 of the 28 C3I centers to understand which tobacco cessation models were used and their associated outcomes. Interviews were recorded, transcribed, and deidentified. Strategies were organized into four Expert Recommendations for Implementing Change evidence-based implementation (ERIC) strategy categories: support clinicians, change infrastructure, engage consumers, and train stakeholders. Each transcript was coded by two unique coders. Inconsistencies among coders were calibrated. Strategies of Group A were further analyzed. Results: Tobacco care model strategies varied across the 4 groups. First, greater utilization of electronic health record (EHR) functions was associated with centers that had greater reach and effectiveness. Second, there was a tradeoff between reach and effectiveness, as related to engaging consumers through either automatic or tobacco treatment specialist (TTS) outreach. Automatic outreach had a greater reach and lower effectiveness, whereas TTS outreach had the opposite. Third, training stakeholders, including providers, and allowing data feedback was associated with centers that had increased reach. Conclusions: Results suggest that there is more than one path to success. High-performing programs may combine strategies from different ERIC categories, seeking synergy and ways to maximize impact for a population through broad reach and high effectiveness. EMR seems critical to achieving this. With the aim to increase smoking cessation treatments for cancer patients, these results can help guide cancer centers in their implementation of tobacco treatment programs in a strategy-supported, detailed manner while adapting to unique center needs.