National Quality Improvement Initiative to Increase Smoking Cessation Assistance in Commission on Cancer Programs and National Accreditation Program for Breast Centers

Abstract

PURPOSE Smoking cessation after a cancer diagnosis improves survival, but widespread adoption of evidence-based cessation assistance has not been demonstrated. American College of Surgeons' accredited cancer programs participated in the nationwide Beyond ASK quality improvement (QI) initiative to increase the proportion of currently smoking patients with cancer offered cessation assistance as part of cancer care delivery. METHODS A national QI project was employed between January 2023 and January 2024 following the Plan-Do-Study-Act methodology, and five longitudinal surveys were administered. Participating programs received educational webinars, an online practice change package that contained information about evidence-based smoking assessment and cessation assistance tools, training opportunities, and electronic health record guidance. Primary outcomes included identification of current smoking among patients with newly diagnosed cancer and rate of providing cessation assistance among currently smoking patients. RESULTS A total of 324 programs (164 [50.8%] community programs) enrolled in Beyond ASK. Participation rates were high with 300 (92.6%) programs completing all five surveys. Among 446,015 reported patients newly diagnosed with cancer, 52,794 (11.8%) were identified as currently smoking of which 33,638 (63.7%) received cessation assistance. The mean assist rate increased from 48.0% (95% CI, 43.7 to 52.2) at baseline to 67.5% (95% CI, 63.6 to 71.3) at final. Full adoption was reported by 65.4% of programs. Delivery of cessation assistance increased over time for in-office brief counseling (33.9%-65.8%, P = .0002), in-office behavioral counseling (7.1%-18.5%, P = .02), referral to in-house program (14.5%-27.3%, P = .02), referral to community program (12.1%-29.5%, P = .002), and referral to web-based programs (12.2%-33.9%, P = .0002). CONCLUSION Scaled improvement in smoking cessation assistance across accredited cancer programs is feasible and achievable relatively quickly. Findings provide a framework to guide national adoption for smoking cessation assistance as standard care for all patients with newly diagnosed cancer.