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. 2024 Feb;20(2):212-219.
doi: 10.1200/OP.23.00393. Epub 2023 Nov 15.

Current Practices, Perceived Barriers, and Promising Implementation Strategies for Improving Quality of Smoking Cessation Support in Accredited Cancer Programs of the American College of Surgeons

Jamie S Ostroff  1 , Eileen M Reilly  2 , Jessica L Burris  3 , Graham W Warren  4 , Rachel C Shelton  5 , Timothy W Mullett  6 ; Just ASK Quality Improvement Task Force
Affiliations

Current Practices, Perceived Barriers, and Promising Implementation Strategies for Improving Quality of Smoking Cessation Support in Accredited Cancer Programs of the American College of Surgeons

Jamie S Ostroff et al. JCO Oncol Pract. 2024 Feb.

Abstract

Purpose: Persistent smoking is associated with poor outcomes in cancer care. It is strongly recommended that oncology care providers provide cessation support; however, there is limited information about smoking cessation assessment and treatment patterns in routine oncology practice.

Methods: Leaders of the American College of Surgeons Commission on Cancer (CoC) and National Accreditation Program for Breast Centers (National Accredited Program for Breast Cancer) elected to participate in a national quality improvement initiative (Just ASK) focused on smoking assessment/treatment in cancer care. Online baseline survey responses were received from 762 accredited programs.

Results: Most programs reported regularly asking about smoking (89.9%), documenting smoking history and current use (85.8%), and advising patients to quit (71.2%). However, less than half of programs reported documenting a smoking cessation treatment plan (41.7%). Even fewer programs reported regularly assisting patients with quitting (41.3%), providing self-help information (27.2%), providing individual counseling (18.2%), and referring patients to an affiliated tobacco treatment program (26.1%) or external Quitline (28.5%). Very few programs reported regularly prescribing medications (17.6%). Principal barriers to tobacco treatment delivery were lack of staff training (68.8%), lack of designated specialists (61.9%), perceived patient resistance (58.3%), lack of available resources (53.3%), competing clinical priorities (50.9%), inadequate program funding (40.6%), insufficient staff time (42.4%), and inadequate reimbursement (31.0%).

Conclusion: Although programs reported a high rate of smoking assessment, critical gaps in advising and assisting patients with cessation were found. Improving equitable delivery of smoking assessment/treatment in cancer care will require addressing key organizational and provider barriers for implementation of best practices.

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Conflict of interest statement

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/op/authors/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Jamie S. Ostroff

Patents, Royalties, Other Intellectual Property: UptoDate

Graham W. Warren

Patents, Royalties, Other Intellectual Property: Patent pending for radioprotective compound (Inst), patent or royalties associated with a radioprotective compound

Other Relationship: non-profit organizations, expert testimony

Timothy W. Mullett

Employment: University of Kentucky

Research Funding: Bristol Myers Squibb Foundation

Uncompensated Relationships: Data2

No other potential conflicts of interest were reported.

Figures

FIG 1.
FIG 1.
Perceptions of the feasibility and effectiveness of various implementation strategies to improve smoking assessment/treatment (N = 762).
See this image and copyright information in PMC

Comment in

References

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    1. US Department of Health and Human Services : National Cancer Institute Tobacco Control Monograph Series—Treating Smoking in Cancer Patients: An Essential Component of Cancer Care. Bethesda (MD), National Cancer Institute (US), 2022
    1. Warren GW, Cartmell KB, Garrett-Mayer E, et al. : Attributable failure of first-line cancer treatment and incremental costs associated with smoking by patients with cancer. JAMA Netw Open 2:e191703, 2019 - PMC - PubMed
    1. US Department of Health and Human Services: The Health Consequences of Smoking–50 Years of Progress: A Report of the Surgeon General. Atlanta, GA, US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014
    1. Talluri R, Fokom Domgue J, Gritz ER, et al. : Assessment of trends in cigarette smoking cessation after cancer diagnosis among US adults, 2000 to 2017. JAMA Netw Open 3:e2012164, 2020 - PMC - PubMed

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