A mixed-methods study exploring free nicotine replacement therapy as a strategy to promote tobacco treatment equity at Cancer Center Cessation Initiative sites

Marguerite A Webster^{1

2}, Jessica L Burris^{3

4}, Camille Cipri⁵, Jennifer Bird⁶, Rashelle B Hayes⁷, Christine E Sheffer⁸, Niharika Khanna⁹, Katie Lenhoff¹⁰, Mara Minion⁶, Elisa K Tong¹¹

Affiliations

¹ Department of Psychology, College of Arts and Sciences, University of Kentucky, 171 Funkhouser Dr, Lexington, KY, 40506, USA. marguerite.webster@uky.edu.
² Markey Cancer Center, University of Kentucky, 800 Rose St., Lexington, KY, 40536, USA. marguerite.webster@uky.edu.
³ Department of Psychology, College of Arts and Sciences, University of Kentucky, 171 Funkhouser Dr, Lexington, KY, 40506, USA.
⁴ Markey Cancer Center, University of Kentucky, 800 Rose St., Lexington, KY, 40536, USA.
⁵ Center for Healthcare Policy and Research, University of California, Davis, 4900 Broadway, Suite 1430, Sacramento, CA, 95820, USA.
⁶ Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe Street, Suite 200, Madison, WI, USA.
⁷ Department of Psychiatry, Virginia Commonwealth University School of Medicine, 501 N. 2nd Street, Suite 400B, Richmond, VA, 23219, USA.
⁸ Department of Health Behavior, Roswell Park Cancer Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA.
⁹ Family and Community Medicine, University of Maryland School of Medicine, 29 S. Paca Street, Baltimore, MD, 21201, USA.
¹⁰ Student Wellness Center, Dartmouth College, 25 N Main Street, Suite 179, Hanover, NH, 03755, USA.
¹¹ Division of Internal Medicine, University of California Davis Comprehensive Cancer Center, 4150 V Street Suite 2400, Sacramento, CA, 95817, USA.

PMID: 41366144
DOI: 10.1007/s00520-025-10244-y

A mixed-methods study exploring free nicotine replacement therapy as a strategy to promote tobacco treatment equity at Cancer Center Cessation Initiative sites

Marguerite A Webster et al. Support Care Cancer. 2025.

. 2025 Dec 9;34(1):17.

doi: 10.1007/s00520-025-10244-y.

Authors

Affiliations

¹ Department of Psychology, College of Arts and Sciences, University of Kentucky, 171 Funkhouser Dr, Lexington, KY, 40506, USA. marguerite.webster@uky.edu.
² Markey Cancer Center, University of Kentucky, 800 Rose St., Lexington, KY, 40536, USA. marguerite.webster@uky.edu.
³ Department of Psychology, College of Arts and Sciences, University of Kentucky, 171 Funkhouser Dr, Lexington, KY, 40506, USA.
⁴ Markey Cancer Center, University of Kentucky, 800 Rose St., Lexington, KY, 40536, USA.
⁵ Center for Healthcare Policy and Research, University of California, Davis, 4900 Broadway, Suite 1430, Sacramento, CA, 95820, USA.
⁶ Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe Street, Suite 200, Madison, WI, USA.
⁷ Department of Psychiatry, Virginia Commonwealth University School of Medicine, 501 N. 2nd Street, Suite 400B, Richmond, VA, 23219, USA.
⁸ Department of Health Behavior, Roswell Park Cancer Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA.
⁹ Family and Community Medicine, University of Maryland School of Medicine, 29 S. Paca Street, Baltimore, MD, 21201, USA.
¹⁰ Student Wellness Center, Dartmouth College, 25 N Main Street, Suite 179, Hanover, NH, 03755, USA.
¹¹ Division of Internal Medicine, University of California Davis Comprehensive Cancer Center, 4150 V Street Suite 2400, Sacramento, CA, 95817, USA.

PMID: 41366144
DOI: 10.1007/s00520-025-10244-y

Abstract

Purpose: Nicotine replacement therapy (NRT) is a safe, efficacious smoking cessation treatment for cancer patients. However, insurance coverage for NRT varies widely, limiting its ability to lessen tobacco-related disease and creating inequities in access. Offering free NRT to cancer patients who smoke has the potential to increase tobacco treatment engagement and promote equity. This mixed-methods study aims to describe how some NCI Cancer Center Cessation Initiative (C3I) sites provided free NRT within their tobacco treatment programs (TTPs).

Methods: Participating sites' (N = 9) TTP and patient population characteristics were measured via site-level survey data and analyzed. The Consolidated Framework for Implementation Research was used to guide and analyze semi-structured interviews among 16 individuals across sites.

Results: On average, 37.0% of patients who were identified as currently smoking cigarettes engaged with the TTPs, 48.4% of whom were prescribed cessation medications. Interviews revealed heterogeneous TTP structures, funding sources for free NRT, and medication distribution models. Patient financial strain appeared to frequently prompt free NRT program development. Common site factors that supported free NRT programs included inter-team collaborations, policy development, and leadership buy-in.

Conclusion: Results highlight both significant heterogeneity and shared factors in how cancer centers might implement free NRT programs. Barriers to implementation and sustainability underscore enduring challenges to providing gold standard tobacco treatment to all patients with cancer who use tobacco. Future research should investigate how to best provide equitable access to tobacco treatment among this population.

Keywords: Cancer; Implementation science; Nicotine replacement therapy; Smoking cessation; Tobacco-related health disparities.

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Conflict of interest statement

Declarations. Ethics approval: This study was reviewed and deemed IRB exempt at the principal investigator’s institution. Competing interests: The authors declare no competing interests. Disclaimer: The views presented in this manuscript are those of the authors and not an official position of the National Cancer Institute or National Institutes of Health.

References

1. National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health (2014) The health consequences of smoking—50 years of progress: a report of the surgeon general. Centers for Disease Control and Prevention (US), Atlanta (GA)
1. United States Public Health Service Office of the Surgeon General, National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health (2020) Smoking cessation: a report of the surgeon general. US Department of Health and Human Services, Washington (DC)
1. National Cancer Institute (2022) Treating smoking in cancer patients: an essential component of cancer care. National Cancer Institute (US), Bethesda (MD)
1. D’Angelo H, Webb Hooper M, Burris JL, Rolland B, Adsit R, Pauk D, Rosenblum M, Fiore MC, Baker TB (2021) Achieving equity in the reach of smoking cessation services within the NCI cancer moonshot-funded Cancer Center Cessation Initiative. Health Equity 5:424–430. https://doi.org/10.1089/heq.2020.0157 - DOI - PubMed - PMC
1. Caturegli G, Zhu X, Palis B, Mullett TW, Resio BJ, Boffa DJ (2025) Smoking status of the US cancer population and a new perspective from the National Cancer Database. JAMA Oncol 11:564–566. https://doi.org/10.1001/jamaoncol.2025.0247 - DOI - PubMed

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A mixed-methods study exploring free nicotine replacement therapy as a strategy to promote tobacco treatment equity at Cancer Center Cessation Initiative sites

Affiliations

A mixed-methods study exploring free nicotine replacement therapy as a strategy to promote tobacco treatment equity at Cancer Center Cessation Initiative sites

Authors

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical