Study reveals considerable gaps in smoking cessation efforts at US cancer centers
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U.S. cancer centers often ask patients about smoking status, but results of an online survey revealed critical gaps in efforts to help patients quit.
Key organizational and provider barriers must be overcome to increase equitable delivery of smoking assessment and treatment in cancer care, researchers concluded.
“There is a perceived barrier that patients aren’t motivated to quit smoking,” study co-author Jamie Ostroff, PhD, director of the tobacco treatment program at Memorial Sloan Kettering Cancer Center, told Healio. “In fact, the responsibility is on us to roll out best practices to ensure that everyone gets high-quality care.”
Prior research established the link between persistent smoking and poor outcomes among people with cancer.
“Smoking cessation is critically important for improving outcomes for patients with cancer,” Ostroff said. “The benefits of quitting include improved treatment effectiveness, reduced second primary cancers, reduced recurrence and disease recurrence, and — ultimately — reduced mortality.”
However, little is known about smoking cessation assessment and treatment patterns in routine oncology practice, according to study background.
The American College of Surgeons Commission on Cancer and National Accreditation Program for Breast Cancers initiated the Just ASK quality improvement project in 2022 to encourage universal smoking status assessment and documentation in electronic health records.
The program encouraged physicians, nurses and other members of the clinical team to ask patients about their smoking status and tell them that quitting can improve outcomes.
A baseline survey administered as part of JUST Ask assessed current tobacco cessation practices and implementation barriers. The findings — based on responses from 776 Commission on Cancer- or National Accreditation Program for Breast Cancers-accredited programs — appeared in JCO Oncology Practice.
The survey revealed near-universal endorsement of the clinical importance of smoking assessment and treatment; however, study authors identified considerable variability in implementation.
The majority of programs reported regularly asking patients about smoking status (89.9%), document smoking history and current use (85.8%), and advise patients to quit (71.2%). However, far fewer programs reported regularly helping patients quit (41.3%), providing self-help information (27.2%) or individual counseling (18.2%), referring patients to an affiliated tobacco treatment program (26.1%) or external program (28.5%), or regularly prescribing medications (17.6%).
The survey also revealed several barriers to delivery of tobacco treatment, the most common of which included lack of staff training (68.8%) or designated specialists (61.9%), perceived patient resistance (58.3%), lack of resources (53.3%), competing clinical priorities (50.9%), insufficient funding (40.6%), lack of staff time (42.4%) and inadequate reimbursement (31%).
Researchers outlined several recommendations to improve the quality of smoking cessation treatment for people with cancer.
The suggestions included:
- implementing a proactive system for screening patients about current smoking status;
- prioritizing and facilitating staff training to help cancer centers adopt tobacco treatment best practices throughout diverse cancer care environments;
- creating learning collaborations or communities to expedite the implementation of clinical practice guidelines for tobacco treatment and customizing them to local settings; and
- offering local referrals and other community resources to counsel and assist patients regarding smoking cessation.
Additional research will be needed to assess approaches to improving evidence-based tobacco treatment in diverse oncology settings, Ostroff said.
To that end, the Commission on Cancer is leading a second quality improvement project —called Beyond ASK — to improve programs’ ability to provide smoking cessation help to current smokers who are newly diagnosed with cancer.
This effort reflects the need to transition from understanding what needs to be done to implementation of the necessary steps, Ostroff said.
“Smoking cessation is our best practice — it’s how we treat the whole person and tailor the treatment to the needs of the patient,” Ostroff said. “This includes psychosocial and behavioral treatment. It also addresses a modifiable risk factor.”
For more information:
Jamie S. Ostroff, PhD, can be reached at ostroffj@mskcc.org.
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