The 2014 Surgeon General’s report underscored the importance of helping patients with cancer quit smoking, because continued smoking after a diagnosis is causally linked to cancer-specific and all-cause mortality.1 More than 50% of patients with cancer who smoked before diagnosis continue to smoke after diagnosis and treatment,2 leading to calls from NCCN,3 ASCO,4 and the American Association for Cancer Research5 to implement tobacco cessation treatment within oncology care. Despite being uniquely positioned to intervene, only half of NCI-designated Cancer Centers systematically identify tobacco use among patients,6 and few centers and oncology practices consistently provide smoking cessation services.5 To enhance patient outcomes, improved systems are needed to consistently identify patients who smoke and to ensure that they more effectively engage in evidence-based treatments.
In recognition of these issues, NCI developed the Cancer Center Cessation Initiative (C3I) in 2017, with support from the Cancer Moonshot initiative (https://cancercontrol.cancer.gov/brp/tcrb/cessation-initiative.html), to build and sustain an infrastructure across the nation’s cancer centers to ensure patients with cancer are systematically screened for tobacco use and provided evidence-based smoking cessation treatment.7 This program supported 22 cancer centers around the United States initially, and an additional 20 were funded in the fall of 2018, with biannual meetings for grant recipients, scientific and technical support from a coordinating center at the University of Wisconsin, and collaborative efforts focused on sustained institutional cancer center commitment to reduce patient tobacco use. This commentary describes the progress made at Abramson Cancer Center at the University of Pennsylvania to build a sustainable and implementation-science–informed infrastructure to address patient tobacco use, including initial program effects on clinical treatment and future directions that might inform other efforts.
The authors wish to thank Dr. Michael Fiore and his staff at the University of Wisconsin for serving as the coordinating center for the C3I; Dr. Glen Morgan for reviewing a draft of this manuscript; Drs. Rebecca Ashare, Lynn Schuchter, Lawrence Shulman, and James Metz for helping to support the TUTS program; and Ms. Tierney Fischer and Ms. Jody Nicoloso for operating TUTS.
Warren GWAlberg AJKraft AS. The 2014 Surgeon General’s report: “the health consequences of smoking—50 years of progress”: a paradigm shift in cancer care. Cancer 2014;120:1914–1916.
Land SRToll BAMoinpour CM. Research priorities, measures, and recommendations for assessment of tobacco use in clinical cancer eesearch. Clin Cancer Res 2016;22:1907–1913.
Shields PGHerbst RSArenberg D. NCCN Clinical Practice Guidelines in Oncology for Smoking Cessation, Version 1.2016. J Natl Compr Canc Netw 2016;14:1430–1468. To view the most recent version visit NCCN.org.
Nekhlyudov LLacchetti CDavis NB. Head and neck cancer survivorship care guideline: American Society of Clinical Oncology clinical practice guideline endorsement of the American Cancer Society guideline. J Clin Oncol 2017;35:1606–1621.
- Search Google Scholar
- Export Citation
)| false . , Nekhlyudov L , Lacchetti C , Davis NB Head and neck cancer survivorship care guideline: American Society of Clinical Oncology clinical practice guideline endorsement of the American Cancer Society guideline. 2017; 35: 1606– 1621. 10.1200/JCO.2016.71.8478
Toll BABrandon THGritz ER. AACR Subcommittee on Tobacco and Cancer. Assessing tobacco use by cancer patients and facilitating cessation: an American Association for Cancer Research policy statement. Clin Cancer Res 2013;19:1941–1948.
- Search Google Scholar
- Export Citation
)| false . , Toll BA , Brandon TH , Gritz ER AACR Subcommittee on Tobacco and Cancer. Assessing tobacco use by cancer patients and facilitating cessation: an American Association for Cancer Research policy statement. 2013; 19: 1941– 1948. 10.1158/1078-0432.CCR-13-0666
Goldstein AORipley-Moffitt CEPathman DE. Tobacco use treatment at the U.S. National Cancer Institute’s designated cancer centers. Nicotine Tob Res 2013;15:52–58.
Croyle RTMorgan GDFiore MC. Addressing a core gap in cancer care - the NCI Moonshot Program to help oncology patients stop smoking. N Engl J Med 2019;380:512–515.
Vidrine JIShete SCao Y. Ask-Advise-Connect: a new approach to smoking treatment delivery in health care settings. JAMA Intern Med 2013;173:458–464.
Leone FTEvers-Casey SMulholland MA. Integrating tobacco use treatment into practice: billing and documentation. Chest 2016;149:568–575.
Damschroder LJAron DCKeith RE. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 2009;4:50.