Increased Reach and Effectiveness With a Low-Burden Point-of-Care Tobacco Treatment Program in Cancer Clinics

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  • 1 Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri;
  • | 2 Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri;
  • | 3 Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; and
  • | 4 Department of Surgery, and
  • | 5 Division of Oncology, Washington University School of Medicine, St. Louis, Missouri.

Background: Tobacco cessation after a cancer diagnosis can extend patient survival by improving outcomes for primary cancer and preventing secondary cancers. However, smoking is often unaddressed in cancer care, highlighting the need for strategies to increase treatment reach and cessation. This study examined a low-burden, point-of-care tobacco treatment program (ELEVATE) featuring an electronic health record–enabled smoking module and decision support tools to increase the reach and effectiveness of evidence-based smoking cessation treatment. Methods: This study included adult outpatient tobacco smokers (n=13,651) in medical oncology, internal medicine, and surgical oncology clinics from a large midwestern healthcare system. We examined reach and effectiveness of ELEVATE with 2 comparisons: (1) preimplementation versus postimplementation of ELEVATE and (2) ELEVATE versus usual care. Data were evaluated during 2 time periods: preimplementation (January through May 2018) and postimplementation (June through December 2018), with smoking cessation assessed at the last follow-up outpatient encounter during the 6 months after these periods. Results: The proportion of current tobacco smokers receiving cessation treatment increased from pre-ELEVATE to post-ELEVATE (1.6%–27.9%; difference, 26.3%; relative risk, 16.9 [95% CI, 9.8–29.2]; P<.001). Compared with 27.9% treatment reach with ELEVATE in the postimplementation time period, reach within usual care clinics ranged from 11.8% to 12.0% during this same period. The proportion of tobacco smokers who subsequently achieved cessation increased significantly from pre-ELEVATE to post-ELEVATE (12.0% vs 17.2%; difference, 5.2%; relative risk, 1.3 [95% CI, 1.1–1.5]; P=.002). Compared with 17.2% smoking cessation with ELEVATE in the postimplementation time period, achievement of cessation within usual care clinics ranged from 8.2% to 9.9% during this same period. Conclusions: A low-burden, point-of-care tobacco treatment strategy increased tobacco treatment and cessation, thereby improving access to and the impact of evidence-based cessation treatment. Using implementation strategies to embed tobacco treatment in every healthcare encounter promises to engage more smokers in evidence-based treatment and facilitate smoking cessation, thereby improving care cancer for patients who smoke.

Submitted August 17, 2021; final revision received December 17, 2021; accepted for publication December 20, 2021.

Author contributions: Conceptualization and design: Ramsey, Baker, Smock, Bierut, L.S. Chen. Data curation: Ramsey, Smock, J. Chen, Pham, L.S. Chen. Formal analysis: Ramsey, J. Chen, Pham, L.S. Chen. Funding acquisition: Ramsey, Bierut, L.S. Chen. Investigation: Ramsey, L.S. Chen. Methodology: Ramsey, Smock, J. Chen, Pham, Bierut, L.S. Chen. Project administration: Smock. Software: J. Chen, Pham. Supervision: Ramsey, L.S. Chen. Validation: Ramsey, Smock, J. Chen, Pham, L.S. Chen. Visualization: Stoneking, Smock, J. Chen, Pham. Writing—original draft: Ramsey, Stoneking, Smock, J. Chen, Pham, L.S. Chen. Writing—review and editing: Ramsey, Baker, Smock, J. Chen, Pham, James, Colditz, Govindan. Bierut, L.S. Chen.

Disclosures: Dr. Baker has disclosed serving as a principal investigator for NCI and NHLBI. Dr. Bierut has disclosed being a patent holder (Patent 8,080,371). The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: Research reported in this publication was supported by the NCI of the NIH under award number P30CA091842-16S2. Dr. Ramsey received grant/research support from the National Institute on Drug Abuse (K12DA041449; R34DA052928) and the NCI (P50CA244431). Dr. James and Dr. Colditz received grant/research support from the NCI (P50CA244431; P30CA091842). Dr. Bierut received grant/research support from the National Institute on Drug Abuse (K12DA041449), the National Center for Advancing Translational Sciences (UL1TR002345), and the Alvin J. Siteman Cancer Center. Dr. L.S. Chen received grant/research support from the National Institute on Drug Abuse (R01DA038076), the Siteman Investment Program, and the NCI (P50CA244431).

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The funders had no role in the conduct of the study; in the collection, management, analysis, or interpretation of the data; in the writing of the manuscript; or in the decision to publish the results.

Correspondence: Alex T. Ramsey, PhD, Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110. Email: aramsey@wustl.edu

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