QIM20-136: Integration of Tobacco Treatment Into Cancer Care at Stanford Health Care

Authors: Cindy Tran MPH a , Brittany Pike MS, BSN, RN a , Matthew Kendra PhD b , Rachelle Mirkin MPH a and Judith J. Prochaska PhD, MPH c
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  • a Stanford Health Care, Palo Alto, CA
  • b Stanford University School of Medicine, Stanford, CA
  • c Stanford University, Stanford, CA

Background: Tobacco is the leading cause of cancer and cancer-related deaths in the United States. The Stanford Cancer Center was awarded a Moonshot P30 Supplement to integrate evidence-based tobacco treatment into cancer care. We have partnered with 3 clinics with high tobacco use prevalence and tobacco screening rates over 95%. However, less than 10% of identified tobacco users were referred for treatment and less than 1% engaged in treatment. Aims: We aimed to (1) Increase tobacco treatment referrals so 100% of identified tobacco users are automatically referred for treatment (opt-out model) and (2) Support patients’ long-term tobacco abstinence, which is assessed 6 months post-treatment. Methods: To address the gap between the number of identified tobacco users and the number referred for treatment, we developed an automated referral process whereby: (1) The medical assistants screen patients for tobacco use; (2) A visual indicator alerts providers of patients who use tobacco; and (3) Providers perform brief counseling and inform patients that a tobacco treatment team specialist will call them within 1 week. When called, patients are offered a menu of treatment options, including: (1) E-referral to the California Quit Line and smokefree.gov; (2) Counseling individually or as a family, in-person or via telemedicine, or in-person group counseling; (3) Cessation medications including nicotine replacement therapy, varenicline, or bupropion, with same-day delivery at a discounted price via Alto Pharmacy. Results: Since January 2019, 317 tobacco users were identified, and all were opted-in to phone outreach by the tobacco treatment service; 214 (68%) patients were reached by phone, and 79 (37% of those reached) engaged in treatment. To date, 7 (9%) of patients are tobacco-free and 72 (91%) are attempting to quit. Conclusion: We increased the tobacco treatment referral rate 10-fold and treatment engagement 20-fold. Our ongoing assessment of 6-month patient outcomes began in September. We track the cost of our services to inform a sustainable financial model. By adhering to the “Plan, Do, Study, Act” methodology, we implement weekly improvements to advance the quality and effectiveness of our tobacco treatment services. We will expand to include all Stanford Cancer Center and Health Care clinics. Funding: P30CA1244351-1S2 with a Moonshot Supplement

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Corresponding Author: Cindy Tran, MPH
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