Cigarette smoking remains the leading cause of preventable cancer and cancer-related deaths in the United States, responsible for roughly 30% of all cancer deaths, representing more than 150,000 Americans killed by tobacco-caused cancer each year.1,2 Among the estimated 1.9 million people who will be diagnosed with cancer in the United States in 2021,3 many will receive their oncology care at one of the 64 clinical NCI-designated Cancer Centers4; approximately 24% will be cigarette smokers at the time of diagnosis.5
Although compelling data have shown that quitting smoking after a cancer diagnosis leads to better health and quality of life outcomes, a 2009 survey reported that only 38% of NCI Cancer Centers recorded smoking as a vital sign, and fewer than half had dedicated personnel to provide smoking cessation treatment.6 Only about half of patients with cancer who smoke and just 15% of those who have completed treatment are counseled to quit.7 These missed opportunities were highlighted in the 2014 Surgeon General’s Report, which documented that continuing to smoke after a cancer diagnosis was associated with significant increases in all-cause mortality, cancer-specific mortality, and second primary cancers.2 In 2015, NCCN established Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Smoking Cessation, highlighting best practices for assessment and treatment of tobacco dependence in cancer care.8 A recent commentary called for tobacco cessation to be designated as the “Fourth Pillar of Cancer Care,” in recognition of its vast potential for improving the lives of patients with cancer.9 Integrating tobacco cessation into routine cancer care may be particularly beneficial for some racial, ethnic, and sexual and gender minorities; rural residents; those of low socioeconomic status; and underinsured or uninsured populations, because they experience a higher burden of tobacco-related cancers and chronic diseases.2,10 In fact, medically underserved populations are less likely to even be offered tobacco cessation services and less likely to participate even though they report high rates of interest in quitting.11
National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. The Health Consequences of Smoking—50 Years of Progress: a report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention (US); 2014.
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National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. The Health Consequences of Smoking—50 Years of Progress: a report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention (US); 2014. 24455788
NCI-Designated Cancer Centers. NIH National Cancer Institute website. Accessed November 14, 2020. Available at: https://www.cancer.gov/research/infrastructure/cancer-centers
Talluri R, Fokom Domgue J, Gritz ER, et al. Assessment of trends in cigarette smoking cessation after cancer diagnosis among US adults, 2000 to 2017. JAMA Netw Open 2020;3:e2012164–2012164.
Goldstein AO, Ripley-Moffitt CE, Pathman DE, et al. Tobacco use treatment at the U.S. National Cancer Institute’s designated Cancer Centers. Nicotine Tob Res 2013;15:52–58.
Ramaswamy AT, Toll BA, Chagpar AB, et al. Smoking, cessation, and cessation counseling in patients with cancer: a population-based analysis. Cancer 2016;122:1247–1253.
Shields PG. New NCCN Guidelines: smoking cessation for patients with cancer. J Natl Compr Canc Netw 2015;13(Suppl 5):643–645.
Fiore MC, D’Angelo H, Baker T. Effective cessation treatment for patients with cancer who smoke-the fourth pillar of cancer care. JAMA Netw Open 2019;2:e1912264–1912264.
Henley SJ, Thomas CC, Sharapova SR, et al. Vital signs: disparities in tobacco-related cancer incidence and mortality - United States, 2004–2013. MMWR Morb Mortal Wkly Rep 2016;65:1212–1218.
Soulakova JN, Crockett LJ. Unassisted quitting and smoking cessation methods used in the United States: analyses of 2010-2011 tobacco use supplement to the current population survey data. Nicotine Tob Res 2017;20:30–39.
Croyle RT, Morgan GD, Fiore 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.
D’Angelo H, Ramsey AT, Rolland B, et al. Pragmatic application of the RE-AIM framework to evaluate the implementation of tobacco cessation programs within NCI-Designated Cancer Centers. Front Public Health 2020;8:221.
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, D’Angelo H , Ramsey AT , Rolland B Pragmatic application of the RE-AIM framework to evaluate the implementation of tobacco cessation programs within NCI-Designated Cancer Centers. Front Public Health 2020; 8: 221. 32596200 10.3389/fpubh.2020.00221
D’Angelo H, Rolland B, Adsit R, et al. Tobacco treatment program implementation at NCI Cancer Centers: progress of the NCI Cancer Moonshot-Funded Cancer Center Cessation Initiative. Cancer Prev Res (Phila) 2019;12:735–740.
D’Angelo H, Webb Hooper M, Burris JL, et al. Achieving equity in the reach of smoking cessation services within the NCI Cancer Moonshot-Funded Cancer Center Cessation Initiative. Health Equity 2021;5:424–430.