Funding: 3P30CA124435-11S2/12S1 and 3P30CA124435-13S2
Background: In 2018 and 2020, Stanford Cancer Institute received two National Cancer Institute (NCI) Moonshot P30 Supplements to integrate, evaluate, and expand evidence-based tobacco cessation treatment into cancer care. The funding, technical, and peer support from the C3I collaboration was instrumental in extending Stanford’s tobacco treatment service into 20+ clinics across 3 cancer centers. Aim: To report on patient outcomes at 6- and 24-months follow-up. Methods: All patients identified as currently using tobacco by the oncology care team are automatically referred for tobacco treatment (i.e., opt-out model). Providers briefly advise cessation and inform patients that they will be contacted by a tobacco treatment specialist (TTS) within a week. The TTS offers patients a variety of services including: a) cessation medication consultation; b) behavioral counseling; c) virtual reality mindful exposure therapy; and d) e-referrals (state quitline, smokefree.gov). Group, family, and individual counseling are provided by supervised clinical psychology doctoral students in a clerkship model. Patient outcomes, including tobacco use and program satisfaction, are obtained by communications with patients and medical record review at 6- and 24-months. Results: From January 2019 – November 1, 2021, the TTS reached out to all 3,301 patients identified as using tobacco, talking with 2413 patients (73%) by phone, of whom 825 (34%) engaged in cessation treatment, with patient outcomes obtained on 68% at 6-months and 85% at 24-months. The percent of patients tobacco-free is 29% (90/308) at 6-months and 32% (18/57) at 24-months. Of the 51 patients with outcomes at both 6- and 24-months: 14% sustained their tobacco-free status, 16% went from using tobacco to tobacco-free, and 8% relapsed. At 6-months, 69% of patients would recommend the program to others, rising to 73% at 24-months. Conclusion: As part of the NCI’s C3I collaboration, the Stanford Cancer Institute’s integrated tobacco treatment service is reaching and engaging patients, supporting their efforts to achieve a tobacco-free lifestyle, and with high program satisfaction. Weekly team huddles monitor process and progress, and a dedicated TTS and student training model enables personalized outreach for engagement. New initiatives include piloting telehealth group-based care, hypnosis, and a virtual reality platform.
