Background: Smoking contributes to 1 in 3 cancer deaths. At the Stanford Cancer Center, tobacco cessation medication management and counseling are provided as a covered benefit for patients and their family members. Patients charted as using tobacco by the cancer care team are contacted by a tobacco treatment specialist (TTS) and offered cessation services. A novel addition, the current study examined the acceptability of a virtual reality mindful exposure therapy (VR-MET) app for quitting smoking called MindCotine. Methods: As part of a pilot study, the MindCotine VR program was offered to English or Spanish-speaking patients interested in quitting smoking. Epilepsy was a medical exclusion. Viewed from a smartphone with an attachable VR headset, MindCotine provides a virtual environment with audiovisual content guiding mindfulness exercises (e.g., breathing techniques, body awareness, and thought recognition), coaching, and cognitive behavioral therapy-based self-reflections for quitting smoking. Interested patients providing informed consent were mailed a MindCotine headset and asked to utilize the app 10+ minutes a day. At the end of 6 weeks, participants completed a feedback survey. Results: Of 301 patients eligible for the study, 18% were not ready to quit smoking, 51% did not want support, 23% chose other cessation services, and 9% (n=27) were interested in MindCotine, of whom 20 completed the informed consent, 11 used the program, and 9 reported their tobacco status at 6 weeks. Participants using MindCotine completed, on average, 11 (SD=19) program activities, 16 (SD=25) journal records, and 10 (SD=11) coaching engagements (Figure 1). Three participants quit tobacco (33% reporting, 15% overall), two others reduced their smoking by 50% or more, and two quit for 24-hours then relapsed; 3 (33%) reported some dizziness with app use; 7 of 9 (77%) would recommend MindCotine to a friend. Conclusions: In an acceptability pilot study of a novel VR-MET tobacco treatment app offered to patients at a cancer center, 5 of 9 (56%) reporting and 5 of 20 (25%) overall, substantially reduced or quit using tobacco after 6-weeks and most would recommend the app to others. Further testing in a larger sample is warranted. Acknowledgment of Funding: National Cancer Institute Moonshot Supplements 3P30CA124435-11S2/12S1 and 3P30CA124435-13S.