February 18, 2019

C3I: Helping cancer patients who smoke quit smoking

With the new year comes New Year’s resolutions, and many smokers will commit to quitting smoking to improve their health and reduce their cancer risk. The UW Carbone Cancer Center, along with cancer centers across the country, has been busy at work on their own smoking cessation resolution: to help cancer patients who smoke, quit.

In late 2017, the National Cancer Institute (NCI) launched its Cancer Center Cessation Initiative (C3I) with “Cancer Moonshot” funding. Through C3I, participating Cancer Centers are seeking to improve the rate at which they offer smoking cessation programs to patients who smoke.

“Currently at cancer centers across the country, only around 30 percent of patients who smoke have been offered cessation services in the past. And we know that cancer patients who smoked and have quit have better clinical outcomes,” says Betsy Rolland, PhD, MLIS, MPH, assistant director of population sciences at UW Carbone and the lead investigator of the C3I Coordinating Center. “The goal of this program is to get every smoker who comes through the door of any cancer center to be offered some sort of tobacco treatment program.”

An “implementation science” program, C3I is not looking to develop new methods to help smokers quit – decades of research has already identified successful cessation programs. Rather, researchers are investigating how best to ensure smokers who are also cancer patients are being given access to those cessation programs.

“There are two main metrics we’re asking the participating centers to collect: reach and effectiveness,” says Heather D’Angelo, PhD, MHS, an assistant scientist with UW Carbone working on C3I. “Reach is the proportion of smokers coming through each Center that received some type of evidence-based tobacco or smoking cessation service, and effectiveness is asking if patients who have received cessation services smoked in the last 30 days.”

One important piece of the implementation is to improve electronic health records (EHR) tracking to help centers reach out to smokers.

“Just making sure patients who are smokers are clearly identified and that they are tracked throughout has been very challenging,” Rolland says. “So NCI has committed additional funds to pay for an EHR consulting firm to get sites up and running more efficiently.”

Adds D’Angelo: “Another important part of the reporting is that we’re asking for patient demographics so we can look at who is receiving tobacco treatment. This information is critical for addressing disparities between patients who receive cessation treatment and those who do not, so we’re collecting information on gender, race, ethnicity, age and insurance status.”

In its first year, 22 cancer centers were funded through C3I, with the program expanding to 42 centers total in its second year.

The University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI) in conjunction with UW Carbone was named C3I’s coordinating cancer center, with Rolland, D’Angelo and CTRI director Dr. Michael Fiore leading UW’s efforts along with other UW-CTRI staff. Rolland says the role of the coordinating center is to ensure all sites are taking a team science-based approach and sharing knowledge.

Because the program is currently ongoing and collecting data, D’Angelo said the team is not ready to make conclusions about the outcomes. However, the preliminary data show that after receiving C3I funding, Centers have increased their staffing of Tobacco Treatment Specialists and have begun switching over to EHR-based referral methods. And, she hopes to see continued progress during the two-year program and beyond.

“One main goal is that the levels of reach and effectiveness that the centers have obtained is able to be sustained after the funding ends, because we don’t want to see those levels drop,” D’Angelo says. “The other main goal, especially of our coordinating center, is to develop resources, lessons learned and best practices that can be disseminated widely to other cancer centers so that they can benefit even if they weren’t one of the 42 selected sites.”