It’s well documented that smoking can lead to cancer. But in recent years, evidence has been mounting that continuing to smoke during cancer treatment can be just as harmful, or even worse.
Not only does cancer treatment become less effective, but patients who continue smoking after a diagnosis increase their chances of developing a second primary cancer and generally have worse mortality outcomes.
For cancer centers, however, identifying who’s a smoker – and connecting them with tobacco cessation programs and resources – hasn’t always been easy or straightforward.
To that end, the National Cancer Institute (NCI) launched the Cancer Center Cessation Initiative, or C3I, in 2017. Funded by the Cancer Moonshot program, C3I now works with more than 50 cancer centers across the United States to help build tobacco cessation treatment programs and streamline the process of getting cancer patients connected to them.
Furthermore, the C3I Coordinating Center – led by Betsy Rolland, PhD, and , MD – is based at the UW Carbone Cancer Center, meaning Wisconsin is playing a leading role in the national effort to help cancer patients quit smoking.
“C3I was really created to address a longstanding gap in cancer care,” said Heather D’Angelo, PhD, a Program Director in the Health Communication and Informatics Research Branch of the NCI’s Behavioral Research Program. “Patients coming through many NCI-designated cancer centers were not routinely being screened for tobacco use, and if they used tobacco products or smoked, they weren’t being consistently referred to resources to quit.”
D’Angelo, formerly an assistant scientist at UW Carbone, notes that there are many barriers for oncology clinicians to advise their patients to quit smoking, including a lack of resources available to assist their patients in making quit attempts.
“Oncologists, just like primary care doctors, are extremely busy,” D’Angelo said. “They’re also not necessarily trained to help people quit smoking, and so may not feel comfortable approaching the question, or feel that there’s other priorities to discuss during limited appointment time.”
So in addition to providing funds to hire tobacco treatment specialists and add new tobacco treatment programs, a big push for C3I has been to adjust clinical workflows to ensure the identification of smokers, with a little help from electronic health records or EHR.
By using EHR-based referral systems to connect patients directly with available cessation treatment programs, patients who are identified as smokers are now automatically provided with information about cessation services, such as quit lines or other counseling.
So far, the approach seems to be working.
In a new paper in the journal Health Equity, D’Angelo and other UW Carbone colleagues examined the reach of cessation services across cancer populations, with reach being defined as the proportion of smokers coming through each cancer center that received some type of evidence-based tobacco or smoking cessation service.
“Once those automatic referrals systems were put in place, reach jumped right up,” D’Angelo said, noting that average reach increased from 18.5 percent to 25.6 percent in just the first year of the program.
Additionally, the researchers found that reach increased for all racial/ethnic groups. That’s important, because the researchers note that minority populations experience a disproportionate burden of tobacco-related cancers, and are offered and also use cessation aids at lower rates compared with white smokers.
Next on the research agenda will be to investigate how many patients were able to successfully quit smoking after receiving a referral to cessation services.
To further C3I’s work, UW Carbone partners with the UW Center for Tobacco Research and Intervention (UW-CTRI), which has been conducting groundbreaking tobacco research and helping smokers quit for nearly 30 years. Many UW-CTRI faculty are also UW Carbone members, making for a natural partnership.
Those UW Carbone members include Fiore, UW-CTRI’s director and senior scientist on C3I. UW-CTRI Research Director Tim Baker, PhD, also provides additional scientific input. And Associate Scientist Sarah Hohl, PhD, leads efforts to evaluate reach, effectiveness, and sustainability of evidence-based tobacco cessation interventions across C3I.
In addition, UW-CTRI Outreach Director Rob Adsit serves as an expert on electronic health records, workflow and health systems change to implement comprehensive tobacco treatment at 52 cancer centers across America. The team also includes UW Carbone Coordinating Center Manager Danielle Pauk, C3I Project Coordinator Mara Minion and physician-scientist Maggie Nolan, MD.