Implementing A Virtual Tobacco Treatment in Community Oncology Practices

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There are over 15.5 million cancer survivors in the U.S.; survival rates are increasing, but unfortunately 10-30% of cancer patients are current smokers at the time of diagnosis. The 2014 Surgeon General's report concluded that there is sufficient evidence ) linking smoking to adverse health outcomes in cancer patients and b) that quitting smoking improves cancer prognosis. Accordingly, the National Comprehensive Cancer Network published its first smoking cessation guidelines for patients with cancer in 2015. a Most cancer patients do not receive tobacco cessation support and, specifically, evidence-based tobacco treatment guidelines have not been implemented in community cancer settings where the vast majority of cancer patients receive care. The investigative team developed and tested the integration of an evidence based intensive tobacco treatment (IT), delivered in-person and via phone in English and Spanish, at two comprehensive cancer centers. Using innovative live videoconferencing technology ), we propose a virtual implementation of the IT in community sites affiliated with the newly established ECOG-ACRIN NCI Community Oncology (delivered via computer or mobile device Research Program (NCORP). We will use a Hybrid Type 1 effectiveness-implementation trial design to examine the effectiveness (7-day cotinine confirmed point-prevalence abstinence at 6 months) of two delivery approaches. We will randomize 224 cancer patients who are current smokers to either the virtual intensive tobacco treatment (VIT) or Enhanced Usual Care (EUC; quitline referral and site-specific usual care ). The VIT consists of extended motivational counseling, delivered by a centralized tobacco coach, plus 12 weeks of combination nicotine replacement therapy (patch plus lozenge). Secondary aims will identify patient and NCORP sites characteristics associated with VIT effectiveness and implementation, guided by Proctor's' implementation research outcome recommendations and the Consolidated Framework for Implementation Research (CFIR). Implementation will be facilitated through patient exit interviews (n=40), biannual meetings with NCORP site PIs and staff, pre/post NCORP PI/clinicians/staff surveys (n=100), and post-trial NCORP site focus groups (n=10). This proposal is innovative in its 1) virtual design (clinician outreach through brief videos (Vidscrip) and treatment delivery), 2) access and targeted cancer treatment to diverse cancer community patients, and 3) transdisciplinary team, which includes experts in cancer care, tobacco treatment, implementation, and community cancer trials. Demonstrating the implementation of a videoconferencing tobacco treatment at NCORP sites will establish a pathway for disseminating evidence based tobacco treatment and close the gap of treatment delivery in resource sparse community oncology settings.