Leveraging the National Cancer Institute’s Cancer Center Cessation Initiative (C3I) Program to Evaluate and Transform Smoking Cessation Treatment in Cancer Care

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PROJECT SUMMARY/ABSTRACT Cigarette smoking is both common and undertreated among oncology patients. Although smoking is a leading cause of cancer and results in worse cancer prognoses, only half of cancer patients who smoke are offered help in quitting during cancer care, and it is unclear that the help they are offered is effective. This R35 proposal is designed to transform oncology practice so that smoking cessation is an integral part of treatment for all cancer patients who smoke. Electronic health records (EHRs) have tremendous potential to accelerate improvements in clinical care by facilitating such treatment delivery. EHR modifications can also increase discovery by enhancing assessment of smoking treatment reach, costs, equity, and effectiveness both in terms of helping patients quit and improving cancer outcomes. The Principal Investigator has 30 years of experience leading research and policy efforts to promote the treatment of smoking. Over the past 7 years, he has led a team that developed and evaluated new EHR-based tools and workflows that markedly increase the proportion of adult patients who receive evidence-based smoking cessation treatment in primary care. The new R35 proposal will similarly identify intervention strategies that increase smoking treatment engagement and effectiveness when implemented in oncologic care. Over the last 4 years, the Principal Investigator has served as Senior Scientist for NCI’s Moonshot-supported Cancer Center Cessation Initiative (C3I), a nationwide effort of 52 NCI-designated cancer centers to develop and implement programs to aid their patients who smoke. Yet, this incredibly important initiative has not been systematically assessed in terms of which EHR-enabled interventions enhance a smoking program’s reach, patient engagement, implementation, cessation effectiveness, and benefits. This R35 renewal is designed to do just that by systematically assessing best practices via EHR data extraction of intervention delivery, healthcare costs, short-term cancer treatment outcomes overall, and by patient demographics. These EHR data will be supplemented by qualitative analysis of C3I smoking treatment components, delivery, adaptations, and contexts in a mixed-methods approach. Higher- and lower-performing smoking treatment programs will be identified and rigorous methods will then be used to select best practice programs from cessation- and cost-effectiveness perspectives. Further assessment will identify implementation strategies and contextual factors that may contribute to the effectiveness of these programs. Best practices from these programs will be implemented in lower-performing C3I programs, with research team support in adaptation and implementation. Pragmatic implementation guides and strategies will be used to disseminate best practices to cancer care programs nationwide. Thus, the proposed project seeks to extend and adapt transformative EHR-facilitated system changes that enhance smoking treatment in primary care to the high-priority cancer care context. The project will demonstrate the benefits of such system changes to cancer patients in terms of costs, smoking cessation, and cancer recovery.