Abstract
As part of a National Cancer Institute Moonshot P30 Supplement, the Stanford Cancer Center piloted and integrated tobacco treatment into cancer care. This quality improvement (QI) project reports on the process from initial pilot to adoption within 14 clinics. The Head and Neck Oncology Clinic was engaged first in January 2019 as a pilot site given staff receptivity, elevated smoking prevalence, and a high tobacco screening rate (95%) yet low levels of tobacco cessation treatment referrals (<10%) and patient engagement (<1% of smokers treated). To improve referrals and engagement, system changes included an automated “opt-out” referral process and provision of tobacco cessation treatment as a covered benefit with flexible delivery options that included phone and telemedicine. Screening rates increased to 99%, referrals to 100%, 74% of patients were reached by counselors, and 33% of those reached engaged in treatment. Patient-reported abstinence from all tobacco products at 6-month follow-up is 20%. In July 2019, two additional oncology clinics were added. In December 2019, less than one year from initiating the QI pilot, with demonstrated feasibility, acceptability, and efficacy, the tobacco treatment services were integrated into 14 clinics at Stanford Cancer Center.
Highlights
30% of cancer deaths in the U.S are attributed to smoking [1]
Prior to the quality improvement (QI) initiative, between January 2018 through the end of December 2018, a total of 5735 patients were seen at the three participating pilot clinics; 5580 (97%) patients were screened for tobacco use; 242 (4%) patients had current tobacco use indicated; and 42 (17%) patients had clinician tobacco treatment assistance documented
All identified tobacco users were opted into treatment and received phone outreach from the tobacco treatment service and information through their electronic health record (EHR) using a secure messaging system
Summary
Continued smoking after a cancer diagnosis can complicate cancer treatments by interacting with medications, increasing the risk of treatment side-effects, and decreasing wound healing time [2,3,4,5]. Quitting smoking as early as possible after a cancer diagnosis eliminates these complications and has been shown to increase survival and well-being while decreasing the risks of disease recurrence and second primary tumors [6,7]. For these reasons, tobacco cessation services are recommended as a standard component of cancer treatment [8]. Among patients who continued to smoke after undergoing treatment for head and neck cancer, most reported being motivated to quit and making past attempts to quit, but few entered a
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