Most of the cancer center teams who agreed to help their patients quit tobacco use have sustained that high-quality care even after funding for it ended, according to a new paper published in Cancer Medicine by a research team that includes UW-CTRI colleagues.
The paper assesses the sustainment of tobacco treatment programs that participated in the Cancer Center Cessation Initiative (C3I), an initiative led by colleagues at the UW Carbone Cancer Center and UW-CTRI and funded by the National Cancer Institute (NCI). It was part of the Cancer Moonshot envisioned by former President Joe Biden in memory of his son Beau, who died of cancer, which passed with bi-partisan support.
Before C3I, surveys of oncology providers demonstrated that, while most ask about tobacco use and advised patients to quit, only approximately one third regularly assisted patients with quitting.
At least half of cancer patients kept smoking after their cancer diagnosis, even though it increases overall and cancer-related mortality, risk for second primary cancer and is associated with increased toxicity from cancer treatment.
NCI launched C3I in 2017 to address this gap in care, funding 52 NCI-designated cancer centers to enhance the delivery of tobacco treatment at their sites.
As part of an NCI-funded R01 research project to characterize the sustainment of the C3I programs, the study team conducted a web-based survey of the 52 participating centers after C3I funding ended.
Of the 47 centers that responded to the survey, most sustained key functions and partnerships to help patients quit smoking, with 83% reporting continued program operation after NCI funding ended. This level of sustainment is consistent with continuing engagement of many C3I-funded centers in C3I Consortium activities coordinated by UW-CTRI.
“Ongoing C3I participation in related activities, such as this R01 study and the Consortium supported by UW-CTRI, continues to astound me,” said C3I Project Manager Mara Minion, when asked about the high response rate to the survey.
“This is a group of dedicated collaborators who are generous with their time.”
Costs and Benefits
Most programs sustained their tobacco treatment with annual operating budgets between $50,000 and $250,000. The majority of operating sites (81.2%) reported institutional support as a source of funding for their budget, while about a quarter of operating sites reported fee-for-service clinical revenue.
“The revenue-based financial incentive for tobacco treatment is modest at best, unfortunately,” said Minion, a co-author of the paper. “However, in the context of cancer care, $50,000 to $250,000 is a relatively small investment for centers to make to provide the best care for their patients.
She said the cost savings of tobacco treatment are significant because it increases cancer patients’ chances of better outcomes. It also decreases their chances of complications, cancer recurrence, and new cancer diagnoses.
In the context of the roughly $3.4 billion in annual cancer treatment costs associated with continued smoking in the U.S. alone, the costs of addressing tobacco use as part of cancer care are modest.
Increasing reimbursement for tobacco treatment delivery fosters long-term sustainment of C3I and other programs in cancer care.
“Some of our C3I colleagues are meeting with leaders at the Centers for Medicare and Medicaid Services (CMS) in early 2026 to make the case to improve the coverage of tobacco treatment,” Minion said. “We are eager to hear how those conversations go. Any systems change that comes from that advocacy would dramatically improve the long-term sustainability prospects of tobacco treatment programs in the U.S.”
While C3I has shown seed funding goes a long way toward sustainability, other groups have picked up on lessons learned from C3I and shown that cancer centers can implement it even without the seed money.
“We know that this can be done,” Minion said. “The American College of Surgeons (ACS) Commission on Cancer (COC) has more than 1500 member programs that treat more than 70% of all cancer cases in the U.S. In 2022 and 2023, the COC successively launched the Just ASK and Beyond ASK quality improvement programs. These programs applied lessons learned in C3I to enhance COC sites’ capacity to screen for tobacco use (Just ASK) and offer treatment (Beyond ASK), without any funding. Both programs were successful; assessment rates and then rates of offering cessation assistance improved for the participating sites, enhancing the care of approximately 1 million cancer patients.”
New Accreditation Standards
Based on the success of these programs, the COC has adopted a new standard as of 2026, Standard 5.9: Smoking Cessation for Patients with Cancer, for accreditation of its member programs, which specifies that programs must screen at least 90% of new patients for smoking in the last 30 days and refer or connect at least 80% of new patients who currently smoke to smoking cessation treatment.
“These efforts were led by Dr. Timothy Mullett, the immediate past chair of the COC,” Minion said, “and supported scientifically and financially by C3I leadership. We are extremely proud that they have resulted in the introduction of this standard, which will transform smoking cessation in cancer care.”
Treatment Roadmap
The new standards also drove significant spikes in traffic to the Tobacco Treatment Roadmap, a website developed by C3I and other UW-CTRI staff. The creation of the Roadmap was led by UW-CTRI Research Director and paper co-author Dr. Danielle McCarthy. It offers steps, templates, best practices and more to help providers integrate tobacco treatment into cancer care or other clinical programs.
“Sustaining tobacco treatment programs is challenging and complex,” Minion said. “Findings from the R01, as well as other resources, have been synthesized in the Sustainability Module of the Roadmap and will continue to be updated as the study progresses. We hope the guidance provided in this web-based tool supports any teams looking to implement sustainable tobacco treatment programs in their healthcare settings.”
Salloum RG, Montague M, Minion M, LeLaurin JH, Lee JH, Ramly E, Liu G, Reid M, Bylund CL, McCarthy D, Shelley D, Ostroll JS, Warren GW. (2025) Sustainment of Tobacco Use Treatment Programs Across National Cancer Institute–Designated Cancer Centers. Cancer Medicine. 14(22):e71424. Online November 26, 2025.