Pre-Implementation Module – Solutions

Solutions: Integrating Tobacco Treatment in Cancer Care

Cancer treatment programs can help patients quit using tobacco. Tobacco treatment for cancer patients can be delivered at the point of care, at the clinic, and through referrals to external treatment programs. This Roadmap provides sample screening, treatment, and referral workflows and tools that you can adapt for your cancer clinic.

See our Case Studies for examples of successful programs.

Successful programs that address tobacco use share the following key features:

• They SCREEN all cancer patients and survivors for tobacco use at regular intervals. They ask patients about tobacco use in an empathic and non-stigmatizing manner (Riley et al., 2017; Ostroff et al., 2022).
• They TREAT all patients who use tobacco with both pharmacotherapy and psychosocial support or counseling (Fiore et al., 2008; Leone et al., 2020; National Comprehensive Cancer Network, 2022; NCI, 2022). They design programs to minimize barriers to accessing treatment (An et al., 2016; Fu et al., 2016; Richter et al., 2016).
• They are PROACTIVE rather than reactive. Programs that reach out to patients to offer tobacco treatment (by mail, EHR portal, phone, text messages, or during encounters) have a greater impact, and greater equity, than programs that rely on patients or clinicians to begin the conversation (Burris et al., 2022; Davis et al., 2020; Fu et al., 2016).

• Some programs make treating tobacco use the default rather than the exception using an OPT-OUT APPROACH in which care teams initiate tobacco treatment for all patients who use tobacco unless the patient actively declines it (Ohde et al., 2021; Richter & Ellerbeck, 2015).

• They ENGAGE STAKEHOLDERS in efforts to develop and implement SUSTAINABLE WORKFLOWS for tobacco screening and treatment (Cancer Center Cessation Initiative Sustainability Working Group, 2021).
• They foster sustainability and quality improvement by developing workflows that allow them to COLLECT DATA on screening and treatment. These data facilitate ongoing performance feedback and refinement of workflows and implementation strategies (Cancer Center Cessation Initiative Sustainability Working Group, 2021; Ivers et al., 2012; Langley et al., 2009).
• They are designed with HEALTH EQUITY in mind to ensure they screen and treat all patients for tobacco use, including those at greatest risk of harm from tobacco use, such as socioeconomically disadvantaged individuals and members of minoritized groups (Cancer Center Cessation Initiative Diversity, Equity, and Inclusion Working Group Members, 2021; D’Angelo et al., 2021; NCI, 2022).