The impact of opt-out tobacco screening and treatment referrals among racially and socioeconomically diverse patients in the oncology setting.

Abstract

Continued smoking following a cancer diagnosis contributes to poorer treatment outcomes and lower survival rates. However, fewer than half of patients who smoke receive tobacco dependence treatment (TDT). To address the TDT barriers, an opt-out clinical program in a racially and socioeconomically diverse oncology patient population was implemented. As part of the National Cancer Institute's Cancer Center Cessation Initiative, the feasibility and impact of improved TDT access and use was assessed. Medical assistants (MAs) assessed tobacco/nicotine use at each outpatient visit at health system-based hematology/oncology clinics. Of those eligible and interested, program reach, enrollment, treatment engagement, and abstinence was assessed by race and socioeconomic deprivation tertiles. TDT included evidence-based behavioral coaching by phone and pharmacotherapy. Of 32,627 unique outpatients (April 2018-September 2024), MAs screened 28,815 (88%) for tobacco/nicotine use and 2150 (7.5%) reported use in <30 days. Of those eligible, 75.6% (1285/1699) were reached, 37.7% (484/1285) were enrolled, and 27.9% (359/1285) were engaged in treatment. Among those enrolled or engaged, patients were 66.7% female, 78.5% African American, and 61.2% in the highest deprivation level. Rates of tobacco/nicotine use, program enrollment, and treatment engagement were highest among African American patients (vs. other racial groups; p < .001). Rates of tobacco/nicotine use and program enrollment were highest among patients in the highest deprivation level (vs. lower levels; p < .001). The six-month self-reported quit rate (22.1%) did not differ by race or deprivation level (all p > .30). These findings demonstrate the feasibility and impact of a robust approach to reach, engagement, and abstinence among racially and socioeconomically diverse patients with cancer, and the potential for improving disease-related survival among the most vulnerable patients.