For patients diagnosed with cancer, continuing to smoke during treatment may shorten survival. Persistent smoking can increase treatment toxicity, reduce the effectiveness of cancer therapy, and raise the risk of disease recurrence and second primary cancers. Yet despite longstanding clinical practice guidelines recommending tobacco treatment as part of cancer care, most cancer patients are only briefly advised to quit ("you need to quit") and are rarely provided with any cessation assistance.
A nationwide clinical trial conducted by the ECOG-ACRIN Cancer Research Group (ECOG-ACRIN) has now demonstrated a more effective approach. Results from the randomized Smokefree Support Study 2.0 (EAQ171CD, NCT03808818), published in the Journal of Clinical Oncology, found that a comprehensive, sustained treatment strategy for tobacco dependence, delivered during active cancer treatment, doubled smoking-cessation rates compared with referral to a Quitline alone.
The study enrolled 306 recently diagnosed patients who were receiving cancer treatment at 37 National Cancer Institute (NCI) Community Oncology Research Program (NCORP) sites nationwide. The study showed that 28.4 % of patients assigned to 6 months of proactive telehealth counseling and nicotine replacement therapy (NRT) were not using tobacco after 6 months, compared with 14.7% of the patients who were referred to a Quitline and had no further support from their health care team.
Among participants who quit smoking, more than half quit early, within 3 months, and relapses remained low. The investigators noted that the extended duration of counseling and dosing of NRT contributed to the reduction in relapses.
"Our study shows that patients undergoing cancer treatment are much more likely to quit smoking when they receive proactive, sustained support rather than a referral alone," said lead author Elyse R. Park, PhD, MPH, a clinical health psychologist at Massachusetts General Hospital and co-chair of the ECOG-ACRIN Psychosocial Outcomes and Health Promotion Subcommittee.
"Just as importantly, these findings demonstrate that evidence-based tobacco treatment can be successfully integrated into routine community oncology care, making it easier for patients to receive the support they need while they are undergoing cancer treatment," she added.
Instead of expecting patients to reach out to a Quitline on their own, the oncology care team connected participants to a centralized team of tobacco treatment specialists for telehealth counseling. This approach provided participants across the country with consistent access to evidence-based support for tobacco cessation. Because the program fit within existing treatment routines and sessions were virtual, no additional trips to the treatment center were required, thus reducing that practical barrier to participation.
Participation rates varied significantly. Among patients assigned to the virtual sustained treatment, 81% attended counseling sessions. In contrast, only 5% of those referred to a Quitline completed even a single session. Participants in the virtual counseling program were more likely to use NRT when offered (skin patches and/or lozenges) versus when referred. Self-reported medication use rates at 6 months were 83% in the sustained intervention group and 49.5% in the control group.
Treatment satisfaction was also considered, and patient exit interviews were conducted with a subset of study participants. About 90% of recipients of the virtual sustained treatment reported receiving the smoking cessation assistance they wanted, compared with 40% of those referred to the quit line. Participants in the virtual program cited the regular check-ins, behavioral coaching, coping strategies for smoking urges, and NRT as valuable.
The study was funded by the National Cancer Institute, part of the United States' National Institutes of Health. It involved clinical sites that are members of NCORP, a national network that brings cancer clinical trials and cancer care delivery research to community hospitals and practices across the United States.
The trial's pragmatic design and broad eligibility criteria were intended to reflect patients and clinical practice in routine community oncology settings.
"Integrating sustained tobacco treatment into community oncology settings can help close a critical gap in cancer care delivery. These findings support the next step of testing how best to scale up sustained, virtual tobacco treatment across community oncology settings so all patients with cancer can access evidence-based cessation support," said senior author Jamie S. Ostroff, PhD, a behavioral health scientist and clinical health psychologist at Memorial Sloan Kettering Cancer Center.
The Smokefree Support Study 2.0 findings come as cancer care programs nationwide implement standards for universal tobacco screening and evidence-based smoking cessation treatment established by the NCI Cancer Center Cessation Initiative and the American College of Surgeons Commission on Cancer . The study results provide important evidence to inform the adoption of these practices in community oncology settings.
"The Smokefree Support Study 2.0 is a great example of the value of the NCORP network, which provided an opportunity to evaluate the generalizability of this intervention among adults with cancer receiving care in the communities where they work and live," said co- author Lynne I. Wagner, PhD, a clinical health psychologist at the University of North Carolina at Chapel Hill and Multiple-PI of the ECOG-ACRIN NCORP Research Base.
"In this day and age, the risks of tobacco use are well known, so adults who continue to smoke following a diagnosis of cancer are truly struggling with addiction and represent a group that is difficult to treat. Extending this effective tobacco treatment intervention to community settings is a remarkable accomplishment," she added.
The full report, "Virtual Sustained Tobacco Treatment for Cancer Patients: A Randomized Controlled Trial (ECOG-ACRIN: EAQ171CD) within the NCI Community Oncology Research Program (NCORP)", is available by subscription at https://ascopubs.org/doi/10.1200/JCO-25-02267 .
Drs. Park and Ostroff discussed their findings in a recent episode of the Journal of Clinical Oncology Podcast, available at https://ascopubs.org/do/effectiveness-virtual-tobacco-treatment-cancer-patients .
About ECOG-ACRIN
The ECOG-ACRIN Cancer Research Group is one of the world's leading scientific organizations, known for innovative multicenter clinical trials involving adults with cancer or at risk of developing it. It is known for trials that integrate state-of-the-art approaches to improve cancer care. Its expansive membership includes over 1,400 hospitals and cancer centers across the United States and worldwide, and nearly 21,000 researchers and advocates. Its research is funded primarily by the National Cancer Institute, one of the United States' National Institutes of Health. To learn more, visit www.ecog-acrin.org , follow us on X @EAonc , Facebook
