Call to quit: Results of a remote, longitudinal tobacco cessation program.
Authors: Kaufman Rebekah , Wei Zihan , Morales Karen , Kiel Lauren , Knelson Lauren , Ramirez Priscila , Morabito Angela , Mazzola Emanuele , Morgans Alicia K. , Partridge Ann H. , Florez Narjust 
Published: September 2024

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Background:
Tobacco cessation counseling remains suboptimal for patients with cancer. The current iteration of the Dana-Farber Cancer Institute Tobacco Cessation Program was established in 2021 to provide virtual, longitudinal tobacco session counseling to patients with cancer. Here, we report the Program’s experience.
Methods:
The DFCI Tobacco Cessation Program data from 2021 to 2023 was analyzed. Descriptive statistics summarized demographics and tobacco cessation experiences from baseline and follow-up visits.
Results:
Of 227 patients referred to the Program and included in the analysis (Table 1), 161 declined participation. 63 participants attended a baseline visit, of whom the median age for first cigarette was 15 years (range: 10-32) and the median age for regular tobacco use was 17 years (range: 10-61). Prior to baseline, most participants (n=43) indicated using tobacco daily; the median number of daily cigarettes was 11-15. Many (n=41) reported smoking within 30 minutes of waking up, and most considered tobacco use to be an addiction (n=50). Though a considerable number of participants (n=27) reported quitting smoking to be extremely important to them, confidence in quitting varied; the most frequently selected confidence level was 5/10 (n=14). Past use of tobacco cessation drugs was reported by one-third of participants (n=22); past use of nicotine replacement therapy was reported by nearly half (n=30). The most frequently reported perceived benefit of quitting smoking was better health (n=48). 51 participants had at least one follow-up visit (median: 4, range: 1-23). At the time of first follow-up, 10 reported decreasing the number of cigarettes smoked per day, 20 reported no change, and 3 reported an increase. However, among 24 participants who attended a fifth visit, 8 reported a decrease and 6 reported no change. Of 11 patients who had attended at least 10 visits, 5 reported decreasing their number of daily cigarettes. 13/63 (20.6%) of all participants reported quitting smoking after enrolling, with a median time from baseline assessment to smoke-free status of 34 days.
Conclusions:
Remote, longitudinal tobacco cessation programs provide an effective way to increase access to tobacco cessation counseling for patients with cancer. However, limitations include high decline rates and loss to follow up. Future analysis of our program will help better understand tobacco cessation efforts.

Demographics
Approached (n=227)
Attended Baseline (n=63)

Median Age
60
62

Sex
Female 130 (57.3%) | Male 94 (41.4%) |Prefer not to say/Unknown 3 (1.3%)
Female 36 (57.1%) |Male 26 (41.3%) |Prefer not to say 1 (1.6%)

Cancer
Lung 80 (35.2%) |Breast 46 (20.3%) |Head & Neck 27 (11.9%) |GI 24 (10.6%)
Lung 22 (34.9%) |Breast 9 (14.3%) |Head & Neck 11 (17.5%) |Lymphoma 6 (9.5%)

Race: White
191 (84.1%)
52 (82.5%)

Black
17 (7.5%)
4 (6.3%)

Asian
4 (1.8%)
1 (1.6%)

Other/Prefer not to say
15 (6.6%)
6 (9.5%)

Hispanic
8 (3.6%)
3 (5.1%)