Abstract PO-058: Piloting a novel strategy to rapidly implement smoking cessation treatment for newly-diagnosed head and neck cancer patients
Authors: Mann Sahajveer , Casazza Julia , Mitchell Dalia , Dang Quynh-Chi , Weston Dequan , Harding Brette , Sumer Baran D. , Tillman Brittny , Kitzman Heather , Jackson George , Schnoll Robert , Singal Amit , Day Andrew T. 
Published: September 2023

Abstract
Purpose The purpose of this study is to evaluate a novel, bimodal strategy to implement smoking cessation treatment prior to oncologic therapy in newly-diagnosed head and neck cancer (HNC) patients. Background Among the 65,000 people who develop HNC in the United States (US) annually, 20-30% smoke cigarettes and 50-80% will continue smoking throughout survivorship. Quitting smoking before oncologic therapy correlates with improved health outcomes. However, the window of opportunity to quit smoking is narrow since cancer treatment often begins 4-5 weeks after the first oncology visit. The failure to rapidly implement evidence-based smoking cessation treatment is a major cause of this problem. Offering both behavioral therapy and pharmacotherapy increases abstinence rates by 2-3-fold. Despite this, only 4-17% of cancer patients receive both therapies at any time. Methods We conducted a pragmatic, quasi-experimental, pilot study using a pre-post design to evaluate a strategy to rapidly implement behavioral therapy and pharmacotherapy. The pre-test period was from 1/21-3/22 and the strategy was deployed from 4/22-10/22. The population included newly-diagnosed patients with mucosal HNC or salivary gland cancer. The setting was an academic medical center with an established tobacco treatment program (TTP). The implementation strategy involved bimodal administration of the evidence-based Ask, Advise, Connect (AAC) approach before and at the first surgical oncology visit. First, a dedicated medical assistant (MA) used an electronic health record (EHR)-based tool to identify, ask, advise, and connect (i.e. refer) smokers to the TTP at the time of clinic referral, or ~1-2 weeks before the first surgical oncology visit. Second, the AAC strategy was delivered by the triage MA and nurse at the time of the first surgical oncology visit. Some surgeons opportunistically offered patients pharmacotherapy. Results Among the 383 eligible, newly-diagnosed HNC patients, and 48 (12.5%) were current smokers. Twelve smokers were diagnosed between 4/22-10/22 and were eligible for the bimodal AAC strategy. However, only six of 12 patients received the AAC strategy before the first oncology visit. Among the 48 smokers, 75% were male, the median age was 65.5-years, and cancer treatment was started a median 34 days after the first oncology visit. Within 30 days of the first surgical oncology visit, 67% were advised to quit, 25% were referred to the TTP, 6% completed a comprehensive TTP visit, 21% had pharmacotherapy ordered, and 17% received both behavioral therapy and pharmacotherapy. While there were otherwise no differences in outcomes between pre- and post-strategy groups, more bimodal AAC strategy-eligible patients received pharmacotherapy (42%) compared to pre-strategy patients (14%, p=0.040). Conclusions Our bimodal AAC strategy correlated with increased use of pharmacotherapy, despite suboptimal fidelity to the approach. Additional strategies to improve delivery of timely behavioral therapy and pharmacotherapy for smoking cessation are needed.
Citation Format: Sahajveer Mann, Julia Casazza, Dalia Mitchell, Quynh-Chi Dang, Dequan Weston, Brette Harding, Baran D. Sumer, Brittny Tillman, Heather Kitzman, George Jackson, Robert Schnoll, Amit Singal, Andrew T. Day. Piloting a novel strategy to rapidly implement smoking cessation treatment for newly-diagnosed head and neck cancer patients [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Innovating through Basic, Clinical, and Translational Research; 2023 Jul 7-8; Montreal, QC, Canada. Philadelphia (PA): AACR; Clin Cancer Res 2023;29(18_Suppl):Abstract nr PO-058.