Smoking cessation support and knowledge among newly diagnosed individuals at community cancer centers (ECOG-ACRIN trial EAQ171CD).
Authors: Park Elyse R. , Ostroff Jamie S. , Sicks Jorean D. , Goshe Brett M. , Gareen Ilana F. , Herman Benjamin A. , Taurone Alexander , Walter Angela Wangari , Regan Susan , Rasmussen Autumn W. , Levy Douglas E. , Muzikansky Alona , Thompson Michael A. , Lui Michelle , Malloy Laura , Gonzalez Irina , Finkelstein-Fox Lucy , Carlos Ruth C. , Wagner Lynne I. 
Published: June 2023

1522 Background: ASCO recommends that all individuals diagnosed with cancer who smoke receive tobacco treatment support. Oncology clinicians can use the 5As (Ask, Advise, Assess, Assist (e.g., talk about quitting and recommend medication), and Arrange follow-up) to provide this support. Previous studies that have typically assessed clinician-reported delivery of 5As, so we assessed patient-reported receipt of 5As to 1) assess prevalence of 5As receipt and variations by tumor type (smoking vs non-smoking-related) and 2) associations between 5As receipt and patient knowledge about smoking risks and motivation to quit. Methods: We analyzed baseline data of 306 patients enrolled in a randomized trial coordinated by the ECOG-ACRIN NCI Community Oncology Research Program (NCORP) Research Base from 37 sub-affiliate Community and Minority/Underserved practices to ascertain whether 5A receipt differs for individuals with a smoking-related vs non-smoking-related tumor and whether patients’ motivation and knowledge of the risks of continued smoking (0 to 10) differs by smoking-related tumor and 5As receipt. Eligibility criteria included a recent cancer diagnosis, English or Spanish-speaking, having smoked a cigarette in the past 30 days, and planning to receive treatment at a participating site. Results: 306 patients enrolled between 08/2019 and 12/2022 (70.9% female; 84.9% white non-Hispanic, 8.8% Black; 3% Hispanic; median age = 57 years); 51% had non-smoking-related tumors. Quit motivation was lower for non-smoking-related vs. smoking-related tumors (median= 7 (interquartile range (IQR): 5,9) vs median= 9 (IQR: 5,9) but knowledge of smoking risks (e.g., How much quitting improves chances of getting the full benefit of treatment) were similar (median = 10 (IQR: 8,10) vs 10 (IQR: 9,10)). Rates of Ask and Advise were high and similar for non-smoking-related and smoking-related tumors (Ask =94.7% vs 96.5% and Advise =89.3% vs 91.0%, respectively). However, rates of Assist were lower for non-smoking-related tumors vs. smoking-related tumors (e.g., talked about quitting =70.0% vs 79.2%; recommended cessation medication =63.3% vs. 72.2%) and Arrange follow-up =27.3% vs 37.5%. Quit motivation was lower for those who had not received the 5As (Ask median=7 (IQR 5,9) vs 9 (IQR 5,9); Assist talked about quitting median=7 (IQR: 5,9) vs 9 (IQR: 5,9) or Assist recommended cessation medication (median=6 (IQR: 5,9) vs 9 (IQR: 5,9)). Conclusions: Rates of assessing tobacco use and advising cessation at community cancer centers are high for addressing smoking but lower for actual assistance, particularly among patients with non-smoking-related tumors. This underscores the importance of clinicians discussing smoking, highlighting persistent smoking risks and the benefits of cessation, and providing actionable recommendations to reduce smoking risks for all patients. Clinical trial information: NCT03808818 .